gastrocnemius in children
Introduction
Introduction to pediatric gastric agglomeration Gastric agglomeration (bezoarofstomach), also known as gastrolithic disease, refers to a foreign body formed by ingestion of certain botanical ingredients or the ingestion of hair or certain minerals such as calcium carbonate, expectorants, tinctures, etc., and Affects digestion function. basic knowledge The proportion of illness: 0.2% (child prevalence rate is about 0.2%) Susceptible people: children Mode of infection: non-infectious Complications: anemia, duodenal ulcer, pyloric obstruction, intestinal obstruction, peritonitis
Cause
Causes of pediatric gastric agglomeration
Plant ball (30%):
The plant ball is composed of a mixture of various plant seeds and cellulose ingested. The persimmon or black jujube is easy to form a plant ball. Because the raw persimmon and black jujube contain a large amount of tannic acid, it can become a viscous effect with gastric acid. A gel-like substance that is bonded to excessive plant fibers that are ingested.
Hair ball (30%):
The hair ball is composed of hair and plant fibers of different lengths, and its color is dark green or black. It is hard and has a bad smell. This disease is easy to occur in girls who have the habit of crunching and swallowing hair.
Pathology (30%):
In the case of fasting, children devour a lot of black dates or persimmons, because they contain citric acid and gums, pectin and other ingredients, the content of immature persimmons can reach 25%, under the action of stomach acid, can solidify and precipitate to form agglomerates, tannic acid Protein, gum, and pectin bind persimmon skin, persimmon nucleus, and plant fiber together to form stomach stone in the stomach. In addition, swallowing hair, eating hawthorn, strawberry, raw egg, and red bean skin also form stomach stone. It is reported that long-term use of calcium and Chinese medicine pills can also form stomach stones. Because of the feeding of milk powder containing more casein, there are reports of stomach stone, but it is rare after switching to formula, and stomach stone is in the stomach. After the formation, it can accumulate with the food residue, and the larger the accumulation, the formation of a huge mass, long-term stimulation of the stomach can cause indigestion, or cause ulcers, or obstruction.
Prevention
Pediatric gastric agglomeration prevention
Strengthen prevention and publicity education to avoid the habit of swallowing a lot of black dates or persimmons in the case of fasting, avoiding swallowing hair and raw eggs.
Complication
Pediatric gastric agglomeration complications Complications anemia duodenal ulcer pyloric obstruction intestinal obstruction peritonitis
Long-term effects on appetite, vomiting can be complicated by anemia, nutritional disorders; can be complicated by stomach, duodenal ulcer; complicated with pyloric obstruction, stone discharge into the intestine causing intestinal obstruction; intestinal obstruction can go to water, electrolyte disorder, alkalosis or acid Poisoning; even gastric perforation causes peritonitis.
Symptom
Symptoms of pediatric gastric agglomeration common symptoms fatigue nausea dyspeps upper abdominal discomfort upper abdominal diffuse tenderness constipation peritonitis intestinal dysfunction appetite loss heartburn
Gastrointestinal disease is more common in preschool children, and its clinical manifestations depend on the type of stomach stone and its location and whether there are complications.
Most of the children with vegetal gastrolithic disease have swallowed a large number of black dates, persimmons, hawthorns and other history on an empty stomach in recent days or a few hours before the onset of illness. The main manifestations are indigestion, nausea, vomiting, paroxysmal upper abdominal pain, loss of appetite. Constipation, etc., a small number of sick children with abdomen lumps for treatment, physical examination can touch the shape of the hard irregular mass in the upper abdomen, can be active, there is tender tenderness.
Children with hairy gastrolithic disease have a history of crunching their own hair. They may have no symptoms in the early stage, or only accidentally discover foreign bodies in the stomach. Symptoms of gastrointestinal dysfunction may occur in the advanced stage, pain or discomfort in the upper abdomen, or swelling. Full, sometimes nausea and vomiting; stomach stone can stimulate the gastric mucosa for ulceration, ulcer symptoms, severe hematemesis or blood in the stool, even perforation of peritonitis, long-term illness, weight loss, malnutrition In the upper abdomen, it can touch a round or elliptical shape with a smooth surface, a clear boundary, a hard, movable mass, no tenderness or only tenderness. A large stomach stone can lead to incomplete or complete obstruction of the pylorus. These children have frequent sparse hair on the forehead.
A few hours after eating a large amount of persimmon, symptoms appear, upper abdominal discomfort or pain, increased after eating, nausea, vomiting, vomit is watery or mucus and food residue, the amount is not much, there may be coffee, but there will not be a lot of hematemesis The cause of bleeding is caused by persimmon stone stimulation of gastric mucosa leading to gastritis or gastric ulcer. There may also be symptoms such as loss of appetite, weight loss, fatigue, acid reflux and heartburn.
About one-third of the patients in the physical examination can reach the mass in the upper abdomen, there is diffuse tenderness in the upper abdomen, and the stomach stone (such as a huge hair group) blocks the pylorus, which may have the performance of pyloric obstruction, and the stomach stone presses the stomach wall to make it necrotic and perforated; Discharge into the intestine can cause intestinal obstruction.
Examine
Pediatric gastric agglomeration examination
Peripheral blood examination showed increased white blood cells and increased neutrophils, may have hemoglobin decreased, red blood cells decreased, blood biochemical examination of water, electrolyte imbalance, blood sodium, blood potassium, blood calcium, blood phosphorus, blood magnesium and blood pH can be Changes occurred; in patients with peritonitis, the peritoneal puncture fluid has increased white blood cells.
X-ray inspection
Persimmon stone can not be seen through X-ray, abdominal fluoroscopy or plain film. It can be found that the density of the persimmon can be increased. The sputum meal can be found in the filling defect. When changing the body position, it can move in the stomach.
2.B Ultra
It can be found that there are retentate in the stomach, the stomach stone is larger, the abdomen can detect the curved light band, the edge is irregular, rough, visible dark areas on both sides, the movement of the stone is not obvious, the stomach stone is smaller, After the water is supplied, the light group moves with the body position.
3. Gastroscopic examination
The dark brown removable stomach stone can be seen, and the diagnosis can be confirmed by taking out the biopsy forceps.
Diagnosis
Diagnosis and diagnosis of pediatric gastric agglomeration
Ask your medical history in detail, especially if you have a history of crunching your own hair, or swallowing a lot of black dates. The history of persimmons is very valuable for diagnosis. X-ray examination of sputum meal shows that there is a huge filling defect in the stomach, and it can move. Abdominal B Ultra-examination can find huge strong reflections, which are helpful for diagnosis.
Fiber endoscopy can observe the size, shape and nature of the stomach stone under direct vision, and can mash the vegetable gas stone for the purpose of treatment.
In autumn, there are medical history of eating persimmons, black dates, etc., with typical symptoms, with X-ray, B-ultrasound, gastroscopy can confirm the diagnosis.
Identification with other acute abdomen such as acute pancreatitis, acute gastroenteritis, appendicitis, and gastric ulcer perforation and other causes of intestinal obstruction.
