Group 2: Leader: Hershee Izell J. Abaya Members: Rez P. Guerrero Adrian Eleazar M. Con hina Ches!

er Cruz Ri hard "i#on A$ena

%is!al Colono&ram Meanin&: I! is a pro edure in 'hi h 'a!er(soluble on!ras! is ins!illed in!o a de)un !ioned olon $ia a s!oma.

A small balloon a!he!er is inser!ed in!o !he dis!al s!oma* !he balloon in)la!ed* and on!ras! in+e !ed by hand !o ade,ua!ely dis!end !he de)un !ioned loop and !he ase o) anore !al a!resia !o demons!ra!e any )is!ula. Prior !o de)ini!i$e re ons!ru !i$e sur&ery in hildren 'i!h a olos!omy* a dis!al olono&ram is re,uired !o assess !he len&!h o) dis!al olon and !o iden!i)y a )is!ula. -.here)ore !he indi a!ion )or a dis!al olono&ram is i! is done prior !o a de)ini!i$e re ons!ru !i$e sur&ery in hildren 'i!h de)un !ioned dis!al olon !o assess !he len&!h o) !he dis!al olon and iden!i)y a )is!ula. I! is also alled dis!al olo&raphy or loopo&raphy. Impor!an! s!ep in !he repara!i$e mana&emen! mal)orma!ions o) !he anore !al /ARMs0 'i!h imper)ora!e anus* Hirs hsprun&1s disease and oloni a!resia in hildren and obs!ru !i$e disorders o) !he dis!al olon / oli!is 'i!h s!ri !ure* ar inoma or ompli a!ed di$er!i uli!is0 in adul!s. I! ser$es !o iden!i)y or on)irm !he !ype o) ARM* presen e or absen e o) )is!ulae* lea2a&e )rom anas!omoses* or pa!en y o) !he dis!al olon. I! is also alled dis!al olo&raphy or loopo&raphy. Impor!an! s!ep in !he repara!i$e mana&emen! mal)orma!ions o) !he anore !al /ARMs0 'i!h imper)ora!e anus* Hirs hsprun&1s disease and oloni a!resia in hildren and obs!ru !i$e disorders o) !he dis!al olon / oli!is 'i!h s!ri !ure* ar inoma or ompli a!ed di$er!i uli!is0 in adul!s. I! ser$es !o iden!i)y or on)irm !he !ype o) ARM* presen e or absen e o) )is!ulae* lea2a&e )rom anas!omoses* or pa!en y o) !he dis!al olon.

3 4e !ions o) !he Colon:

As endin& Colon( e#!ends up'ard on !he ri&h! side o) !he abdomen. .rans$erse Colon( e#!ends )rom !he as endin& olon a ross !he body !o !he le)! side. %es endin& Colon( e#!ends )rom !he !rans$erse olon do'n'ard on !he le)! side. 4i&moid Colon( named i) i!s 4(shape5 e#!ends )rom !he des endin& olon !o !he re !um.

Indi a!ion: 6leedin& Abdominal pain and ons!ipa!ion Anore !al a!resia "e ro!izin& en!er oli!is Hirs hsprun&1s %isease 7bs!ru !ion o) 6o'el Presen e o) Cys! Adhesions E#!ra$asa!ion Presen e o) 8is!ula

Imper)ora!e Anus9 Anore !al A!resia Con&eni!al .he openin& o) !he anus is missed* blo 2ed or 4!eno!i . .he Re !um may no! onne ! !o !he Colon. .he Re !um may ha$e openin& !o !he o!her s!ru !ures :RARE; 4i&ns and 4ymp!oms: 7penin& $ery near !o !he $a&ina. "o Me onium 'i!hin )irs! 23(3<= 4'ollen 6elly 4!ool passes ou! o) !he >a&ina9 6ase o) !he Penis Missin& Anus .rea!men!: Re ons!ru !i$e 4ur&ery Colos!omy I) )is!ula is presen!* &i$e a broad spe !rum an!ibio!i 'i!hin !he )irs! 3<=.

