Pyloric stenosis ( pyloric stenosis ) - Causes, Symptoms and Treatment .MF .
Pyloric stenosis - a scar deformation of the pyloric part of the stomach in his gatekeeper, which can occur in both adults and children alike.Pyloric stenosis should be distinguished from pilorospazme, as in the first case there is a permanent replacement of normal muscle tissue dense scar tissue, and in the second case of violation of the gatekeeper function due to functional changes in the tone of his muscles.
Gatekeeper (Pylorus) - is part of the digestive tract, located between the stomach and the duodenum, provided a well-developed layer of circular muscle as the sphincter.Functions sphincter lumen occlusion is gatekeeper during the digestion of food in the stomach, the evacuation opening when the chyme from the stomach into the duodenum 12, and closing the digestion of food in the small intestine.Such a coherent mechanism of the pylorus, which is under the control of the autonomic nervous system, provides a distinction between different environments - an acidic environment in the stomach and in t
With pyloric stenosis pyloric sphincter can not relax and contract as the scar tissue does not possess such properties, as opposed to the muscle.Consequently, impaired bolus passage through the digestive tract, the food stays in the stomach for a long time, and in severe cases, even the minimum amount of liquid is not able to overcome the barrier of a tight formation instead of a gatekeeper.This leads to significant disturbances of digestion - to reduce the absorption and assimilation of essential nutrients.
Causes of pyloric stenosis.
Adults pyloric stenosis gradually develops in the presence of diseases such as gastric ulcer and bulbs 12 duodenal ulcer, chronic gastritis, gastric polyps in the output section, malignant tumors of the stomach and small intestine.These diseases involve in the progression of the mucosa pyloric, resulting in normal tissues are replaced by dense scar, incapable of promoting food in the intestines.
Children disease often is congenital in nature, the reasons for it are not fully understood.Contributing factors may be considered hereditary, viral infections, transferred the mother in the first trimester, morning sickness in the early stages, the presence of a pregnant woman endocrinological or other pathology requiring admission of drugs.Most such malformation in boys, is diagnosed in 6-30 children per 10,000 births.In some cases, pyloric stenosis in children associated with other malformations (heart disease, polycystic kidney disease, syndactyly, etc.).
symptoms of pyloric stenosis.
Adults pyloric stenosis symptoms appear gradually.In the development phase of the disease is isolated compensation, and decompensation subcompensation .When first two general condition of the patient is suffering slightly more signs of lesions of the gastrointestinal tract - loss of appetite, severe bloating, lack of chairs for a few days, frequent belching putrid odor and vomiting of food eaten within two or three days before.On examination, especially in lean individuals, determined by eye visible boundaries enlarged stomach.
In phase decompensation , besides abundant frequent vomiting stagnant content, pronounced violations of all types of metabolism - a significant weight loss, hair loss, decreased elasticity of the skin caused by dehydration, pallor and weakness due to anemia.Possible convulsions, which developed as a result of gross violations of metabolism of electrolytes - potassium, calcium, magnesium.
emergence of such symptoms on a stomach ulcers, polyps or tumors should alert the patient and encourage him to turn to a doctor for examination as soon as possible.
Children disease usually manifests in the second week of life.The baby often vomits, and then within a few days picking symptoms such as frequent vomiting fountain up to ten times a day and more, with the vomit presented curdled milk, have an unpleasant, sour smell, possible blood veins or brown vomit staining.If untreated during this period develop malnutrition or underweight, reduced urination, and urine volume, decreased skin elasticity, retraction of a large fontanelle, the long absence of the chair.With further progression of observed violations of water-salt balance, may develop seizures.During the inspection, parents may notice the baby reduce overcrowding in the stomach under the skin of the abdomen, while massage the abdomen to determine the presence of dense tumor-like formations in the upper right section.
Newborn baby with similar symptoms should be immediately examined by a doctor, as pyloric stenosis if untreated, may lead to death due to the pronounced metabolic disorders and dehydration.
Diagnosis of the disease.
To confirm the diagnosis, in addition to routine blood and urine tests, are appointed by the additional methods of research:
- Gastroscopy - allows to assess the existence of a causal disease (ulcer, polyp, tumor), to determine the degree of stenosis of the pylorus, the expansion of the stomach and atonic, stretched wall
- X-ray examination of the stomach with contrast barium suspension is carried out immediately after filling the stomach and after a few hours.Impaired evacuation function of the stomach is considered contrast delay it for more than 8 hours.The delay of 24 hours or more a sign of decompensated pyloric stenosis.
- MRI or CT of the abdomen allow a better assessment of the localization of the tumor, the degree of damage adjacent organs, as well as to determine the thickness of the stomach wall and the thickness of the pylorus.
Treatment of pyloric stenosis.
Treatment of pyloric stenosis - surgery alone.In the presence of underlying disease in the adult shows the surgical removal of part of the stomach (resection) in a zone covering an ulcer or a tumor.When polyps shows a polypectomy.Along with gastric resection performed pyloroplasty - a longitudinal incision gatekeeper outside with suturing the incision in the transverse direction for the expansion of its lumen.In the case of an inoperable tumor shows overlay gastroeyunoanastomoza - anastomosis between the stomach and the intestine for promoting food.
Children enough of pyloroplasty preserving the anatomical integrity of the stomach.
operations are carried out under general anesthesia with providing laparotomy - a dissection of the anterior abdominal wall.In two - three days before the scheduled intervention conducted preoperative preparation - gastric lavage, intravenous electrolytes and protein solutions with the aim of correcting the body's dehydration and disorders of salt metabolism.
Postoperative treatment comes to observing a strict diet, prescription of antibiotics, anti-ulcer drugs reception, and in the case of cancer of the stomach or intestine is shown holding a chemo- and radiotherapy.
Lifestyle with pyloric stenosis.
recommendations on diet and lifestyle for children and adults are different.In the treatment of adult human need to follow a strict diet for 3-4 days after surgery, with a gradual expansion of the menu.Allowed pureed soups, low-fat cereal, steam scrambled eggs, stewed vegetables and fruits in the form of baked or stewed.After two or three weeks after the operation allowed the use of fermented milk products, fresh bread, steam cutlets of lean meat and fish.
Further recommendations are to life in observance of the basics of good nutrition with the exception of "harmful" food - fatty, fried, smoked foods and salty foods.
newborns after surgery is allowed to feed expressed breast milk every two hours, and at 5-6 day move to full breastfeeding or artificial feeding.
addition to proper nutrition, to avoid recurrence of gastrointestinal disease, adult patients should avoid stress, get plenty of rest and a walk in the fresh air.
have children for pyloric stenosis with frequent vomiting may be complicated by the development of asphyxia (suffocation), otitis media, and aspiration pneumonia.It is also probable adverse outcome from dehydration, severe malnutrition, metabolic disorders and joined pyo - septic complications (meningitis, pneumonia, sepsis, etc.).
Adults complication is the complete cessation of intake of nutrients with the development of dystrophy.
complications after surgery are rare, they include inflammation of the postoperative wound, suture failure and bleeding from the wound.
forecast in the absence of adverse treatment.With timely treatment to the doctor, and the operation time favorable prognosis.Children after the operation in the physical and psychomotor development did not lag behind their peers, if there are no other serious diseases.
When the tumor nature of pyloric stenosis doubtful prognosis.
therapists Sazykina OJ