浙江大学医学院：Digestive system in children（婴儿肥厚性幽门狭窄 Infantile hypertrophic pyloric stenosis，PPT讲稿）

Infantile hypertrophic pyloric stenosis 浙江大学医学院附属儿童医院 江米足

Infantile hypertrophic pyloric stenosis 浙江大学医学院附属儿童医院 江米足

胃小弯 责门口 胃小凹 胃道 幽门瓣 十二指拨上部 冒大弯 幽门口 胃襞 幽门括约肌 幽门窦 角切迹 胃

Gastric outlet obstruction Symptoms: non-bilious vomiting abdominal pain and nausea Signs: abdominal distention and bleeding from secondary inflammation Most common cause of non-bilious vomiting is infantile hypertrophic pyloric stenosis(IHPs) Similar symptoms including pyloric atresia, antral webs gastric duplications and gastric volvulus

Gastric outlet obstruction ◼ Symptoms: non-bilious vomiting, abdominal pain and nausea ◼ Signs: abdominal distention and bleeding from secondary inflammation ◼ Most common cause of non-bilious vomiting is infantile hypertrophic pyloric stenosis (IHPS) ◼ Similar symptoms including pyloric atresia, antral webs, gastric duplications, and gastric volvulus

Pyloric stenosis First described by Hirschsprung in 1888 Ramstedt described an operative procedure to alleviate the condition in 1907 the procedure used to this day to treat pyloric stenosis Harald Hirschsprung(1830-1916)

Pyloric Stenosis ◼ First described by Hirschsprung in 1888 ◼ Ramstedt described an operative procedure to alleviate the condition in 1907 – the procedure used to this day to treat pyloric stenosis Harald Hirschsprung (1830-1916)

THPS a Description thickening of the pyloric portion of the stomach causing obstruction of gastric outflow a Also called: IHPS hypertrophic pyloric stenosis congenital pyloric stenosis

IHPS ◼ Description: ◼ thickening of the pyloric portion of the stomach causing obstruction of gastric outflow ◼ Also called: ◼ IHPS ◼ hypertrophic pyloric stenosis ◼ congenital pyloric stenosis

Pyloric stenosis Esophagus Stomach Enlarge Pylor odeum Normal Pyloric Anatomy Stenosis Normal values Length <15mm Single muscle thickness:<3mm Pyloric width: <7mm

Epidemiology age distribution 3-8 weeks reported incidence 1-5 per 1,000 births highest incidence in first-born infants 4-5 times more common in boys than girls more common in western world a less common in black and asian patients than white patients in United States

Epidemiology ◼ age distribution : 3-8 weeks ◼ reported incidence 1-5 per 1,000 births ◼ highest incidence in first-born infants ◼ 4-5 times more common in boys than girls ◼ more common in Western world ◼ less common in black and asian patients than white patients in United States

Causes unknown hypotheses include abnormal neurophysiology in muscular layer including decreased nerve terminal number reduced nitrous oxide reduced number of interstitial cells of Cajal (IcC) a bacteria infection, such as Hellicobacter pylori genetic factors pyloroduodenal duplication cysts as cause of neonatal gastric outlet obstruction in case report

Causes ◼ unknown. hypotheses include ◼ abnormal neurophysiology in muscular layer including ◼ decreased nerve terminal number ◼ reduced nitrous oxide ◼ reduced number of interstitial cells of Cajal (ICC) ◼ bacteria infection, such as Helicobacter pylori ◼ genetic factors ◼ pyloroduodenal duplication cysts as cause of neonatal gastric outlet obstruction in case report

Pathogenesis circular muscle of pylorus becomes hypertrophied pyloric sphincter fails to open causing obstruction of gastrointestinal tract stomach cannot drain becomes fuller and stretches until emesis occurs jaundice seen in 1%-2% of infants with IHPS

Pathogenesis ◼ circular muscle of pylorus becomes hypertrophied ◼ pyloric sphincter fails to open causing obstruction of gastrointestinal tract ◼ stomach cannot drain, becomes fuller and stretches until emesis occurs ◼ jaundice seen in 1%-2% of infants with IHPS

Complications dehydration (1, 4) a starvation (1) hyperbilirubinemia(1) a jaundice 2)

Complications ◼ dehydration(1, 4) ◼ starvation(1) ◼ hyperbilirubinemia(1) ◼ jaundice(2)