pilorospazme - a pathological condition manifests itself in childhood.Characterized pilorospazm vegetative dystonia of the sympathetic type due to not fully mature nervous system, often cured on their own.At the base lies pilorospazme spasm site at the junction of the antrum into the duodenum.The result is a difficult movement of food through this site and its stagnation.In the long neglect, and the transformation process in the severe stage.As a result, changes in the structure of the mucosal side of atrophy and develops the condition requiring the intervention of the surgeon be put off.
As time and conditions of the disease distinguish primary and secondary pilorospazm.
Primary pilorospazm occurs as a primary disease under the influence of a number of these adverse factors:
- failures in the work of the central nervous system is disturbed nervous regulation of the entire stomach, and pyloric;
- in violation of the autonomic nervous system marked
- at various intoxications (nicotine, morphine);
- with a lack of certain vitamins and minerals (vitamins B);
- less if severe fatigue (physical or mental), stressful situations.
Secondary pilorospazm occurs against a background of other diseases and conditions:
- gastric ulcer (ulcer in the pylorus) and gastritis (usually chronic);
- in inflammation in the initial sections of the small intestine (duodenitis);
- when polyps of the stomach;
- in diseases of the biliary tract (cholecystitis, cholelithiasis, etc.);
- in diseases of the bowel (colitis, Crohn's disease);
- the formation of intestinal adhesions in the postoperative period.
smoking, some medications, exposure to chemicals in some cases may also be provoking factors pilorospazme.
pilorospazme newborn clinically rare, as usually required 2-3 weeks prior to clinical manifestation of the disease.The exception is a difficult birth and severe damage to the central nervous system: the posthypoxic encephalopathy, or mixed genesis of hypertension or hypertension-hydrocephalic syndrome.
pilorospazme infants - common problem and it occurs as a consequence of prolonged hypoxia during labor, the immaturity of the nervous system, the syndrome of neuro-reflex hyperexcitability.Characterized by independent cure after some time (the need to have only palliative treatment).
pilorospazme Symptoms depend on the stage of the disease.At the stage of the food compensated with effort, but pushed through the narrowed opening.Classically, this form appears hypochondrium feeling of heaviness and nausea.But there may be colicky pain in the stomach area (the area of the left hypochondrium and epigastrium), in rare cases, vomiting.After an attack of pain, a large number of light-colored urine with a low specific gravity ("urinary crisis").
decompensated pilorospazme person suffers frequent attacks of pain in the stomach.Patency of the output of the stomach is completely broken.Ingestion followed by vomiting, bringing short-term relief (the vomit may be stagnant with an unpleasant odor).Maybe "vomiting fountain", usually with hypersecretion of gastric acid.Because of frequent vomiting worsening state of human weakness, weight loss, insomnia.With vomitus excreted water and salt, which leads to dehydration and malnutrition.In this case it is necessary to think about moving pilorospazme chronic.
pilorospazme infants appear 2-3 weeks of age and the clinical picture it quite characteristic.First, the child begins to spit up often becomes restless.Then there is "a fountain vomiting."She often bothers after feeding, and even after 1-2 hours, is characterized by a small amount of vomit without bile, sour smell of curds.There is a delay in weight gain.In severe cases, can be confusing for constipation, urination becomes less.The child restless, cranky, bad sleep.Frequent cramps can be accompanied by tears.In the long altered blood parameters: hemoglobin level is reduced, and then potassium chloride, which gradually leads to dehydration.
On palpation of the abdomen may be palpable Education tight epigastric.In rare, severe cases pilorospazm children (especially depleted) can manifest symptom of the so-called "hourglass": the visible eye motility of the stomach, usually after one or two hours after a meal.
pilorospazme Diagnosis begins with anamnesis.It should be clarified whether there is a chronic disease in humans.If not, you worry whether abdominal pain, there is nausea, vomiting.It is also worth asking whether to perform surgery on the abdomen (suspected adhesions).In the case of pyloric stenosis in children need to check with parents flowed like pregnancy: whether the factors of encephalopathy, fetal hypoxia, whether a threat of miscarriage.
is necessary to take into account the clinical picture.Nausea, vomiting and pain are not pathognomonic for pilorospazme.But the possibility of the presence of the disease is necessary to remember always.The only specific symptom pilorospazme is "vomiting fountain", but is also seen more frequently in children.
analysis of blood and urine tests, as laboratory methods, is not informative.In mild and uncomplicated cases pilorospazme they are changed.In severe, decompensated states marked anemia, hypokalemia, hloremiya.Light-colored urine with a low specific weight.
