Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
BY
RASHID HUSSAIN
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AIM: To share the knowledge among the
participants about the Cogenital
disorders of G.I system.
OBJECTIVES:
At the end of presentation the participants will be able to:
Describe the normal characteristics of pediatric G.I
system.
Define congenital disorder.
Enlist the congenital disorders of G.I system.
Explain different congenital abnormalities of G.I system
with causes, pathophysiology and signs & symptoms.
Describe the nursing care plan for each disorder.
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Characteristics of the
pediatric GI System
Peristalsis occurs within 2 ½ to 3 hours in
the neonate and extends to 3 to 6 hours in
older infants and children.
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Up until 4 to 8 weeks, the neonatal
abdomen is larger than the chest and the
musculature is poorly developed.
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Spit-ups are frequent in the neonate because
of the immature muscle tone of the lower
esophageal sphincter (LES) and the low
volume capacity of the stomach.
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The liver’s slow development of
glycogen storage capacity makes the
infant prone to hypoglycemia.
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Cleft Lip
Cleft lip and palate Tx: surgery –
results when fusion Cheiloplasty;
involving the first
brachial arch faills to to usually 1-3 mos
take place uring
embryonic Rule of 10’s-
devellopment. failure of 10 wks, 10 lbs,
fusion of maxillary and
median nasal process Hgb 10 gm/dl
hereditary
unilateral/bilateral
males
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Cleft Palate
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Pathophysiology of cleft lip &
palate
Cleft lip
Varies from a notch in the lip to complete separation of the lip into the
nose.
Failure of maxillary process to fuse with nasal elevations on frontal
prominence; normally occurs during 5th and 6th week of gestation.
Merge of upper lip at midline complete b/w 7th and 8th week of
gestation.
Cleft palate
Failure of mesodermal masses of lateral palatine process to meet and
fuse; normally occurs b/w 7th and 12th week of gestatioon.
• s/s: ?????
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Nursing Dx:
Risk for imbalanced nutrition, less than body
requirements R/T feeding problems
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Nursing Care
Preop
Adequate nutrition; sips of fluid btw feeding in upright
position; use rubber tipped syringe; Burp
Prevent ear and upper respiratory tract infection
Address body image and speech concerns
Reassurance to parents
Postop
monitor respiratory distress d/t edema, hemorrhage
Suction mucus and blood gently
dropper feeding 1st 3 weeks; regular feeding after
Anticipate needs and position to prevent tension on sutures
Dx:
Ba swallow
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Nursing Dx:
Risk for imbalanced nutrition, less than body
requirements R/T inability for oral intake
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Nursing care
Preop
Suction regularly
Elevate the head
Gastrostomy feeding
hydration
O2
Postop
1. Observe for respiratory distress
2. Proper positioning –avoid hyperextension of neck
3. Continue suction
4. Prevent wound infection
5. Provide pacifier
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Post Gastrostomy
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Hirschprung’s Disease
Aganglionic megacolon.
Absence of parasympathetic
ganglionic cells in a segment of
the colon (usually at the distal
end of the large intestine:
rectosigmoid colon)
Lack of innervation to a bowel
segment causes a lack of, or
alteration in, peristalsis in the
affected part
Male predominance
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Causes
Familial, congenital defect
Complications
Severe Constipation
Enterocolitis – severe diarrhea, Hypovolemic shock, Death
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Dx:
Rectal biopsy provides definitive diagnosis by showing
the absence of ganglion cells
Ba enema – shows distention of the colon; spasm and a
narrowed lumen in the affected bowel
Abdominal X-rays show distention of the colon and
air-fluid levels; No air is seen in the rectum
Tx: 1: primary resection of aganglionic segment.
2: colostomy, surgery: To decompress the colon, a
temporary colostomy or ileostomy may be necessary
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Nursing Dx:
Constipation R/T reduced bowel function
Imbalanced nutrition, less than body requirements R/T reduced bowel
function
Nursing Care
Preop
1. Administer isotonic enemas: Normal saline solution or mineral oil to
evacuate the bowel
Daily enemas with 0.9% NaCl
Don’t administer tap water.
