This document provides information on gastrointestinal disorders (GI) including hernias, intestinal obstruction, and other conditions affecting the digestive system. It discusses the causes, symptoms, diagnosis, and treatment of various GI disorders. For hernias, the risk factors, types, and surgical repair are described. Intestinal obstruction is defined and the causes, classifications, pathophysiology and clinical features are outlined. The diagnosis involves physical examination, blood tests, and radiological imaging like CT scans. Treatment depends on the severity but generally involves GI decompression, fluid replacement, and sometimes surgery to relieve the obstruction.

1. GASTROINTESTINAL
DISORDERS (GI)
PREPARED BY
MISS SHIWANI SAH

2. Disease conditions
Medical Surgical Nursing
Digestive System
Peptic ulcer
Oesophagial varices
Hernias
Appendicities
Intestinal obstruction
Peritonitis
Tuberculosis of Abdomen
Ulcerative colitis
Hemorrhoids
Hepatitis
Cirrhosis of liver
Cholecystits
Child Health Nursing
Dysentry
Worm infestation
Imperforated anus
Undiscended Testis
Phimosis
Hemophilia
Hair-lip
Cleft palate
Common health hazards of children in Nepal and
their prevention

3. HERNIA

4. HERNIA
• A condition in which part of an organ is displaced and protrudes
through the wall of the cavity containing it (often involving the
intestine at a weak point in the abdominal wall)
• The most important elements in the development of a hernia are
congenital or muscle weakness and increased of the intra-abdominal
pressure.

5. Risk factor
Obesity
constipation
Heavy
weight
lifting
Congenital
defect
Chronic
cough
Damage
from
injury or
surgery
Muscle
weakness
Smoking
pregnancy
5

6. Causes/Etiology
Pressure on abdominal cavity :
a) Any condition that is increases b) Family History
 Combination of muscle weakness and strain
 Obesity
 Heavy Lifting
 Persistant coughing or sneezing
 Pregnancy
 Straining during bowel movement or urination
6

7. Pathophysiology
Congenital
Obesity
Pregnancy
Trauma
Defects in
muscular
walls
Increased
Intra-
abdominal
pressure
Hernia
7

8. 8

9. Classification

10. TYPE OF HERNIA
1.) Inguinal hernia
i.)Indirect inguinal hernia
ii.)Direct inguinal hernia(in contrast)
2.) Hiatal Hernia ( stomach bulges up into the chest through an opening in diaphragm)
3.)Femoral hernias(protrude through the femoral ring)
4.) Umbilical hernia(congenital/acquire)
5.) Incisional/ventral hernias(occur at he site of previous surgical incision)
1
0

14. Pathophysiology
Result of the deep inguinal ring failing to close during embryogenesis
after a testicle has moved through it.
Once bowel or other abdominal tissue moves into and enlarges the
empty space,
a visible bulge forms
hernia
Clinical features

16. Signandsymptoms
• Small to moderate size hernia don’t usually causes any symptoms.
• Large hernia may be noticeable and cause same
discomfort.
- Pain when lifting heavy object
- Tenderness
- Bulging
Severe symptoms
- Severe and sudden pain
- Nausea
- Vomiting
- Constipation
1
6

17. Clinical Features
■ Bulge in inguinal area extending towards / into
scrotum with crying / straining
■ may be present at birth or appear later
■ reduces in size when the child is relaxed / asleep
■ smooth soft-firm mass that emerges from the external ring lateral and
above pubic tubercle, enlarges with increased abdominal pressure

18. DIAGNOSIS
 Physical examination
 Barium swallow
•Barium is a non-toxic chemical, that shows up clearly on x-ray, will be fast for 6 hours
 MRI
 X-ray abdomen
•abdominal X-rays may be ordered to determine if a bowel
obstruction is present
 Blood test
 CBC
 WBC
• detect inflammation, infection and presence of tissue necrosis