basis for diagnosis pilorospazme are instrumental techniques: X-ray of the intestine with a contrast agent and fibroezogastroduodenoskopiya.When X-ray contrast agent is administered (barium sulfate).Children are barium sulfate, mixed with breast milk or formula.On radiographs, there were delays of food, with the suspension of barium enters the intestine in small portions.The stomach can be reshaped.In this study must enter antispasmodics (usually a solution of atropine sulfate).If pilorospazme spasm leaves and the contrast will be held without delay to the intestine.Such X-ray pattern is typical for the most severe form of pilorospazme, when there is concomitant muscle wasting output of the stomach.In the case of mild permeability is not compromised, and the gastric emptying of contrast will occur after 3-4 hours.
addition, endoscopy.Reveals oval gatekeeper endoscope passes freely through its hole.Stomach is free.Carry out air insufflation, and the doorman slowly revealed.It also speaks in favor pilorospazme.In severe cases, the stomach will be digested food, the gatekeeper spastic, but passable.Morphological changes are absent.
In rare cases, the stomach is carried ultrasound, which does not show any changes pylorus.
view of the fact that the symptoms are non-specific pilorospazme, it is essential to carry out a comparative diagnosis with a number of similar diseases.First of all, with pyloric stenosis.It is characterized by "vomiting fountain" with two weeks of age, constipation, rapid deterioration.Changes in the blood and urine tests.On radiographs gatekeeper long closed pylorus into a thin thread.Antispasmodic agents does not change the picture.When endoscopy visible morphological changes in the walls of the outlet of the stomach, muscle hypertrophy.
pilorospazme children differentiate well as hiatal hernia and achalasia.In all cases, it is crucial to X-ray examination.Adults comparative diagnosis is carried out with bowel diseases: peptic ulcer, gastritis, cholelithiasis, cholecystitis, colitis, and others.
main treatment pilorospazme should be getting rid of the causes of the disease.If this is a secondary pilorospazm then made treating the underlying disease.If this vegetative dystonia of the sympathetic type, it is assigned sedation.The mainstay of treatment is diet and antispasmodic agent.
pilorospazme infants in the lungs, not started cases does not require a special diet.Need a quiet, friendly atmosphere.The volume of food and feeding frequency is not changed.Recommend thick porridge and 1-2 teaspoons of alkaline mineral water before meals.In severe cases, appointed by the fractional frequent feeding.If that breastfeeding is frequent breastfeeding.If it is artificial feeding, it is recommended mixed with thickeners (Frisovom, Nutrolon, Semper-Lemolak, Enfamil-AP Bellakt - AR).The composition of these blends include locust bean gum, which increases the viscosity of the gastric contents, which greatly reduces the amount of vomiting.In addition, it stimulates the intestinal peristalsis, what helps to combat colic.After feeding the child should wear a half-hour in the hands of the "column" and then spread to the stomach.
adult prescribe a diet with the use of a mechanically and chemically gentle food.It is recommended to use puree food in the form of heat, the best porridge.Limit the use of any kind of spicy, salty, acidic foods.Excluded are smoking and alcohol.You need to eat often and in small portions.
Medication pilorospazme used:
- myotropic antispasmodics - 0.04 - 0.08 g Papaverina Drotaverine hydrochloride or 3 p / day for adults (or 2% solution of these drugs by intramuscular injection of 2 ml);
- muscle relaxants (m- anticholinergics) - 0.1% solution of atropine sulfate 1-2 drops 3 r / d or 0.2% solution platifillin gidroaratata 1-2 ml per day;
- blockers H1 - histamine receptors - 1-2 drops of 2.5% Promethazine (pipolfen) before meals to children or 0.2 ml of 0.5% Promethazine / m;
- neuroleptics - 0.002 g Chlorpromazine 3 p / day orally;
- B vitamins - thiamin 10-15 mg per day intramuscularly 10 days;
- sedatives - Valerian drops, Motherwort.
If severe vomiting spend infusion therapy: is appointed by the introduction of 10% solution of glucose (500 - 1500 ml) isotonic 0.9% sodium chloride-ra (about 500 ml).In addition, according to indications, 10% solution of potassium chloride (20 ml) and insulin 1-2 units 5-10 grams of glucose.
physiotherapy at pilorospazme is an important part of a comprehensive approach, as it helps to relieve muscle spasms.Apply electrophoresis antispasmodics (Papaverina or drotaverine) in epigastrium 5 - 10 sessions or Novocain electrophoresis on 5-10 sessions.Also used applications ozokerite, paraffin 5-10 sessions a day.
pilorospazme prognosis is generally good, but it depends on the causes of the disease.If this is the primary pilorospazm (occurring most commonly in children), when certain conditions are met and the correct mode of the day and nutrition, the disease can be cured on their own.If this is a secondary pilorospazm (adults), everything depends on the disease that caused pilorospazm and cure of this disease.Very often, the symptoms pilorospazme initially mistaken for errors in feeding, for functional dyspepsia.The toga disease becomes chronic with the morphological changes in the pyloric area of the stomach.In this case, only the operative treatment, and even if successful operation, rather an unfavorable prognosis.