The document discusses several gastrointestinal disorders in children including cleft lip/palate, ankyloglossia (tongue tie), tracheo-esophageal fistula, pyloric stenosis, diarrhea, liver abscess, intestinal obstruction, biliary atresia, and amoebiasis. It describes the causes, signs and symptoms, diagnosis, treatment, and nursing care considerations for each condition.

1. Prepared By:
Ibne Amin
GIT DISORDERS IN
CHILDERN

2. Objective
At the end of this presentation the students will
be able to:
• Discuss about ingestion problems and structural
defects.
• Describe pyloric stenosis , biliary atresia , liver
abscess , amoebiasis and necrotizing enterocolitis.
• Enlist causes, signs and symptoms of the above
disorders
• Discuss nursing care approach for the patient with
above conditions.

4. Cleft lip
 It is due to the failure of fusion of the maxillary and
medial nasal processes .
 Cleft lip is formed in the top of the lip as either a
small gap or an indentation in the lip (partial or
incomplete cleft) or it continues into the nose
(complete cleft).
 Cleft lip can be unilateral or bilateral

6. Cleft palate
 It is a condition in which the two plates of the
skull that form the hard palate (roof of the
mouth) are not completely joined.
 Children with these structural disorders may have
associated dental malformations, speech
problems, and frequent otitis media.

7. Cleft lip and palate
 Most common craniofacial anomaly.
 Males to female ratio is 3 : 1.
 Higher in Asians.
 Familial history.
 Often diagnosed during pregnancy by ultrasound.

8. Cleft lip/palate repair
 Labioplasty is used to close the separation and
rebuild the cleft lip/palate.
 The surgeon makes incisions on both sides of the
cleft and repositions the tissue and muscles. The
repair is then stitched closed.

9. Nursing diagnosis
 Risk for Aspiration (Breast Milk, Formula, or
Mucus) related to anatomic defect.
 Altered Nutrition less than body requirements
related to the infant’s inability to ingest nutrients,
 Risk for Infection related to location of surgical
procedure.
 Knowledge Deficit (Parent) related to lack of
exposure and unfamiliarity with resources.

10. Nursing intervention
 Assess fluid and calorie intake daily.
 Assess weight daily (same scale, same time, with
infant completely undressed.
 Observe for any respiratory Impairment.
 Keep the infant well medicated for pain in initial
postoperative period.
 Have parents hold and comfort the infant.

11. Ankyloglossia
 Ankyloglossia or tongue tie, is a congenital oral
anomaly which may decrease mobility of the
tongue tip and is caused by an unusually short,
thick lingual frenulum, a membrane connecting
the underside of the tongue to the floor of the
mouth.

13. Clinical manifestation
 Abnormally short frenulum.
 Difficulty lifting the tongue to the upper dental
alveolus.
 Inability to protrude the tongue more than 1 to 2
mm past the lower central incisors.
 Impaired side-to-side movement of the tongue.
 Notched or heart shape of the tongue when it is
protruded.

14. Management of ankyloglossia
 Ankyloglossia (tongue tie) is repaired by surgery
in the form of frenectomy.
 This may be done by laser.

15. Tracheo-esophageal fistula
 Tracheo-esophageal fistula or TEF, is an abnormal
connection between the trachea and the
oesophagus.
 Normally, the trachea and oesophagus are not
connected. In TEF, air can pass from the trachea
into the stomach or food can pass from the
oesophagus into the lungs.
 This may lead to breathing or swallowing
problems, which can be serious or life-threatening.

17. Clinical manifestation
 Excessive drooling / frothy mucus.
 Inability to pass NG tube.
 Choking and cyanosis with feeding.
 High risk for aspiration of HCl from stomach
causing a chemical pneumonia.

18. Pre-surgery care
 NPO (nothing per oral).
 Head of bed is elevated.
 Continuous suction.
 G-tube to decompress stomach.

19. Surgical management
 Surgery is needed to close or remove the part with
the fistula.
 The oesophagus is reconnected to make it a
continuous tube that is separate from the trachea
 In some cases, a piece of tissue from the large
intestine is used to join the parts.