19. Management

20. Management
■ Inguinal hernia does not resolve spontaneously
■ Must be operated because of high risk of incarceration
■ Operation :
Herniotomy - High suture ligation of the sac at the internal ring
■ Open technique / Laparoscopy

21. Technique
■ Anaesthesia:
Facial or laryngeal mask
■ Transverse groin skin crease incision
■ Open layers
■ Incision in external oblique aponeurosis
lateral to external ring

22. • Non-pharmacological management
1.) Avoid food that cause acid reflux or
heartburn such as spicy food
2.) Don’t lie down or bend over after a meal
3.) Exercise
4.) stop smoking
5.) Avoid gassy drinks
6.) Avoid lift heavy object
2
2

23. Non-Surgical Management
• Truss (Inguinal hernia)
- a pad made with firm material that will held in place
over the hernia with belt to help keep the abdominal
contents from protruding into the hernia sac
Surgical Management
Nissen fundoplication Laparoscopic (LEP)
Herniorrhaphy(hernia repairs)
2
3

24. Non-Surgical Management
• Truss (Inguinal hernia)
- a pad made with firm material that will held in place
over the hernia with belt to help keep the abdominal
contents from protruding into the hernia sac
Surgical Management
Nissen fundoplication Laparoscopic (LEP)
Herniorrhaphy(hernia repairs)
2
4

25. NURSINGDIAGNOSES
PRE-OPERATIVE FOR HERNIA REPAIR
1) Fear and anxiety related to undergoing surgery
POST-OPERATIVE FOR HERNIA REPAIR
2) Acute pain related to surgical intervention
3) Risk of infection related to surgical site
HIATAL HERNIA
Risk for aspiration related to reflux of gastric content
2
5

26. INTESTINAL OBSTRUCTION

27. Bowel obstruction occurs when the normal propulsion and passage
of intestinal contents does not occur.
Definition

28. Intestinalobstruction
• This obstruction can involve only the small intestine (small bowel
obstruction), the large intestine (large bowel obstruction), or via systemic
alterations, involving both the small and large intestine (generalized ileus).
• The "obstruction" can involve a mechanical obstruction or, in contrast,
may be related to ineffective motility without any physical obstruction,
so-called functional obstruction, "pseudo-obstruction," or paralytic ileus

29. ETIOLOGY
CAUSES FROM OUTSIDE THE WALL (Extraluminal)
CAUSES FROM THE WALL (Intramural)
CAUSES IN THE LUMEN (Intraluminal)

30. ETIOLOGY
• Adhesions
• Tumors
• Inflammatory
• Obstructed hernia
• Miscellaneous

31. CLASSIFICATION
 Dynamic/ Adynamic
 Small bowel obstruction [ high or low ]
 Large bowel obstruction
 Acute
 Chronic
 Acute on chronic
 Subacute
 Simple
 Strangulated
 Closed loop obstruction

32. ACUTE
OBSTRUCTION :
It usually occur in small bowel obstruction with sudden onset of
severe colicky central abdominal pain, distention and early
vomiting and constipation.

33. CHRONIC OBSTRUCTION :
Usually seen in large bowel obstruction with lower abdominal
colic and absolute constipation,followed by distention.

34. ACUTE ON CHRONIC
OBSTRUCTION :
It starts in large bowel but gradually involves the
small intestine.
Early symptoms are pain and constipation but when
small intestine is involved it is characterized by
vomiting and general dstention.

35. ON THE BASIS ,WHETHER THE OBSTRUCTION IS
SIMPLE MECHANICAL
STARANGULATED
CLOSED LOOP

36. INTUSSUCEPTI
ON

37. INTUSSECEPTION

38. Duodenal Artesia

39. Intestinal tumor

40. ADHESIVE BANDS AND
CONSTRICTION

41. CAUSES ACCORDING TO AGE
 BIRTH : Atresia, Meconium, Volvulus, Hirschsprung’s
 3 WEEKS : Pyloric stenosis
 6-9 MONTHS : Intussusception
 TEENAGE : Appendicitis , Meckel’s diverticulitis
YOUNG ADULT : Adhesions ,Hernia
 ADULT : Adhesions ,Hernia, Appendicitis, Crohn’s, carcinoma
 ELDERLY : Carcinoma, Diverticulitis, Sigmoid Volvulus , Feces

