Kongenitalna hipertrofična stenoza pilorusa

master's thesis

• Title (english): Congenital hypertrophic pyloric stenosis
• Author: Iris Čerfalvi
• 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: 2019-07-12, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Surgery

Abstract

Hipertrofična stenoza pilorusa (HSP) jedno je od najčešćih kirurških stanja u djece koje se obično otkriva unutar prvih 12 tjedana života. Nepoznate je etiologije, ali pretpostavlja se da veliki utjecaj imaju genski čimbenici i okoliš, uz hipergastrinemiju i hiperaciditet želuca. Češća je u muške novorođenčadi s omjerom 4-6:1, ovisno o literaturi. Hipertrofija i hiperplazija mišićnog sloja pilorusa uzrokuju opstrukciju lumena što rezultira karakterističnim povraćanjem u mlazu bez primjesa žuči. Zlatni standard u postavljanju dijagnoze predstavlja ultrazvuk. Terapija je kirurška, a prije operacije potrebna je nadoknada tekućine i elektrolita radi sprječavanja perioperativnih komplikacija. Cilj ovog rada je prikazati korelaciju promjene acidobaznog statusa i ultrazvučne debljine mišića u novorođenčadi s HSP-om te povezanost duljine trajanja simptoma i nastanka težih metaboličkih poremećaja. Provedeno je retrospektivno istraživanje u kojem je promatrano 41 dijete hospitalizirano zbog sumnje na HSP. Podaci su obrađeni metodama deskriptivne statistike u programu TIBCO Statistica 13.4. Rezultati su pokazali da nema statistički značajne povezanosti između ultrazvučno izmjerene debljine mišića i stupnja alkaloze. Duljina trajanja simptoma i promjena pH vrijednosti nisu linearno povezane, ali je u djece s višim stupnjem alkaloze primijećena teža hipokloremija i veća učestalost komplikacija nakon kirurškog zbrinjavanja. Iako je hipertrofična stenoza pilorusa stanje koje može dovesti do teških metaboličkih poremećaja, oni se u današnje vrijeme rijetko javljaju zbog ranog postavljanja dijagnoze, korekcije elektrolita i kvalitetne zdravstvene skrbi.

Abstract (english)

Hypertrophic pyloric stenosis (HPS) is one of the most frequently treated pediatric surgical conditions usually discovered within the first 12 weeks of life. Its etiology remains incompletely understood but genetic inheritance, environmental factors, hypergastrinemia and gastric hyperacidity may be involved. It has a strongly male predilection with a male to female ratio 4-6:1, depending on the literature. Hypertrophy and hyperplasia of the muscular layers of the pylorus cause gastric outlet obstruction with projectile nonbilious emesis. Diagnosis is confirmed with ultrasound. Definitive management is surgery, after the correction of electrolyte abnormalities. The aim of this study is to show the correlation between acid-base status changes and ultrasonographic pyloric muscle thickness in infants with HPS and also the connection between duration of symptoms and incidence of severe metabolic disorders. This retrospective study included 41 newborns with HPS. The data was processed using descriptive statistics methods in TIBCO Statistica 13.4. The results showed that there was no statistically significant correlation between pyloric muscle thickness and stages of metabolic alkalosis. The duration of symptoms and changes in pH were not in linear association, but in infants with severe alkalosis was noticed pronounced hypochloremia with more complications after surgical treatment. Although hypertrophic pyloric stenosis can lead to severe metabolic disorders, they occur rarely nowadays due to early diagnosis, correction of electrolyte derangements and good health care quality.

• Keywords: stenoza pilorusa; hipertrofija; debljina mišića; hipokloremija
• Keywords (english): pyloric stenosis; hypertrophy; muscle thickness; hypochloremia
• Language: croatian
• URN:NBN: urn:nbn:hr:105:248542
• 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: 2020-02-25 10:19:43