20. Post operative care
 Respiratory support
 Gastric decompression
 Gentle suctioning
 Antibiotics

21. Pyloric stenosis
 Pyloric stenosis is a condition caused by an
enlarged pylorus.
 The pylorus is a muscle that opens and closes to
allow food to pass through the stomach into the
intestine.
 When this muscle becomes enlarged, feedings are
blocked from emptying out of the stomach. The
retained feedings cause the infant to vomit

22. Cont…
Most common cause of gastric outlet obstruction in
infants.
 1 in 500
 More common in males
 3 weeks to 2 months of age
 Vomiting becomes projectile

24. Clinical manifestation
 Projectile vomiting
 Visible peristaltic waves
 Olive shape mass in the upper abdomen to right of
the midline.
 Electrolyte imbalance

25. Management Pre-surgery
 NPO
 IV therapy / Correct electrolyte imbalance
 Provide Comfort to infant

26. Surgical management
 Pyloric stenosis does not get better by itself and
must be corrected with an operation.
 The operation is called a "pyloromyotomy" where
the surgeon cuts through the muscle fibers of
enlarged pyloric muscle in order to widen the
opening into the intestine.

27. Diarrhea
 Definition: Increase in the stool weight to greater
then 250g per day accompanied by increased
frequency and liquidity of stool is called diarrhea.
OR
 It is irregular passage of watery stool from the
body.

28. Individual with Diarrhea.

29. Types of diarrhea.
 Two types
1) Acute diarrhea &
2) Chronic diarrhea.

30. Acute diarrhea.
 Diarrhea lasting less then two weeks is called acute
diarrhea. It has two subtypes.
1) Inflammatory or bloody diarrhea.
2) Non inflammatory diarrhea.

31. Inflammatory diarrhea.
 Inflammatory or bloody diarrhea suggests
involvement of large intestine by invasive bacteria
or parasites or toxins.
 Clinically patient experience lot of difficulties and
problems regarding frequent bloody small
volumes stools ,fever, abdominal cramps and fecal
urgency.

32. Non inflammatory diarrhea
 Non inflammatory diarrhea is generally a milder
disease and is caused by viruses, or toxins that
affect the small intestine and interfere salt and
water balance, resulting in large volume watery
diarrhea, often with nausea, vomiting and cramps.

33. Chronic diarrhea
 Diarrhea continuing for weeks or months either
persistent or intermittent is called chronic
diarrhea.

34. Types of chronic diarrhoea
 There are two types:
 Osmotic diarrhea
 Secretory diarrhea
 Osmotic diarrhea: Diarrhea that stops when
feeding is discontinued is osmotic diarrhea.
 Secretory diarrhea: Diarrhea that persists even, if
the patient is fasted, is secretory diarrhea.

35.  Viruses: Rota virus, measles virus etc.
 Bacteria: E.coli, Shigella, Salmonella, cholera vibrio
etc.
 Parasites: E.histolytica, etc.
 Fungi: Candida albicans
 Food poisoning
 Drugs
- NSAIDs
- Antibiotics
Causes of Acute Diarrhea

36. Causes of chronic diarrhea
 Ulcerative colitis.
 Chron's diseases.
 Malignancy
 Thyrotoxicosis
 Tuberculosis enteritis
 Mal absorption of bile salt

37. Investigation
 Stool analysis;
 Blood
 Ova parasite and clostridium toxins
 Stool culture in bloody diarrhea.
 Serum electrolytes
 Sigmoidoscopy
 Blood tests

38. Management
 Treatment of the cause
 Anti diarrheal drug
 Soft food
 Rehydration

39. Nursing management
 Replace fluid and electrolyte losses
 Provide good perianal care.
 Promote rest. To reduce peristalsis.
 Diet
 Small amounts of bland foods
 Low fiber diet
 BRAT Diet (banna, rice, apple, toast)
 Avoid excessively hot or cold fluids. These are
stimulants.
 Potassium-rich foods and fluid (e.g. banana,
Gatorade)


40. Apply Your Knowledge
What are the types of acute diarrhea?
ANSWER: There are two types :
1. Inflammatory
2. Non inflammatory

41. Liver abscess
 Liver abscess is a pus-filled cavity in the liver.
Now what is pus???
So it is yellowish or greenish colour fluid containing
dead WBCs ,living and dead bacteria as well as
fragments of dead tissues.
 It is caused by bacteria, entamoeba histolytica and
fungi especially candida species.

42. Types of liver abscess
 The 3 major forms of liver abscess, classified by
etiology, are as follows:
 Pyogenic abscess (80 %).
 Amebic abscess (10%).
 Fungal abscess (10%).