42. THE OBSTRUCTION COULD BE :
- Simple
- Closed loop
- Strangulated
PATHOPYSIOLOGY

43. PATHOPYSIOLOGY
SIMPLE OBSTRUCTION :
1 ABOVE THE OBSTRUCTION
OBSTRUCTION  Peristalsis increases  Intstine dilates  Reduction in
peristaltic strength  Flaccidity and paralysis (protective but late)
2 BELOW THE OBSTRUCTION
NORMAL PERISTALSIS & ABSORBTION  Until it
becomes empty  It contracts & becomes immobile

44. PATHOPHYSIOLOGY
Distention of the intestine is caused by
accomulation of:
1 GAS
2 FLUIDS
fluids
Distention
gas
fluids

45. Gas in the intestine is due to:
1. Swallowed air
2. Bacterial overgrowth
3. Diffusion from blood

46. Fluids come from :
1. Ingested fluids
2. Saliva
3. Gastric and intestinal juice
4. Bile & Pancreatic secretions

47. STARANGULATED OBSTRUCTION

48. STARANGULATED
OBSTRUCTION :
Strangulating obstruction is obstruction with
compromised blood flow; it occurs in nearly
25% of patients with small-bowel obstruction.
It is usually associated with hernia, volvulus,
and intussusceptions.
Strangulating obstruction can progress to
infarction and gangrene in as little as 6 h.

49. .
• Venous obstruction
occurs first, followed by arterial
occlusion, resulting in rapid
ischemia of the bowel wall.
• The ischemic bowel becomes
edematous and infarcts, leading
to gangrene and perforation.
• In large- bowel obstruction,
strangulation is rare (except with
volvulus)

50. CLOSED LOOP
OBSTRUCTION

51. CLOSED LOOP
OBSTRUCTION
Closed loop obstruction is a specific type of
obstruction in which two points along the
course of a bowel are obstructed at a single
location thus forming a closed loop.
Usually this is due to adhesions, a twist of
the mesentery or internal herniation.

52. • In the large bowel it is known as a
volvulus.
• In the small bowel it is simply known as
small bowel closed loop obstruction.
• Obstruction to the blood supply occur
either from the same mechanism which
caused obstruction or by the twist of
the bowel on mesentery.

53. VOLVULUS
 Abnormal twisting of a portion of the
gastrointestinal tract, usually the intestine,
which can impair blood flow.
 Volvulus can lead to gangrene and death of
the involved segment of the gastrointestinal
tract.

54. DIAGNOSIS
History
Clinical examination
Investigations

55. Examination findings
Intestinal
obstruction
Vomiting
Distention
constipation
Pain

56. CLINICAL FEATURE OF INTESTINAL
OBSTRUCTION
Clinical obstruction of intestinal obstruction
vary according to :
 The location of the obstruction;
 The age of the obstruction;
 The underlying pathology;
 The presence or the absence of the intestinal
obstruction;

57. PAIN
Pain is the first symptom encountered, it occurs suddenly and
is usually severe..
It is colicky in nature and usually centered on the umbilicus
(small bowel) or lower abdomen (large bowel).
The pain coincides with the increasing peristaltic activity

58. VOMITING
The more distal the obstruction
,the longer the interval between the onset of symptoms and the
appearance of nausea and vomiting .
More proximal the obstruction, more the frequency.
The interval ,frequency & nature of vomitus depends on the site
of obstruction

59. Pyloric obstruction
•Watery and acidic vomitus
Large bowel obstruction
• Uncommon and late symptoms.

60. Long standing low small bowel obstruction-
• feculent material.
• Strangulation- blood.

61. DISTENTION
In the small bowel, the degree of
distention is dependent on the site of
obstruction & is greater the more
distal the lesion.
Central abdomen is distended in low
small bowel obstruction.
Distention is much less in high small
bowel obstruction.

