Seminar presentation in diagnostic test related to congenital disorders of GI

1. BSC(H) NURSING

2. INTRODUCTION
Genitourinary is a word that refers to the urinary and
genital organs .
Urology is the branch of medicine concerned with the
urinary tract in both genders and genital tract of the
reproductive system in males.
Nephrology is the the branch of medicine concerned
with the kidney.

3. DEFINITION
Congenital urologic anomalies are birth defects
involving the urological and genital systems.

4. INCIDENCE
 Congenital disorder of genitourinary system occurs 1 out of 500
newborns and constitute approx 20-30%of all anomalies identified in
the prenatal period.
 Account for 1/3rd of all anomalies detected by routine fetal
ultrasonography.
 15%of congenital urogenital anomalies are secondary form
underlying chromosomal disorders.
 In children 20% of chronic renal failure is due to renal dysplasia
orthypoplasia.
 In adult 10% of chronic renal failure is due to adult polycystic kidney
disease.

5. ETIOLOGY
Congenital disorders may
be included by :
1.Genetic factor
2.Environmental factor
3.Unknown etiology

6. 1. GENETIC FACTORS
Gene play an important role in many congenital
disorders.
*CHROMOSOMAL ABNORMALITIES:
-late maternal age the time of pregnancy leads to
chromosomal dysfunction.
-Virus like German muscles
-Some chemical agents as anti -mitotic drugs.

7. SINGLE GENE DISORDER
-AUTOSOMAL INHERITANCE :
 DOMINANT TRAITS : one affected parents
 RECESSIVE TRAITS: both parents
-LINKED OR SEX LINKED INHERITANCE :
 DOMINANT TRAITS: daughter affected
 RECESSIVE TRAITS: son affected
POLYGENIC OR MULTIFACTIONAL INHERITANCE
Polygenic refers to the sum total of many genes, whereas multifactorial
also includes the interaction of environmental and genetic
determinants.

8. 2. ENVIRONMENTAL FACTORS
1.INTRA UTERINE INFECTION -STORCH
-Syphilis ,Rubella, Taxoplasmoids
2.X-RAY EXPOSURE TO PREGNANCY:
-Exposure to a large dose of x ray can
lead to microcephaly spinal bifida or
cleft palate.

9. 3. MATERNAL DISEASE :
-Diabetes mellitus , endocrine abnormalities
,iodine deficiency, malnutrition
4.MATERNAL ADDICTION:
-Use of alcohol , smoking , tobacco
3.UNKNOWN ETIOLOGY
Although approx 50% of all congenital disorder
cannot be linked to specific cause.

10. CONGENITAL aNOMALIES
oF
URINARY
TRACT

11. CLASSIFICATION
Congenital anomalies of urinary tract can be broadly classify as follow:
1. DEVELOPMENTAL ANOMALIES:
 RENAL AGENESIS
 SMALL KIDNEY
 ECTOPIA AND FUSION ANOMALIES
 EXSTROPHY BLADDER
 ABDOMINAL MUSCLE DEFICIENCY SYNDROME

12. CONT.
2. CYSTIC ANOMALIES :
 POLYCYSTIC KIDNEY
 MULTICYSTIC DYSPLASTIC KIDNEY
 RENAL CYST
 MULTILOCULAR CYSTIC NEPHROMA
3.OBSTRUCTIVE ANOMALIES:
 PELVIURETHRAL JUNCTION OBSTRUCTION
 POSTERIOR URETHRAL VALVE

14. 1.RENAL AGENESIS
 Presence of normal urethral bud is necessary for renal development ,
therefore an abnormality of urethral
bud during development is responsible for renal
agenesis.
SIGN AND SYMPTOMS :
 Absence of kidney and or urine in baby.
 Excess and dehydrated skin
 Deformities of hands & feet
 In female, absence of uterus and upper vagina .
 In male ,absence of seminal vesicles & spermatic duct

15. MANAGEMENT:
 Keep balance of Na,K and other electrolytes
in the blood.
 Assess the patient peripheral edema in every
shift
 Measure the wt of pt. Daily.
 Nurse should educate the pt about foods and
diet plan.

