Correlation between pyloric muscle thickness and changes of acid-base status in children with congenital hypertrophic pyloric stenosis

Hipertrofična stenoza pilorusa jedno je od najčešćih kirurških stanja u djece, koje se obično otkriva unutar prvih 12 tjedana života.Nepoznate je etiologije, ali se smatra da veliki utjecaj imaju genski čimbenici i okoliš, uz hipergastrinemiju i hiperaciditet želuca. Češćaje u muške novorođenčadi s omjerom 4-6:1. Hipertrofija i hiperplazija mišićnog sloja pilorusa uzrokuju opstrukciju lumena, štorezultira karakterističnim povraćanjem u mlazu bez primjesa žuči. Zlatni standard u postavljanju dijagnoze je ultrazvuk. Terapija jekirurška, a prije operacije potrebna je nadoknada tekućine i elektrolita radi sprječavanja perioperativnih komplikacija.Cilj: Svrha ovog rada je prikazati korelaciju promjene acidobaznog statusa i ultrazvučne debljine mišića u novorođenčadi s kongenitalnom hipertrofičnom stenozom pilorusa te povezanost duljine trajanja simptoma i nastanka težih metaboličkih poremećaja.Metode: Provedeno je retrospektivno istraživanje u kojem je promatrano 41 dijete hospitalizirano zbog sumnje na stenozu pilorusa. Podatci su obrađeni metodama deskriptivne statistike u programu TIBCO Statistica 13.4. Rezultati: Pokazalo se 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 dvoje djece s višim stupnjem alkaloze zamijećena teža hipokloremija, pa je to dvoje bolesnika imalo i komplikacije nakon kirurškog zbrinjavanja.Zaključak: 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.Introduction: Hypertrophic stenosis of the pylorus is one of the most common surgical conditions in children, which is commonly detected within the first 12 weeks of life. There is no known aetiology, but it is assumed that genetic factors and the environment are key elements, along with hypergastrinaemia and hyperacidity of the stomach. It is more common in male infants with a 4-6:1 ratio. Hypertrophy and hyperplasia of the muscular layer of the pylorus cause luminal obstruction resulting in characteristic explosive vomiting without admixture of bile. The gold standard for diagnosis is ultrasound. Therapy is surgical, but before surgery it is necessary to compensate fluid and electrolyte imbalance to prevent perioperative complications. Objective: The purpose of this paper is to show the correlation between changes of acid-base status and ultrasound muscle thickness in newborns with congenital hypertrophic stenosis of pylorus and the correlation between the duration of symptoms and the severity of metabolic disorders. Methods: In this retrospective study, we analysed medical history of 41 children hospitalized for suspected stenosis of the pylorus. Data were processed using descriptive statistics methods in TIBCO Statistics 13.4. Results: There was no statistically significant correlation between ultrasound muscle thickness and alkalosis level. The duration of symptoms and changes in pH value were not linearly related, but in two children with higher alkaline levels there was a higher degree of hypochloremia, and both patients had complications after surgical treatment. Conclusion: Although hypertrophic pyloric stenosis is a condition that can lead to severe metabolic disorders, they are rarely present owing to early diagnosis, effective electrolyte correction and quality health care

Congenital hypertrophic pyloric stenosis

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.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

Congenital hypertrophic pyloric stenosis

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.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

Congenital hypertrophic pyloric stenosis

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.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