62. CONSTIPATION
• Failure to pass flatus or faeces through the
rectum is important symptom of bowel
obstruction.
• It may be classified as
1. ABSOLUTE
2. RELATIVE

63. VISIBLE PERISTALSIS
Visible peristalsis may be present if the
abdomen is examined carefully.
Borborygmi is quite loud ,does not require
stethoscope to hear it .

64. VISIBLE PERISTALSIS

65. BLOATING
• The accumulation of chyme and gas gives rise
to a feeling of fullness and causes bloating.
This may also give rise to high-pitched gurgling
sounds from the abdomen

66. FATIGUE
• Obstruction and the resulting digestive
inability hampers the absorption of vitamins
and other nutrients from food, leading to
weakness, headache and dizziness. Even
regular activities may make the individual feel
exhausted and drowsy

67. INFREQUENT URINATION
• Dehydration due to diarrhea and vomiting,
results in the loss of body fluids and
electrolytes. As a response to this, the body
tries to retain water through lowered urine
output.

68. OTHER
MANIFESTATION
• Dehydration
• Hypokalamia
• Pyrexia
• Abdominal tenderness
• Bowel sound

69. PHYSICAL
EXAMINATION
• Inspection
• Palpation
• Percussion
• Auscultation
• Rectal examination

70. INSPECTION
Shape of the abdomen
Movement of the abdomen wall
Umbilicus
Visible loop of bowel/visible peristalsis
Scar
Prominent veins
Pubic hair
Hernial orifices

71. INVESTIGATIONS
• BLOOD EXAMINATION
• CBC
• RADIOLOGICAL EXAMINATION

76. CT scan
CT scan examination is particularly
useful in:
• patient with a history of abdominal
malignancy
• in postsurgical patients
• patient who have no history of
abdominal surgery.
• present with symptoms of bowel
obstruction.

78. DANGEROUS SIGNS
(Red Flags)
Constant pain
Absent bowel sounds
Tenderness with rigidity
Leukocytosis
Fever and tachycardia
Shock

79. Three main measures-
 GI drainage
 Fluid &Electrolyte replacement
 Relief of obstruction, usually surgical

80. Treatment
Conservative:
 Nasogastric aspiration by Ryles tube
 IV fluids- volume varies depending on dehydration
 NPO
 urinary catheter
 check temp. and pulse 2 hourly
 abdominal examination 8 hourly
 Broad spectrum antibiotics initiated early- reduce bacterial
overgrowth.

81. ⋅ Some cases will settle by using this conservative regimen,
other need surgical intervention.
⋅ Surgery should be delayed till resuscitation is complete unless
signs of strangulation and evidence of closed-loop obstruction.
⋅ Delay should be monitored continuously for 72 hours in hope of
spontaneous resolution
e.g. adhesions with radiological findings but no pain or
tenderness

82. Indication for surgery:
- failure of conservative management
- tender, irreducible hernia
- strangulation
- virgin abdomen
• If the site of obstruction is unknown; laparotomy assessment
is directed to-
-The site of obstruction.
-The nature of obstruction.
-The viability of gut.
• The site of obstruction can be determined by caecum

83. Surgical treatment
• Operative decompression required-if dilatation of bowel loops
prevent exposure, bowel wall viability is compromised,or if
subsequent closure will be compromised.
• Savage’s decompressor used within seromuscular
purse-string suture.
• Or large-bore NG tube maybe used for milking intestinal contents
into stomach.

84. MANAGEMENT OF ACUTE CASE
 I.V Fluids and electrolytes rescusitation for all
 N.G tube if repeated vomiting
 Antibiotics for all
 Hernia  Operation
 Adhesions  Conservative first
 Obstruction  Remove
 Volvulus  Derotate and or Operate
 Mesenteric ischemia  Operate
 Abscess or Peritonitis  Drain and Treat
 Intussusception  Pneumatic or Barium Reduction or Operate

85. • Usually conservative treatment is curative.
(i.v. rehydration & nasogastric decompression)
• It should not be prolonged beyond 72 hrs.
Surgery
• Division of band.
• Minimal adhisiolysis.