"e ro!izin& En!ero oli!is

Prema!ure in)an!s durin& ?s! 2 'ee2s o) li)e* 'hen mil2 )eedin& has be&un* !hru "G.. @ lbs baby Por!ions o) bo'el under&o ne rosis. 2nd mos! morbidi!y in prema!ure in)an! Idiopa!hi %ue !o 'ea2 mu osal in!e&ri!y !he ba !eria an in$ade !he 'ea2 'all and &e! in)e !ed. Aea2 'all o ur due !o !he ora&n is imma!ure and lo' blood supply* !his supply &oes !o $i!al or&ans ins!ead o) Gas!roIn!es!inal .ra !* !hus ma2in& i! 'ea2. air in !he bo'el 'all in 4mall In!es!ine Lon& se&men! usually.

4i&ns and 4ymp!oms: Abdominal %is!en!ion 6lood in !he 4!ool %iarrhea 8eedin& In!oleran e .emper Ins!abili!y Le!har&y >omi!!in&

Colos!omy Ileos!omy on Bray: 6ubbly Appearan e o) !he &as in !he 'alls o) in!es!ine

Hirs hsprun&Cs %isease /Con&eni!al In!es!inal A&an&lionosis0 is a disorder o) !he abdomen !ha! o urs 'hen par! or all o) !he Lar&e In!es!ine or an!e eden! par!s o) !he Gas!roin!es!inal .ra ! ha$e no ner$es and !here)ore anno! )un !ion.

Harold Hirs hsprun& A&an&lioni Me&a olon .he Colon anno! rela# and pass s!ool !hrou&h !he olon rea!in& an obs!ru !ion. an be on)irmed !hrou&h su !ion biopsy o) Re !al Mu osa 'hi h is sen! )or y!o&ene!i analysis. Common in 6oys /?9DEEE0

4i&ns and 4ymp!oms: Abdominal Pain Ribbon li2e 4!ool Poor 8eedin& 2 .ypes 4hor! 4e&men! ( Las! 4e&men! o) Lar&e In!es!ine /<EF ME"0 Lon& 4e&men! ( Mos! o) !he Lar&e In!es!ine /2EF ME" G A7ME"0 .rea!men!: 4hor! 4e&men!: Rese !ion o) !he A&an&lioni 4e&men! 'i!h Anas!omosis. Lon& 4e&men!: Colos!omy

Con!raindi a!ion:

Pa!ien! un'illin& !o &i$e onsen! Hn oopera!i$e pa!ien! 8ulminan! oli!is Pre&nan y

Hl era!i$e Coli!is In)lamma!ory 6o'el %isease. Re urren! in In)lamma!ion o) !he Mu osal Layer o) !he Lar&e 6o'el. "on rela!ed !o an In!es!inal In)e !ion9 "4AI%4 i! is in !he Re !um and an e#!en! pro#imally in a on!inuos )ashion. Distal colitis* po!en!ially !rea!able 'i!h enemas: Pro !i!is: In$ol$emen! limi!ed !o !he re !um. Proctosigmoiditis: In$ol$emen! o) !he re !osi&moid olon* !he por!ion o) !he olon ad+a en! !o !he re !um.

Left-sided colitis: In$ol$emen! o) !he des endin& olon* 'hi h runs alon& !he pa!ien!Cs le)! side* up !o !he spleni )le#ure and !he be&innin& o) !he !rans$erse olon. Extensive colitis* in)lamma!ion e#!endin& beyond !he rea h o) enemas: Pancolitis: In$ol$emen! o) !he en!ire olon* e#!endin& )rom !he re !um !o !he e um* beyond 'hi h !he small in!es!ine be&ins.

In)lamma!ion is Chara !erized by Hl era!ion. Idiopa!hi

Ris2 8a !or: Gene!i s E!hni i!y Ci&are!!e 4mo2in& %ie! Iso!rerinoin 4i&ns and 4ymp!oms: Re !al 6leedin& /6ri&h! Red0 .enesmus /ur&en! desire !o e$a ua!e s!ools bu! 'i!h li!!le passa&e o) i!0 Lo'er Abdominal Pain I 3# 9 day bo'elsJ I! an lead !o 8ulminan! Coli!is 4i&ns and 4ymp!oms: ?E# 9 day bo'els Con!inuous 6leedin& Abdominal .enderness9 %is!en!ion Anemia

Medi a!ion: Mesalamine /lialda0 Amino 4ali yla!es Relie$e in)lamma!ion o) in!es!ines and help pre$en! re urren e. 4!eroid may be added i) symp!oms on!inues. I! help relie$e in)lamma!ion

%e#ame!hasone An an!i in)lamma!ory a&en!.

