问题 问答题 简答题

试述先天性肥厚性幽门狭窄的临床表现。

答案

参考答案:

先天性肥厚性幽门狭窄的临床表现:

①呕吐为主要症状,多在出生后3~4周内开始,特点为进行性加重,最初病儿仅有溢奶,很快几乎每次喂奶后15~30分钟均将发生呕吐,不伴恶心,呈喷射状,呕吐物为带凝块的奶汁,白色而不含胆汁,其量有时可多于一次的喂奶量,少数病例有带凝血的咖啡色呕吐物。病儿有很强的饥饿感,呕吐后有觅食反射,如再喂奶,仍能用力吸吮。

②腹部检查可见上腹部膨胀,并有起自左肋下向右上腹移行的胃蠕动波,在喂奶10分钟后最容易观察到这个体征。本病的特征是右上腹触摸到幽门肥厚形成的橄榄样肿块,在病儿熟睡或在呕吐后胃空虚时较易触及。

③尿少、便秘、消瘦,体重非但不增,且逐渐下降,时间越久,消瘦越严重。呕吐可引起碱中毒,呼吸变浅而慢,碱中毒可使血中游离钙下降,表现有喉痉挛和手足抽搐,晚期脱水严重,肾功能受损,酸性代谢产物潴留,可形成代谢性酸中毒,碱中毒症状不明显。

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