86. OPERATIVE MANAGEMENT
•Reducing the terminal part of the intussusception :
•Reducing is achieved by squeezing the most distal part of the mass.

87. VOLVULUS
 Abnormal twisting of a portion of the
gastrointestinal tract, usually the intestine,
which can impair blood flow.
 Volvulus can lead to gangrene and death of
the involved segment of the gastrointestinal
tract.

88. CAECAL VOLVULUS

89. SIGMOID VOLVULUS

90. SIGMOID
VOLVULUS
• Symptoms resembles that large
bowel obstruction.
• Rotation always occurs in
anticlockwise direction.

91. • Flexible sigmoidoscopy/ rigid sigmoidoscopy
• Laparotomy- untwisting
Treatment

92. SIGMOID VOLVULUS
BEFORE UNTWISTING AFTER UNTWISTING

93. MCQ
1. A condition in which part of an organ is displaced and
protrudes through the wall of the cavity containing is called:
a) Hernia
b)Appendix
c)Constipation
d) Volvulus
Answer:A

94. MCQ
2. Dehydration caused by :
a) Reduced intake
b)Reduced absorption
c)Increased loss (Vomiting & sequesration)
d) All of them
Answer:D

95. MCQ
3. Hernias, occur at he site of previous surgical incision is:
a) Stomatitis
b) Incisional Hernia
c) Umbilical Hernia
d) All of them
Answer:B

96. MCQ
4. Usually seen in large bowel obstruction with lower
abdominal colic and absolute constipation, followed by :
a) Distention.
b)Reduced absorption
c)Increased loss (Vomiting & sequesration)
d) All of them
Answer:A

97. MCQ
5. Central abdomen is distended in
a) low small bowel obstruction.:
b) low large bowel obstruction.:
c) Umbilical Hernia
d) Intusseception
Answer: A

98. MCQ
6. Operative decompression required-
a)If dilatation of bowel loops
b) If ulcer found in lumen
c) Umbilical Hernia develops and increases
d) All of them
Answer:A

99. Cleft lip and Cleft palate
 CLEFT PALATE (cheiloschisis) is a condition in which the two palates of the skull that
form the hard palate are not completely joined. The soft palate in these cases are cleft as
well.
 CLEFT LIP (palatoschisis) is a physical split or separation of the two sides of the upper
lip and appears as a narrow opening or gap in the skin of the upper lip. This separation
often extends beyond the base of the nose and includes the bones of the upper jaw
and/or upper gum.

100. •Between the 6th and 12th weeks of fetal gestation,the left and right sides of the
face and facial skeleton fuse in the midddle. When they do fail to do so, the
result is a craniofacial cleft.
•Cleft palate without cleft lip occurs more in females (57%) than males (43%).
Cleft lip with or without cleft palate occurs twice as many males than females.
•Another theory is that facial clefts are caused by failure of the fusion process
and failure of inwards growth of the mesoderm.

101. As with a complete cleft lip deformity, the nose has some
distortion. The distortion is usually to a lesser degree. The nostril
may be widened, but the floor of the nostril is intact.
Incomplete cleft lips can take on a variety of appearances. There
may be just a small gap or cleft in the vermillion or it may slightly
extend into the skin above the lip or extend almost to the nostril.
A mild form of a cleft lip is a microform cleft. A microform cleft can
appear as small as a little dent in the red part of the lip or look like a
scar from the lip up to the nostril.

102. In a bilateral incomplete cleft lip deformity, the nose is
affected, although not to the same degree as with a
bilateral complete cleft lip deformity.
A bilateral complete cleft lip affects both the right and
left sides of the lip. There are no philtral columns, no
philtral dimple, and there is no orbicularis muscle in the
central segment. On both sides, the cleft extends from the
vermillion to the nostril.

