PYLOROSPASM (grech, pyloros the gatekeeper + a spasm) — spastic reductions of a pyloric (peloric) part of a stomach, one of forms of dyskinesia of digestive tract.
The item is observed preferential at babies, is more often in the first weeks and months of life, is more rare at more advanced age and at adults.
The pylorospasm at children
P. at children is caused by functional frustration of the neuromuscular device of a pyloric part of a stomach. The item occurs preferential at the excitable children who had a pre-natal hypoxia, born in asphyxia with signs of a birth trauma of c. N of page. At P. poor development of muscles of a cardial part of a stomach and more expressed its development in the field of the gatekeeper is noted that promotes easy developing of vomiting and vomiting.
Morfol, changes of walls of a stomach at P. are poor. Spastic reductions of the gatekeeper at children of chest age lead to a hypertrophy of muscle fibers of a stomach with a gradual thickening of all its muscular coat. Histologically depletion by neurons of neuroplexes of a stomach is found.
The disease is shown not right after the birth, and in 1 — 2 weeks. The general condition of children at P. considerably does not suffer, especially at the beginning of a disease, the weight (weight) of a body increases according to age more often. At P. hypererethism, clamorousness, excessive physical activity of the child is noted. The leading symptoms of P. — vomiting and vomiting, to-rye have no strict pattern and have no so persistent character, as at a pylorostenosis. Vomiting usually arises soon after meal. As a rule, the number of emetic masses are less than the volume of eaten food. Emetic masses does not contain patol, impurity, has an acid smell and the type of stvorozhenny breast milk is more often. Especially easily vomiting and vomiting at P. arise at a restern.
At P. the chair remains normal, there are no persistent locks, the peristaltics of a stomach is not strengthened, at a palpation of a stomach the gatekeeper is not probed. In blood and urine there are no changes. The electrolytic composition of blood is almost not changed.
Diagnosis the wedge, pictures and rentgenol, researches, and also data is put on the basis of data of the anamnesis, gastroscopies (see). At X-ray inspection of a stomach with a contrast agent passability of the gatekeeper is not broken, there is no gastrectasia, the peristaltics has not segmented, as at a pylorostenosis, and krupnovolnovy character. Usually normal and only some children can have a slowed down till 9 — 12 o'clock evacuation of a contrast agent. At endoscopy of changes of a mucous membrane of a stomach it is not noted, the gatekeeper easily we pass.
Differential diagnosis carry out with pylorostenosis (see), aerophagia (see), the malformations which are followed by a gastroesophagal reflux (an inborn short gullet, hernia of an esophageal opening of a diaphragm, a halaziya of the cardia), a solteryayushchy form adrenogenital syndrome (see), various forms of inborn high intestinal impassability (see. Impassability of intestines, at children ).
Treatment includes respect for frequency rate of meal taking into account age of the child, purpose of vitamins, especially Vkh; the means removing a spasm of the gatekeeper; the drugs reducing concern of the child. Children, to-rye easily belch, it is necessary to put after feeding sideways in order to avoid aspiration of the belched liquid. Are shown physiotherapeutic procedure (UVCh) on epigastric area.
Forecast, as a rule, good. Frequency and intensity of vomiting and vomiting in favorably proceeding cases gradually decrease, the child puts on weight, becomes quieter and within 3 — 4 months recovers.
Features of a pylorospasm
At adults P. Pervichny, or neurogenic occurs at adults primary and secondary, P. develops at neurosises, hysteria, emotional stressful situations, an intellectual overstrain, B 1 hypovitaminosis, intoxications zinc, lead, drug addiction (morphinism, nicotinism). Secondary P. most often develops against the background of a peptic ulcer, at localization of an ulcer in the gatekeeper or in an ampoule of a duodenum, but can be connected also with hron, antral gastritis, gastroduodenity, hron, cholecystitis.
The item is followed by a myopachynsis of the gatekeeper, and gradually against the background of is long spazmirovanny muscles the organic stricture of the gatekeeper can develop. Speed of transition of P. to a pylorostenosis depends on character and extent of disturbances of a nervous system, a functional condition of a stomach, the course of a disease against the background of which P., age of the patient developed.
On extent of narrowing of the gatekeeper distinguish the compensated and dekompensirovanny Item. The compensated P. differs in preservation of evakuatorny function thanks to a hypertrophy of a muscular coat of a stomach. Dekompensirovanny P. is characterized by expansion (ectasia) of a stomach and a delay of evacuation. It is difficult to distinguish this phase from organic pylorostenosis (see).
The item is shown by periodically arising acute kolikoobrazny pains in an anticardium and in a piloroduodenalny zone, feeling of weight, nausea and vomiting, body weight is lost. Upon termination of a painful attack at P. a large amount of light urine with a low ud often separates. it is powerful — so-called urina spastica. At secondary P. all listed symptoms develop against the background of a wedge, pictures of a basic disease.
At rentgenol, a research stomach (see) long reduction of the gatekeeper is defined, a cut conducts to a delay of initial evacuation of contrast weight from a stomach. In normal conditions its first portions come through the gatekeeper to a duodenum within the first minutes after reception of barium. If spastic reduction extends to a pyloric part of a stomach, then it looks trubkoobrazno narrowed. However contours of a stomach in a pyloric part keep the correct, equal relief. At rentgenol, a research of the bucketed gatekeeper several minutes it is possible to notice variability of a picture: sometimes the spasm disappears in the face of the researcher and is replaced by regular, portion evacuation of contrast weight from a stomach.
In case of long P. for the purpose of differential diagnosis from an organic stricture of the gatekeeper it is necessary to resort to hypodermic introduction of 1 ml of 0,1% of solution of Atropini sulfas or intramuscular introduction of 1 — 2 ml of 0,1% of solution of Methacinum, to-rye remove a spasm of the gatekeeper. On the speed of evacuation and extent of disclosure of the gatekeeper at his organic narrowing specified pharmakol, test has no significant effect.
The item often meets as a result of an ulcer of the gatekeeper therefore the purposeful research of this department is necessary, a cut provides, first of all, performance of a series of aim pictures, including after introduction of spasmolysants. If in the course of the first research P. does not disappear, despite use of spasmolysants, the research of a stomach in several days during which the patient continues to accept spasmolytic drugs (atropine, Methacinum, a papaverine) is shown repeated rentgenol. P.'s presence at repeated X-ray inspection serves as the indication to a gastrofibro-skopiya (see. Gastroscopy ). The expressed P. can lead to a long delay of a contrast agent in a stomach, however it never reaches the degree which is observed at an organic stricture of the gatekeeper, at Krom contrast weight is late in a stomach for 24 hours and more.
As P. often accompanies cholelithiasis and inflammatory processes of biliary tract, the research is shown further them rentgenol.
At P. appoint a sparing diet. Administration of solution of atropine and other antispasmodics, 2% solution of a papaverine of a hydrochloride on 2 — 3 ml 2 times a day, 0,2% solution of Platyphyllinum on 1 — 2 ml 2 — 3 times a day, sedatives is shown. Recommend thermal procedures, heat baths, massage, to lay down. physical culture. At secondary P. carry out treatment of a basic disease.
Forecast for life favorable.
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M. F. Deshchekina; A.S. Belousov, T. L. Kozhevnikova (features of a pylorospasm at adults), V. V. Kitayev (rents.).