16. 2.SMALL KIDNEY
Kidney may be small either due to dysplasia or can be small in size
without any alternation in renal parenchyma and normal function.
SIGN & SYMPTOMS:
 Pain while passing urine
 Pain in abdomen
 Blood in urine
 Feeling tired
 Loss of appetite
 Itchy skin
 Muscle cramps

17. MANAGEMENT:
 A surgery Nephrectomy is surgery to remove a kidney.
POST OP:
-provide and ensure understanding of discharge instruction’
-monitor for bleeding from the insertion site or biopsy site .
-enforce bed rest for pt until stable.

18. 3.ECTOPIA AND FUSION ANOMALIES :
Renal ectopy and fusion are common congenital anomalies of the
kidney and the urinary tract and result from normal embryology
migration of the kidney.
TYPES:
SIMPLE RENAL ECTOPIA
CROSSED RENAL ECTOPIA
HORSE SHOE KIDNEY

19. SIGN AND SYMPTOMS :
1. RENAL ECTOPIA:
 UTI
 Belly pain
 Kidney stone
 Hypertension
2.HORSE SHOE KIDNEY
 Hank pain
 Blood in urine
 Nausea
 Vomiting

20. Management
1. Blood pressure should be carefully monitored
and elevation treated.
2. Protecting the kidney function
3. Treatment of sepsis
4. Temporary relieve of pressure

21. 4. BLADDER EXSTROPHY
>It is rare birth defect in which the bladder develops
outside the foetus.
SIGN AND SYMPTOMS :
 The uretheral not forming
completely
 Abnormal genitalia development
 Belly button displacement or umbilical hernia

22. MANAGEMENT
1.Complete primary repair of bladder exstrophy .Complete repair surgery
is performed in a single procedure that closes the bladder and abdomen
and repairs the urethra and outer sex organs.
2.Urinary diversion.
3.Protection from bladder infections.
3. Avoid irritating clothes over exposed bladder.

23. 5. ABDOMIANL WALL MUSCLE
DEFICIENCY SYNDROME
 PRUNE BELLY SYNDROME
 It is rare genetic disorder in which there is a complete or partial
absence of abdominal muscles causing the belly to appear wrinkled
or prune like.
 SIGN AND SYMPTOMS
 Large abdomen with loops of intestine
 Urinary system problems
 stomach and intestinal problem
 Testicles that fails to descend into the scrotum.

24. MANAGEMENT
 BP should be carefully monitored and elevation
treated.
 Pain should be assessed continuously and
should be acted upon.
 GI function should be monitored to assess
response to interventions.

26. 1.POLYCYSTIC KIDNEY
>It is an inherited disorder in which cluster of cysts develop
within kidneys causing them to enlarge and lose function
overtime.
SIGN AND SYMPTOMS
>High BP
>back at side pain
>blood in urine
>headache
>kidney stone

27. MANAGEMENT
 KIDNEY TRANSPLANTATION is the best
treatment for ADPKD pt’s with kidney failure.
 Nurses should control BP and abnormalities
related to renal failure of patient.
 Nurses should treat hematuria by analgesics plus
copius oral hydration.

28. 2.RENAL CYSTS
 Simple renal cysts are rare in children .It is a benign
lesion situated in cortex and lined by simple epithelium
.Renal cysts may be simple or multiple.
 SIGN& SYMPTOMS
 Fever
 Pain or tenderness
between ribs and pelvis
 UpperPain abdominal pain
 Hematuria

29. MANAGEMENT
 Monitor fluid and electrolytes balance
 Promote pulmonary function
 Provide safety measures
 Prevent the infection