105. GENETIC FACTORS – different regions of the human genome contains genes
controlling risk for cleft lip and palate:
ENVIRONMENTAL FACTORS
•Maternal smoking
•Maternal alcohol abuse
•Maternal diet and vitamin intake
•Medications take during pregnancy
•Exposure to viruses in chemicals of fetus
•Women with diabetes diagnosed before pregnancy

106. MAYAPPEAR AS:
•A split in the lip and roof of the mouth
and palate that can affect both sided of
the face
•A split in the lip that can appear as
only a small notch in the lip or can
extend from the lip through the upper
gum and palate into the bottom of the
nose
•A split in the roof of the that doesn’t
affect the appearance of the face.
 Difficulty in swallowing
 Nasal Speaking voice
 Recurring ear infections
 Change in Nose shape
 Poorly aligned teeth
OROFACIAL CLEFT:
• Failure to gain weight
• Feeding problems
• Flow of milk through nasal passage
during feeding
• Poor growth
• Speech difficulties

107. • Orofacial clefts can be detected during pregnancy by
ROUTINE ULTRASOUND.
• Usually, orofacial clefts are diagnosed when the baby is
born.
• Minor clefts might not be diagnosed until later in life.
• PHYSICAL EXAMINATION.

108. SURGERY
• To close the cleft lip, when the child is between 6wks- 9 months
old.
•Surgery may be needed later in life if has an effect on the nose
area.
•A cleft palate is usually closed within the first year of life so that
the child's speech develops normally.
•Sometimes a prosthetic device is temporarily used to close the
palate so the baby can feed and grow until surgery can be done.

109. •Children born with orofacial clefts also
might need different types of
treatments and services, such as special
DENTAL OR ORTHODONTIC CARE or
SPEECH THERAPY.

110. •First dental visit be scheduled at about one year of age or even earlier if there are
special dental problems.
•A cleft of the lip and/or palate in the front of the mouth can produce a variety of
dental problems. These may involve the number, size, shape, and position of both the
baby teeth and the permanent teeth.
•The teeth most commonly affected by the clefting process are those in the area of
the cleft, primarily the lateral incisors.

111. •In other cases there may be a “twinning” (twin = two) of
the lateral incisor so that one is present on each side of the
cleft.
•Finally, the teeth in the area of the cleft may be displaced,
resulting in their erupting into abnormal positions.

112. Oral Problems in Children with Cleft Lip & Palate
•Feeding Problems
•Missing teeth
•Supernumerary Teeth
•Dystrophic (hypoplastic) teeth
•Disturbances of tooth eruption
•Ectopic tooth eruption
•Dental caries and gingivitis

113. Ano-rectal malformations

114. DEFINITION
Anorectal malformations are developmental
deformities of the lower end of the
alimentary tract i.e. the anorectal canal.

115. CAUSE
■The exact cause not known.
■Congenital defects

116. Pathophysiology
Congenital defects
If the membrane separating the rectum from the anus is not absorbed, and if the union does not
take place, an anorectal anomaly results.
The membrane that separates the endodermal hindgut from the ectodermal anal dimple perforates
and a continuous canal is formed, the outlet of which is the anus.
It occurs due to the arrest in the embryonic development of the anus, lower rectum and
urogenital tract at the 8th week of embryonic life.

117. ANAL STENOSIS

118. 2) Ano-perineal fistula

119. 3) Ano-vestibular fistula in female.

