Health Worlds

(A) etiology
To elucidate the etiology of pyloric stenosis and pathogenesis, extensive research work over the years, including pathological, animal model, gastrointestinal hormone testing, virus isolation, genetics research, but the cause has not been determined.
1. Genetic factors in the etiology plays an important role, the incidence had obvious family, and even a Chinese mother and seven sons with the disease, and in monozygotic twins than dizygotic twins more common, parents are H. History of the incidence of stenosis of children up to 6.9%, if the mother has this history, then the sub-19% probability of disease, his daughter is 7%; father has a history here, were 5.5% and 2.4%, after a study Zhichu the genetic mechanism of pyloric stenosis is a multi-gene nature, neither genetic nor sex-linked recessive inheritance, but by a single dominant gene, and constitute a modification of the directional multi-factor genes, the genetic tendency by certain environmental factors The work, such as social class, and diet, a variety of seasons, the incidence is higher in spring and autumn, but the related factors is unknown, common in high-weight baby, but it has nothing to do with the length of gestation.
2. Nerve function is mainly engaged in pyloric plexus of intestinal smooth muscle, researchers found that ganglion cells until postnatal 2 to 4 weeks before maturation, therefore, many scholars believe that poor development of nerve cells is caused by the mechanism of py


loric muscle hypertrophy, while the negative pyloric ganglion cell degeneration in the past led to the doctrine of disease, the use of tissue for chemical analysis method for the determination of ganglion cells in pyloric activity of the enzyme; but there are dissidents, pyloric stenosis observed in the ganglion cells and the fetus is not common, such as ganglion cell dysplasia is the cause, the incidence of preterm children should be more than full-term children, but there was no difference between the two, recent studies suggest that structural changes in peptide and nerve dysfunction may be one of the main causes, observed by immunofluorescence to the circular muscle containing enkephalin and vasoactive intestinal peptide significantly reduced the number of nerve fibers, measured by radioimmunoassay decreased tissue content of substance P, which speculated that the peptide and the pathogenesis of neurological changes.
3. Gastrointestinal hormones experiment to take pentagastrin pregnant dog, puppies born to the results of high rate of occurrence of pyloric stenosis, and found that pregnant women in late pregnancy, 3 to 4 months when the serum gastrin concentration is relatively high, thus believe that the pregnant women in late pregnancy, the emotional anxiety that serum gastrin concentration, and through the placenta into the fetus, genetic orientation to the role of the fetus, causing long-term spasm pyloric obstruction, pyloric expansion has stimulated the secretion of gastrin G cells, Thus the disease, but repeated measurements of other scholars, gastrin, increased part of the report, some but no abnormal changes, even in cases of elevated gastrin can not infer a cause or result of pyloric stenosis, because 1 week after surgery gastrin in some cases returned to normal levels, but increased some in recent years of the gastrointestinal tract stimulating hormone, serum and gastric juice prostaglandin (E2 and E2a) concentration, suggesting that gastric juice was significantly higher in children, which prompted pathogenesis of hormone concentration is increased local muscular pyloric muscle in a continuous state of tension that may cause disease, while others conduct a study of serum cholecystokinin, showed no abnormal changes.
4. Muscle hypertrophy through the careful observation of some scholars have found that some babies born 7 to 10 days to force the curd through the signs of pyloric stenosis, which that such mechanical stimulation may cause mucosal edema and thickening, and the other On the one hand also leads to dysfunction of the cerebral cortex of the internal organs, so that pyloric spasm, two factors have contributed to a serious obstruction and pyloric stenosis symptoms, but also held a negative that Helicobacter pylori causes muscle spasms first functional hypertrophy is not appropriate because the muscle hypertrophy is mainly circular muscles Moreover, should attract some of the early symptoms of cramps, vomiting attack, however, in some cases early surgery, usually found in mass has been formed, tumor size and age independent of disease duration muscle hypertrophy to a certain critical value, the only show signs of pyloric obstruction.
5. Environmental factors have significant seasonal incidence peaks in spring and autumn, mainly in biopsy tissue sections of ganglion cells found in peripheral leukocytes infiltration, suggesting that viral infection may be related, but testing the blood of children and their mothers , fecal and throat are not isolated Coxsackie virus antibodies in serum and no changes in animals infected with Coxsackie virus has no pathological changes, research in continuing.
The main pathological changes are pyloric muscle hypertrophy, especially as the circular muscles, but also expressed in longitudinal muscle and elastic fibers, pyloric part was olive, hard elastic, when the muscle spasm is more rigid, general long-2 ~ 2.5cm, diameter of 0.5 ~ 1cm, muscle thickness of 0.4 ~ 0.6cm, mass in older children, even a little bigger, but the size and symptom severity and duration of disease unrelated to the tumor surface covered with peritoneum and very smooth, but because of the blood effects for some blocked by pressure, so the color looked pale, and increased muscle fiber ring hypertrophy, muscle like gravel as hard, muscle hypertrophy was extruded longitudinal mucosal folds, narrow the lumen, to mucosal edema, inflammation appears later, so that more small lumen, H. pylori only in the autopsy specimens of the probe by 1mm, thin narrow tube to the pyloric antrum transitional tapered gradually widened when the cavities, hypertrophy of the muscle is gradually thinning, no precise boundaries between the two, but in the duodenal side of the line was due to gastric and duodenal smooth muscle is not continuous with muscle, hypertrophy of the pyloric mass, and convex to the abrupt termination of the duodenum cavity the shape of the cervix like structure, histology and see muscle hyperplasia, hypertrophy, muscle fiber disorder, mucosal edema, hyperemia.
Because pyloric obstruction, proximal gastric dilatation, wall thickening, mucosal fold increase and edema, and retention of gastric contents due to, often leads to mucosal inflammation and erosion, and even ulcers.
(B) of the pathogenesis
Full-thickness pyloric muscle hypertrophy, hyperplasia, as the muscle to ring, the Department of muscle fiber thickening and hyperplasia of connective tissue between muscle bundles, muscle hypertrophy gradual migration to the normal stomach, the duodenum side, because the stomach muscle and duodenal wall muscle of non-renewal, so an abrupt end in the duodenum hypertrophy Qiduan Department, so that H. spindle-shaped mass, length is 2 ~ 3cm, diameter 1.5 ~ 2cm, myometrial thickness 0.4 ~ 0.6cm surface, pale, smooth, and hard as cartilage, the mass increases with age, hypertrophic mucosa inward to push the muscle, and the formation of wrinkles, resulting in pyloric stenosis, resulting in incomplete obstruction, gastric emptying blocked the enhanced gastric motility , gastric wall thickening, secondary to gastric distention in the duodenum side, because of gastric motility to pyloric part of the strongly pushed into the duodenal bulb, duodenal mucosal fold was cervical samples, pyloric obstruction After the stimulation of gastric retention milk produced congestion and edema (Figure 1).


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