* Tap/hypotonic water will cause cardiac congestion or cerebral edema
2. Minimal residue diet with vitamin supplementation
3. Position semi fowlers to relieve dyspnea from distended abdomen
4. pacifier
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After colostomy or Ileostomy
1. Monitor fluid intake and output (ileostomy will likely
cause excessive electrolyte loss)
2. Keep the area around the stoma clean and dry; use
colostomy or ileostomy appliances to collect drainage
3. Monitor for return of bowel sounds to begin diet
Postop
1. Observe for abdominal distention
2. Small frequent feedings after NGT removal
3. Colostomy care
4. Assist parents to cope with children’s feeding problems
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Intussusception
Is the invagination or
telescoping of the portion of the
intestine into an ajucent, more
distal section of the intestine.4-
10 months
S/S: Intense abdominal pain,
vomiting, blood in stool “currant
jelly”, abdominal distention
(sausage shaped mass)
Dx: sonogram “coiled spring”
Tx: Ba enema (reduction by
hydrostatic pressure), surgery
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Nursing Dx:
Pain R/T abnormal abdominal peristalsis
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Nursing Care
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Pyloric Stenosis
Hypertophy/hyperplasia
of pyloric sphincter
Males
S/S: nonbillous vomiting,
s/s of dehydration and wt
loss, abdominal
distention, “olive” sized
mass RUQ, visible
peristalsis
Dx: xray-”string sign”,
USG, endoscopy
Tx: surgery
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Nursing Dx:
Risk for deficient fluid volume R/T inability to
retain food
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Nursing care
Hydration
Pacifier
may give thickened feedings on upright position then NPO
just before surgery
Monitor I and O, weight, and vomiting
Postop
1. Dropper feeding 4-6 hrs after surgery 45 min- 1 hr
duration; oral rehydration soln then half strength
breastmilk/formula at 24 hr interval
2. Side lying position
3. Monitor weight and return of peristalsis
4. Wound care
5. Pacifier for oral needs
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Hiatal or Diaphragmatic
Hernia
Part of stomach protrudes through the esophageal hiatus
of the diaphragm into thoracic cavity. OR
Herniation of intestinal content into the thoracic cavity.
• Congenital weakness
• Increased intra-abdominal pressure
• Increased age
• Trauma
• Forced recumbent position
Diaphragmatic Hernia
Left side
S/S: respiratory difficulty,
cyanosis, retractions, (-)
breath sounds affected
side, scaphoid abdomen
Dx: CXR, Upper
endoscopy
Tx: Diaphragmatic
Hernia repair
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Nursing Dx:
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Nursing Care
Preop
Mechanical ventilation
Elevate head
Low intermittent suction
Postop
1. NICU care.
2. Semi-fowlers
3. Wound care
4. Maintain warm, humidified environment– lung fluid drainage
5. Suction prn
6. Chest physio
7. NPO – prevent pressure on diaphragm 39
Celiac Disease/Gluten sensitive
enteropathy/Celiac sprue
Causes:
Gluten intolerance
Immunoglobulin deficiency
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Pathophysiology
A decrease in the amount and activity of enzymes in the
intestinal mucosal cells causes the villi of the proximal
small intestine to atrophy and decreases intestinal
absorption.
Malabsorption of fat-soluble vitamins (????), minirals &
some protiens & carbohydrates.
Complications
Lymphoma of the small intestine
Impair growth, succeptibility
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S/sx:
steatorrhea (????) because of inability to absorb ____?
chronic diarrhea
anorexia
malnutrition; weight loss
failure to thrive
coagulation difficulty from the malabsorption of fat soluble
vitamins
irritability
anemic (Fe deficiency)
abdominal pain and distention
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CELIAC CRISIS: constitutes acute medical
emergency and threat to life
acute vomiting and diarrhea,dehydration &
acidosis
Give the child: corn and rice products, soy and potato flour,
breast milk or soy- based formula, and fresh fruits.
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Imperforate Anus
Pathophysiolog:
An arrest in embryonic development of the anus,
lower rectum and urogenital tract at the 8th week
of embryonic life.
Fistula is more likely to be formed.
Others anomalies likely, especially TEF.
Cause unknown.
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Types ano-rectal malformations
Anal stenosis.
Imperforate anal membrane.
Anal agenesis.
Rectal agenesis.
S/S:
No anal opening.
Absence of meconium stool.
Green-tinged urine---if fistula is present.
Progressive abdominal distention.
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Treatment for
Low-type imperforate anus.
• Local dilatation of fistula.
• Definitive repair.
• Anoplasty.
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Poost-op nursing care
Depending on the location, type of imperforate anus,
sex of child.
Prevent infection of suture line.
after of anoplasty).
Moniter for return of paristalsis.
perinium 51
References:
http://www.scribd.com/doc/6663904/Pediatric-Disorders
http://www.scribd.com/doc/6685930/Nursing-Care-of-Clients-
With-Upper-Gastrointestinal-Disorder
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Thank you!
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