Spasm of the pylorus (the muscle at the outlet of the stomach) or pilorospazm - a pathological condition in which there is a strong spasmodic contraction of the muscles in the pyloric region of the stomach.
As a result of disrupted pilorospazme timely removal of food from the stomach and leads to unpleasant symptoms, disturbed digestion.
Causes
Distinguished primary and secondary forms pilorospazme occurring against the backdrop of various pathologies.
Primary pilorospazm is the result:
- disorders timely receipt of relaxing stimuli on gatekeeper receptors that occur with malfunction of the nervous system,
- deficiency of vitamins (especially B group),
- sharp fatigue (mental or physical)
- reflex during stimulation in the bowel primary divisions ilioblasti ileocecal angle (the place of transition into the small intestine thick)
- intoxication nicotine or morphine,
- disturbances in the autonomic nervous system (increase of vagal tone).
Secondary piloropazm occurs when:
- peptic ulcerEspecially when the ulcer localized in the gatekeeper,
- chronic gastritisEspecially with high acidity,
- inflammation of the outlet of the stomach and intestines department entry (piloroduodenite)
- polyposis of the stomach,
- diseases of the lower digestive departments - colitis, polyposis colon, Crohn's disease or chronic appendicitis,
- diseases of the biliary tract,
- adhesions,
- inflammation in the pelvic area in women (pyloric spasm reflex occurs due to occurrence of abnormal pulses).
Aggravating factors for the development of pilorospazme is smoking, work in hazardous chemical production, use of certain medications.
Pilorosprazm often occurs in infants as a result of a difficult birth, and long-term hypoxia, Immaturity, or pathology of the nervous system. In adults usually occurs on the background of unfavorable painful or exhaustion.
development mechanism
Gatekeeper - a special digestive system muscle, it is constantly shrinking, regardless of the digestion process. However, the tone of the pyloric responsive to the active work of all the departments of the digestive and nervous system impulses, as well as changes in the concentration of digestive juices.
As a result, there is a very strong stimuli twitching gatekeeper - there is a spasm. Long spasms disrupt the internal structure of the gatekeeper - it can lead to a more serious condition - pyloristenosis (Organic muscle disorders).
Due to spasm of the stomach begins to contract more strongly, trying to overcome the force of contraction of the pylorus and push food further into the gut. Pilorospazme there are unpleasant symptoms.
Provided pilorospazme 2 forms:
- compensated, spasm overcome the efforts of the stomach, the food is pushed through the narrowed space of the pylorus,
- uncompensated - the wall of the stomach tired and cease to decline, the food stagnates.
Pyloric spasm can be absolute or full, said opening completely overlaps muscles, and relative - there is a small opening for passage of food.
manifestations pilorospazme
When pilorospazme may arise:
- pain in the stomach colicky nature,
- painful spasms in podlozhechki,
- there is weight loss,
- after the pain passes, there is a "crisis of uric" patient emits large amounts of urine with low density and light color,
- can be confusing for nausea and heaviness in the stomach, especially after eating,
- in severe cases, there is vomiting, which brings relief
- due to vomiting occurs salts loss, weakness occurs
- with long-term stagnation of food in the stomach vomit have a bad smell.
The last three symptoms may be a sign of transition in pilorospazme stenosis that requires more than the active therapeutic measures.
Pilorospazm children
In infants manifested pilorospazm
- resistant regurgitation larger than 2 tablespoons, even after 1-2 hours after feeding,
- sometimes vomiting fountain
- poor weight gain, weight curves flattened,
- general anxiety, frequent crying,
- sleep disorders,
- bouts of colic.
There have been signs of nervous system in violation of the general muscle tone.
Diagnostics
Diagnosis and treatment has been a gastroenterologist.
Diagnostic Base - holding stomach X-ray contrast agent, the X-ray observed delay food contrasting mixture flows from the stomach into the intestine in small portions.
The stomach gets in the unusual form of X-rays. To distinguish it from pyloric spasm stenosis administered drug, relaxing muscles. Spasm after it disappears and the X-ray contrast detected normal passage mixture into the intestine.
Complementing the study endoscopy (swallowing "bulbs"), in which the monitor can be seen visually spastic pyloric section of the stomach and the contents of the delay.
pilorospazme treatment
Begin treatment measures to maximize the elimination of the causative factors. The mainstay of treatment pilorospazme - it
- a special diet with the exception of acute, irritating food, crude fiber,
- strict daily routine and nutrition, adequate rest,
- during dehydration and loss of salts with vomiting administered saline orally or intravenously,
- performed physiotherapy, massage and breathing exercises,
- in severe cases, used antispasmodics (no-spa, Drotaverinum, papaverine) and muscle relaxants (atropine and its analogues).
An exemplary treatment regimen pilorospazm
- Diet: Feeding fractional increase in the number of feedings and the reduction of a single volume; while breastfeeding: breast milk; artificial feeding use mixtures with thickeners (e.g. "Frisovom", "Nutrilon-anti-reflux", "Nestargel", "Semper Lemolak")
- Antispasmodics chlorpromazine 0.002 g of 3 p / day orally (0.5 to 1 ml of 0.25% solution of chlorpromazine); promethazine 2.5% 1-2 drops per 15 min before feeding;
- physiotherapy: electrophoresis papaverine hydrochloride, drotaverine on area epigastrium №5-10; paraffin application on the abdomen №5-6 a day.
Treatment in children
Children pilorospazm treated using fractional feeding a small volume, the adoption of special provisions in the crib, taking antispasmodic, sedative and massage therapy (receiving sedatives - valerian, motherwort, novospassita). As the nervous system maturation pilorospazm gradually extends.
Forecast
Often patients do not attach importance to emerging symptoms, mistaking them for food of error, with the result that pilorospazm flows into heavy and progressive disease - pyloric stenosis, when the defeat of the pylorus muscle becomes irreversible.
This disrupts the normal life of the patient and can lead him to the operating table.