Colo$esi al 8is!ula9 Re !o$esi al 8is!ula9 >a&ino$esi al 8is!ula

Presen e o) Communi a!ion be!'een !he Colon and 6ladder.

Mos! Common Cause %i$er!i uli!is 4i&ns and 4ymp!oms: 8e alisis Re urren! H.I Passa&e o) Hrine in !he Re !um Pneuma!uria Lo a!ion: A! !he pos!erior par! o) !he 6ladder. Medi a!ion: Rese !ion o) !he 8is!ula and A6 4e&men! o) !he 6o'el is re,uired )or Anus.

Pa!ien! Prepara!ion:

8as!in& o) a! leas! < hours "o bo'el prepara!ion .he pa!ien! 'ill be as2ed !o han&e lo!hes and 'ear a pa!ien! &o'n

Prior !o Pro edure:

.he physi ian 'ill e#plain !he pro edure !o !he pa!ien! and o)) !he pa!ien! !he oppor!uni!y !o as2 ,ues!ions !ha! are rela!ed !o !he pro edure. .he pa!ien! 'ill be as2ed !o si&n a onsen! )orm !ha! &i$es permission !o do !he pro edure. .he pa!ien! should read i! are)ully and as2 ,ues!ions i) some!hin& is un lear. "o!i)y !he physi ian i) !here is any suspe !ed pre&nan y. "o!i)y !he physi ian i) !here is hypersensi!i$i!y !o any medi a!ion* la!e#* !ape and anes!he!i a&en!s /lo al and &eneral0. "o!i)y !he physi ian o) all medi a!ions /pres ribed and o$er !he oun!er0 and herbal supplemen!s !ha! !he pa!ien! has !a2en or is !a2in&. .he physi ian 'ill !emporarily 'i!hhold su h medi a!ions prior !o !he pro edure.

6ased on !he pa!ien!s ondi!ion* !he physi ian mi&h! re,ues! o!her spe i)i prepara!ion.

Ma!erials: 8oley a!he!her ( ( ( ( 4ize o) 8C per a&e: ? day old !o ? mon!h K )?E 2 mon!hs !o L mon!hs K )?3 M mon!hs !o 2 years oldK )?L @ years !o abo$e K )?< D syrin&e LE syrin&e /asep!o syrin&e0 Glo$es NO +elly Plas!er /leu2oplas!0 ?; (74 /opera!in& spon&e0 Co!!on balls 4!erile Nidney 6asin Aspira!in& needle G?< CM non ioni

Con!ras! Media

6arium 4ulpha!e Aa!er 4oluble

Pro edure: A mar2er is pla ed o$er !he anal dimple or !he e#pe !ed posi!ion o) !he anus. Ano!her mar2er is pla ed a! !he poin! 'here urine or )e al ma!erial is seen !o be dis har&in&. As2 !he do !or !o he 2 !he ima&e be)ore pro eedin& !o !he pro edure. As2 !he do !or 'hen !o s!ar! !he pro edure

.he a!he!er !hrou&h !he s!oma leadin& !o !he dis!al olon* i!s balloon is in)la!ed and i! is pulled ba 2 durin& in+e !ion o) !he on!ras! !o a$oid any spilla&e. .he dis!al blind end o) !he olon &e!s )illed pro&ressi$ely and pressure is main!ained !ill !he on!ras! )ills !he )is!ulous !ra !. Aa!er(soluble on!ras! is used. In adminis!erin& !he Cm* pa!ien! 'ill be as2ed !o han&e posi!ion. Ima&es are ob!ained under )luoros opy.

Ri&h! La!eral -6es! demons!ra!e !he :up; medial side o) !he as endin& olon and !he la!eral side o) !he des endin& olon* 'hen !he olon is in)la!ed 'i!h air due !o &ra$i!y. -CR a! !he le$el o) !he L3 or a! !he le$el o) !he ilia res! PA or AP Pro+e !ion

4!ru !ures 4ho'n: .he !rans$erse olon should be primarily barium( )illed on !he PA and air()illed on !he AP 'i!h a double( on!ras! s!udy. En!ire lar&e in!es!ine* in ludin& !he le)! oli )le#ure* should be $isible.

Le)! La!eral -6es! demons!ra!e !he :up;* medial side o) !he des endin& olon and !he la!eral side o) !he as endin& olon* 'hen !he olon is in)la!ed 'i!h air. -CR is a! !he le$el o) !he L3 or a! !he le$el o) !he ilia res!