Bsc and Gnm Nursing Syllabus

1. ANORECTAL
MALFORMATION

2. INTRODUCTION
Comprises a wide spectrum of defects involving
distal anus and rectum as well as urogenital
tract.

3. • It involves arrest of rectal
descent resulting in
absence of an anal
opening.
• Occurs during 4th to 16th
week of gestation.

5. INCIDENCE
• Boys are more affected than girls.
• Minor abnormalities occurs in about 1/500 live births
while major abnormalities occur in 1/5000 live
births.

6. RISK FACTORS
• Genetic inheritance
• Family history
• Down syndrome

7. CLASSIFICATION
Anal stenosis Anal
membrane
atresia
Rectal atresia
Anal agenesis
or imperforate
anus

8. 1. Anal stenosis
• Stricture 1 - 4 cm above the
anus.
• Stricture may extends
through the entire length
of anus.

9. Anal membrane atresia
• A persistent anal
membrane produces
obstruction behind which
meconium can be seen.

10. Rectal atresia
• A normal anus is present
but rectum ends as a
blind pouch in the
hollow of the sacrum.

11. Anal agenesis or imperforate anus
• An imperforate anus possibly seen
as a dimple with rectum ending as
a blind pouch some distance above
the anus.
• Accounts for about 80% of
anorectal malformations.

12. • Fistula may
also be
present
between the
rectum and
urogenital
tract.

13. DIAGNOSTIC EVALUATION
Through newborn assessment:
• No anal opening
• NG tube or thermometer cannot be inserted into the
infant’s rectum.
• No history of passage of meconium
• Presence of meconium in urine (rectovaginal fistula)

14. • Abdominal USG
• Intravenouspyleogram (IVP)
• Cystourethrogram
DIAGNOSTIC EVALUATION

15. MANAGEMENT
SURGICAL PROCEDURE:
ANAL STENOSIS:
• Manual dilatation is done by Hegar’s dilators
for increasing the diameter.
ANAL MEMBRANE ATRESIA:
• Incision of membrane or perforation with a
blunt instrument followed by anal dilatation.

16. IMPERFORATE ANUS:
• Two stage surgery is done.
• First stage: creation of a temporary colostomy.
• Second stage: Intestinal repair and colostomy
closure.
MANAGEMENT

17. NURSING MANAGEMENT
PRE OPERATIVE:
• Hold oral feeding as soon as the anomaly is noticed.
• IV fluids
• Measure abdominal girth
• Nasogastric aspiration for gastric decompression.
• Monitor vital signs
• Psychological preparation of family members.

18. POST OPERATIVE
• General post anesthesia care
• IV fluids
• Nasogastric suctioning
• Start oral feeding as the peristalsis begins.
• Care of colostomy.

19. THANK
YOU