小结
定义
病史和体格检查
关键诊断因素
- first-born male infant
- non-bilious projectile vomiting
- 2 to 12 weeks old
- upper abdominal mass
- peristaltic waves
其他诊断因素
- family history of pyloric stenosis
- multiple formula changes
- tachycardia
- decreased wet nappies
- dry mucous membranes
- flat or depressed fontanelles
- constipation
- poor weight gain
- irritability
危险因素
- prematurity
- early exposure to erythromycin
- exposure to prostaglandins
- maternal exposure to macrolides
- geographic location/ethnic background
- first-born male infant
- family history of pyloric stenosis
诊断性检查
首要检查
- chemistry panel
- ultrasound abdomen
治疗流程
all patients
撰稿人
作者
Catherine J. Hunter, MD
Professor of Surgery and Division Chief of Pediatric Surgery
Oklahoma Children’s Hospital
The University of Oklahoma College of Medicine
Oklahoma City
OK
利益声明
CJH declares that she has no competing interests.
鸣谢
Dr Catherine Hunter would like to gratefully acknowledge Dr Samuel C. Klonoski, Dr Jeffrey S. Upperman, Dr Yigit S. Guner, and Dr Arturo Aranda, previous contributors to this topic. SCK, JSU, YSG, and AA declare that they have no competing interests.
同行评议者
Evan Nadler, MD
Assistant Professor of Surgery
Department of Surgery
Division of Pediatric Surgery
NYU Medical Center
New York
NY
利益声明
EN declares that he has no competing interests.
Lewis Spitz, PhD FRCS MD (Hon), FRCPCH FAAP (Hon), FCS (SA) (Hon)
Emeritus Nuffield Professor of Paediatric Surgery
Institute of Child Health
University College
London
UK
利益声明
LS declares that he has no competing interests.
Ruth Hallows, BSc, MB BS, FRCS, FRCS III (Paediatric Surgery)
Consultant in Paediatric and Neonatal Surgery
Royal Alexandra Children's Hospital
Brighton
UK
利益声明
RH declares that she has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
参考文献
关键文献
Aspelund G, Langer JC. Current management of hypertrophic pyloric stenosis. Semin Pediatr Surg. 2007 Feb;16(1):27-33. 摘要
Expert Panel on Pediatric Imaging., Alazraki AL, Rigsby CK, et al. ACR Appropriateness Criteria® Vomiting in infants. J Am Coll Radiol. 2020 Nov;17(11s):S505-S515.全文 摘要
Staerkle RF, Lunger F, Fink L, et al. Open versus laparoscopic pyloromyotomy for pyloric stenosis. Cochrane Database Syst Rev. 2021 Mar 9;3:CD012827.全文 摘要
参考文献
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
鉴别诊断
- Gastro-oesophageal reflux
- Over-feeding
- Malrotation
更多 鉴别诊断指南
- ACR appropriateness criteria: vomiting in infants
更多 指南
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