~Teachingcenter的醫學筆記~

Case Presentation:

Chief complaint
Projectile vomiting once last night.

Present illness
1. 1-month-and-1-day-old male baby
2. He was born to a 33-year-old mother G1P1 at GA 38 weeks on 104/3/14 via NSD.
---The mother had no complication during pregnacy.
3. The baby was noted to have (in 台北榮總)
---left hydrocele
---patent foramen ovale
---left develomental dysplasis of the hip.
4. He had progessively decreased appetite after leaving postpartum center.  (100mL → 50-60ml every 4 hours)
5. The born body weight was 3226 gm and turned into 3700 gm in one month.
6. No stool passage for 3 days, and his mother said he had projectile vomiting 3 times last night (4/13)
---color of vomitus was the same as the milk just fed.

Infantile Hypertrophic Pyloric Stenosis (嬰兒肥厚性幽門狹窄)

1. 注意到這個疾病，最初始通常都是因為nonbilious vomiting，可能也會伴有poor appetite、failure to thrive等情形。

2. 嬰兒從0到1個月大時，應該要增加1公斤重，平均約是1周增加250g。

3. 此疾病通常是在1個月大的時候被診斷出來，而最輕微的症狀約是在3周大的時候就有，不過根據過去案例，1周~5個月大的嬰兒都有可能。

4. 診斷為藉由X光和超音波診斷，當一個1個月大的嬰兒，母親主訴噴射狀嘔吐，腹部可能摸到一棵橄欖狀(約2公分)的腫塊時，即會趕緊做X光和超音波，X光片上可以看到single bubble sign(不過發病初期可能會不好判斷，因為此時還會有部分腸氣)；而腹部超音波中，其幽門的肌肉壁>3mm，幽門長度>14mm，就是IHPS了。

5. 當沒有超音波輔助時，也可以做upper GI series，鋇劑(barrium)會在幽門處出現string sign。

6. 治療上，主要先矯正病人的脫水情況，同時作手術治療將幽門擴約肌切開(Pyloromyotomy或又稱為Ramstadt surgery)，使胃與十二指腸的通道可以暢通。