120. IMPERFORATE ANUS

121. 2) Rectal atresia

122. CLINICAL MANIFESTATIONS
Absence of meconium
No anal opening
Unable to insert a gloved finger or a rectal thermometer into the
rectum
Abdominal distention
History of difficult defecation, abdominal distention and ribbon like
stools in an older child in case of anal stenosis.
Greenish bulging membrane behind anus in case of imperforate
anal membrane
Intestinal obstruction if no fistulas
Passage of meconium through vagina, perineal orifice
or with urine in case of fistula

123. DIAGNOSTIC TESTS
■ Physical examination by passing the gloved little finger through the anus and
by observing the passage through which meconium was passed.
■ Ultrasounds scan to locate the rectal pouch.
■ X-ray with inverted infant called as invertogram or Wangensteen-Rice X-ray
when the infant is 24 hrs of age.
■ Urine examination for presence of meconium and epithelial debris.
■ Micturating cystourethrogram (MCU) to detect urinary abnormalities.
■ Intravenous pyelogram to rule out vesicourethral reflux.

124. MANAGEMENT
■ The reconstructive surgery is done to correct or repair the congenital malformations. It
depends upon the type of anomaly and sex of the infant.
■ Colostomy closure is done after 10 to 12 weeks of successful definitive surgery.
■ In case of imperforate anal membrane, the membrane is perforated with a blunt instrument.
Repeated dilatation might be necessary to prevent scar formation.
■ In case of anal stenosis, dilatation is done every 4-6 months.
■ In case of fistulas, the colon can be brought down through the anal dimple by an abdominoperineal
procedure. The anus is positioned in the area of external sphincter and the fistula is removed.

125. PREOPERATIVE CARE:
– Gastric suction may be done
– Withhold oral feedings
– Start parenteral hydration
– Measurement of abdominal girth
– Intake output chart
– Consent from parents
– Pre-medications

126. POST OPERATIVE CARE
■ Perineal care
■ Change perineal dressings whenever soiled
■ Apply protective ointments such as zinc oxides to
decrease skin irritation.
■ Position baby in a side-lying or a supine position
with the legs suspended at a 90° angle to the trunk to
prevent pressure on perineal sutures

127. POST OPERATIVE CARE contd…
■ Intravenous feedings till the wound heals or until
peristalsis appear.
■ Prevention of constipation by exclusive
breastfeeding and proper weaning with stool
softeners or fibers.
■ Bowel habit training

128. POST OPERATIVE CARE
■ Daily enemas until control are achieved if
necessary.
■ Do not use diaper in case of anoplasty
■ Colostomy care by changing the collection device and
meticulous skin care.
■ Family support, discharge planning and home care

129. COMPLICATIONS
■ Urinary tract infection
■ Intestinal obstruction
■ Fecal impaction
■ Colostomy related problems
■ Recurrence of fistula
■ Anal stenosis
■ Poor bowel control
■ Constipation

130. NURSING CARE
Preoperative : Impaired bowel elimination related to bowel malformation as evidenced
by lack of patency or passage of stool through a different opening.
Goal: The child will pass meconium and will not have abdominal distention Interventions:
■ If there is a fistula, keep the perineum clean until surgery.
■ Follow pre-operative orders.
■ Do gastric decompression with NG tube.
■ Start IV line.
■ Follow strict nil per oral.

131. Nursing care contd…
2) Fluid volume deficit related to nil per oral
Goal: The child will maintain normal fluid balance
Interventions:
– Maintain intake output chart
– Administer IV fluids as ordered.
– Do gastric decompression.

132. Nursing care contd…
■ Postoperative:
1) Pain related to surgery
Goal: The child will have less pain Interventions:
■ Keep the sutured site clean.
■ Do not spread the legs or place in prone position to avoid strain on the sutures.
■ Keep the legs suspended at 90°angle to the trunk.
■ Prevent constipation by restarting breastfeeding when peristalsis appears.

133. Nursing care contd…
2)Impaired skin integrity related to surgery
Goal: The wound heals faster.
Interventions:
■
Keep the sutured site clean.
Do not spread the legs or place in prone position to avoid strain on the
sutures.
Keep the legs suspended at 90°angle to the trunk.
Prevent constipation by restarting breastfeeding when peristalsis appears.
Apply zinc oxide ointment to prevent skin irritation.
Change dressing often.
Do not use diaper.
A heat lamp may be used to facilitate healing.