30. OBSTRUCTIVE
ANOMALIES

31. PELVIURETRIC JUNCTION OBSTRUCTION
 It is when a part of the kidney is blocked at renal pelvis . The
blockage slows or stops the flow of urine out of the kidney. Urine
Can then build up and
 damage kidney.
 SIGN & SYMPTOMS
 Abdominal mass
 UTI
 Flank pain
 Kidney stones
 vomiting

32. MANAGEMENT
 PYELOPLASTY surgery is done to treat this
anomalies.
 POST –OP
 Close monitoring of child condition.
 Special attention to UTI
 Avoid irritating clothing
 Check for any palpable abdominal mass

34. 1.Cryptochidism
 It is the most common birth defect
of the genitourinary tract in male babies .
Normally ,the testicle develop in the
abdomen in the male fetus and descend to the scrotum before
birth,but in this it does not happen.
 SIGN & SYMPTOMS
 Not feeling or seeing a testicle where you would expect it to be in
scrotum
 Scrotum is empty on the affected side.

35. MANAGEMENT
 Determine the child’s expectation regarding illness and
hospitalization through discussion &plan therapy
 Monitor daily intake & output
 Encourage adequate fluids & monitor daily weight .
 Continue ressaurance about appearance of genitilia
 Administer fluid as ordered , monitor vital signs for
hypotension or tachycardia.

36. 2.URETERO CELEO URETERAL
DUPLICATION
 When a child has a ureterocele the portion of the ureterocele , the ureter closest to the
bladder becomes enlarged because the ureter opening is very tiny and obstruct urine flow
. As the urine flow is obstructed , urine backs up in the ureter tube .
 SIGN & SYMPTOMS
 Side , back or abdominal pain
 UTI
 Fever
 Painful urination
 Foul – smelling urine
 Excessive urination

37. MANAGEMENT
 Asses the patient’s pattern of elimination
 Palpate the client bladder every 4 hours
 Encourage the client to void every 2- 3 hrs

38. 3.HYPOSPADIAS
 It is congenital condition in males
in which the opening of urethra is on
underside of penis
 SIGN & SYMPTOMS
 Downward curve of penis
 Opening of urethra at a location other than tip of penis .
 Abnormal spraying during urination
 Fertility problems

39. MANAGEMENT
 Assist in the identification of defects in complete
newborn exam
 Prevent potential complication
 Promote parenteral understanding & attachment
 Promote normal voiding pattern

41. 1.BIOPSY : .This Technique is usually done as skin
biopsy through needle insertion into lower lobe
of kidney.
CYSTOSCOPY: It is indispensable for
assessing and treating prostate &urologic
problems. It is used to determine the
cause of urinary manifestation such as
those related to prostatic hypermtropy &
to obtain specimens

42. 3. CYSTOGRAPY : Bladder cystography ,also called
voiding cystourethrogram {VCUG} or micturating
cystourethrogram {MCUG } helps doctor’s diagnose
urethra abnormalities or urinary dysfunction ,UTI’s.
4.LAPROSCOPY: used to identify and diagnose the
source or abdominal pain &
to diagnose endometriosis ,
ovarian cysts , fibroids .
Eg: cryptochidism

43. 5.PELVIC ULTRASOUND : It is used the bladder
prostate gland ,seminal vesicles , and for
diagnosis of bladder, tumor , stones.
6.PELVIC MAGNETIC RESOSNACE IMAGING : In
In female –to find problems such as tumours in
ovaries ,rectum , uterus .
In male – to check man prostate & seminal
vesicles & to examine wheather it has spread.

45. Research findings

46. SUMMARY
Today we all have discussed together on the topic
congenital disorders. Here we all get to know what is meant
by congenital disorders ,its etiology , epidemiology, types
,clinical manifestation and diagnostic test related to them,
the management of genitourinary system disorders.

47. BIBLIOGRAPHY
 BRUNNERS AND SIDDHARTH “TEXTBOOK OF MED –
SURG NURSING ”
 LEWIS MEDICAL SURGICAL NURSING “ CHINTAMANI”
 WWW. MAYOCLINIC .ORG