Kongenitalna hipertrofična stenoza pilorusa

master's thesis

• Title (english): Congenital hypertrophic pyloric stenosis
• Author: Sven Nikles
• Mentor: Stjepan Višnjić (mentor)
• Committee member: Božidar Župančić (predsjednik povjerenstva)
• Committee member: Tomislav Meštrović (član povjerenstva)
• Committee member: Stjepan Višnjić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Surgery); Zagreb
• Defense date and country: 2014-07-15, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Surgery

Abstract

Stenoza pilorusa je suženje otvora koji odvaja želudac od početnog odsječka tankog crijeva duodenuma (dvanaesnika). Uzrokovano je zadebljanjem (hipertrofijom) mišićnog dijela pilorusa (pylorus – što u prijevodu sa grčkog znači „vrata“) koji se opušta kako bi hrana mogla napustit želudac i nastaviti prema tankom crijevu. Takvo stanje dovodi do karakterističnog povraćanja bez primjesa žuči. Najčešće se takvo stanje prezentira u prvih nekoliko tjedana do mjeseci života, te se tada označava kao kongenitalna hipertrofična stenoza pilorusa (HSP). Hipertrofija pilorusa palpacijom se osjeti kao masa koja odgovara veličini masline lokalizirana u srednjem gornjem ili desnom gornjem kvadrantu abdomena novorođenčeta. O samom uzroku stenoze pilorusa ne zna se sa sigurnošću radi li se o stvarnom kongenitalnom anatomskom suženju ili se radi samo o funkcionalnoj hipertrofiji mišićnog sloja piloričkog sfinktera. Obično se ovo stanje razvija između 2. i 6. tjedna života novorođenčeta.
Etiologija hipertrofične stenoze pilorusa je nejasna, ali vjerojatno je multifaktorska, uključujući genetsku predispoziciju i okolišne čimbenike. Dojenačka hipergastrinemija i želučani hiperaciditet može biti uzrok. Incidencija HSP je oko 2 do 3,5 na 1000 živorođenih. Bolest je češća kod dječaka nego kod djevojčica (4:1 do 6:1).
Bolesnika sa sumnjom na HSP treba procijeniti s ciljanim fizikalnim pregledom i laboratorijskim testovima te potvrditi ultazvukom.
Definitivno izliječenje HSP-a postiže se kirurškim zahvatom. Vrijeme operacije ovisi o kliničkom statusu dojenčeta. Ako je dijete dobro hidrirano s normalnim nalazom elektrolita i ako je na raspolaganju kirurg s potrebnim znanjem operacija se može učiniti isti dan kada je postavljena dijagnoza.

Abstract (english)

Pyloric stenosis is narrowing (stenosis) of the opening from the stomach to the first part of the small intestine known as the duodenum, due to enlargement (hypertrophy) of the muscle surrounding this opening (the pylorus, meaning "gate"), which spasms when the stomach empties. This condition causes severe projectile non-bilious vomiting. It most often occurs in the first few months of life, when it may thus be more specifically labeled as infantile hypertrophic pyloric stenosis (IHSP). The pyloric hypertrophy is felt classically as an olive-shaped mass in the middle upper part or right upper quadrant of the infant's abdomen. In pyloric stenosis, it is uncertain whether there is a true congenital anatomic narrowing or whether there is merely a functional hypertrophy of the pyloric sphincter muscle. This condition typically develops in infants in the first 2 to 6 weeks of life. The etiology of infantile hypertrophic pyloric stenosis is obscure but probably is multifactorial, involving genetic predisposition and environmental factors. Neonatal hypergastrinemia and gastric hyperacidity may have a role. IHPS occurs in approximately 2 to 3.5 in 1000 live births. It is more common in males than females (4:1 to 6:1). Patients with suspected IHPS should be evaluated with a focused physical examination, laboratory testing and to confirm it with ultrasound.
Definitive management of IHPS is surgery. The timing of surgery depends upon the clinical status of the infant. If the child is well-hydrated with normal electrolytes, and if surgeons with expertise in the procedure are available, surgery may take place on the day of diagnosis.

• Keywords: hipertrofična stenoza pilorusa; novorođenče; kirurgija
• Keywords (english): hypertrophy of the pyloric sphincter; infant; surgery
• Language: croatian
• URN:NBN: urn:nbn:hr:105:649066
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2016-03-10 10:36:10