44. Etiology
 Abdominal infection such
as appendicitis, diverticulitis.
 Infection of the bile duct.
 Recent endoscopy of the bile duct.
 Trauma that damages the liver.
 Cholangitis
 Generalized sepsis.

45. Clinical manefestation
 Chest pain (lower right)
 Clay-colored stools
 Fever, chills
 Loss of appetite
 Nausea, vomiting
 Pain in right upper abdomen
 Unintentional weight loss
 Weakness

46. Exams and test
 Abdominal CT scan
 Abdominal ultrasound
 Bilirubin blood test
 Blood culture for bacteria
 Complete blood count (CBC)
 Liver biopsy
 Liver function tests

47. Treatment
 USG or CT guided aspiration or drainage of
abscess.
 Antibiotic therapy is given especially in a case with
multiple liver abscesses.
 Metronidazole(35-50mg/kg in 3 divided doses for
10 days) in a case of amebic abscess.
 Surgical treatment: if abscess ruptures outside the
liver.

48. Nursing Diagnosis
 Impaired Liver Function related to cysts in the
liver
 Acute pain related to disease process.
 Imbalanced nutrition: Less than body
requirements related to loss of appetite.
 Risk for impaired skin integrity related to
surgical drainage of the cyst.
 Risk for infection related to surgical incision.

49. Nursing intervention
 Asses and checked signs and complaint of pain
 Administered pain killer, analgesic as order
 Administered antipyretic : panadol as ordered
 Administered IVF as order
 Assist patient and encourage him to take food
 Observed and monitor output and condition of
liver abscess drainage
 Administered antibiotic as order

50. Apply Your Knowledge
What are the types of liver abscess
ANSWER: There are three types of liver abscess
1. Pyogenic abscess(80%)
2. Amoebic abscess(10%):
3. Fungal abscess(10%)

51. Intestinal obstruction
 Intestinal obstruction is a partial or complete
blockage of the intestines that prevents the
contents of the intestine from passing through.
 It can occur at any level distal to the duodenum of
the small intestine and is a medical emergency.

53. Pathophysiology
 Obstruction gives rise to increased intra luminal
pressure.
 Accumulation of gas and fluid occurs in the
obstructed segment.
 There is impairment of blood supply. Bacterial
invasion occurs.
 Peritonitis may occur.
 Ventilation becomes restricted due to elevation of
diaphragm and distention of abdomen.

54. Etiology
 Chemical, electrolyte, or mineral imbalances (such
as decreased potassium levels)
 Complications of abdominal surgery
 Decreased blood supply to the intestines
 Infections inside the abdomen, such as
appendicitis
 Hernias
 Tumors blocking the intestines
 Volvulus (twisted).

55. Sign and symptom
 Abdominal swelling (distention)
 Abdominal fullness
 Abdominal pain and cramping.
 Constipation
 Inability to pass gas
 Vomiting

56. Diagnosis
 Physical exam: During a physical exam, the
health care provider may find bloating,
tenderness, or hernias in the abdomen.
 Tests that show obstruction include:
 Abdominal CT scan
 Abdominal x-ray
 Barium enema

57. Treatment
 Treatment involves placing a tube through the
nose into the stomach or intestine to help relieve
abdominal distention and vomiting.
 Surgery may be needed to relieve the obstruction if
the tube does not relieve the symptoms, or if there
are signs of tissue death.
 Placing an intravenous (IV) line into a vein in arm
so that fluids can be given.

58. Nursing diagnosis
 Acute pain related to abdominal distention.
 Imbalanced nutrition less than body
requirements related to decreased nutrient intake.
 Constipation related to intestinal obstruction.
 Ineffective tissue perfusion (gastrointestinal)
related to obstruction.
 Risk for deficient fluid volume related to
intestinal obstruction.

59. Nursing intervention
 Administer analgesics to relieve pain.
 Administer laxatives to prevent constipation.
 Advice the patient to take soft food and fluid to
reduce the volume of stool.
 Avoid the patient from eating hard and spicy food.
 Teach the patient the dosages, routes, and side
effects for all medications.

60. Biliary atresia
 Biliary atresia is a blockage in the tubes (ducts)
that carry a liquid called bile from the liver to the
gallbladder.

61. Cont.…
 Biliary atresia occurs when the bile ducts inside or
outside the liver do not develop normally. It is not
known why the biliary system fails to develop
normally.
 The bile ducts help remove waste from the liver
and carry salts that help the small intestine break
down (digest) fat.
 In babies with biliary atresia, bile flow from the
liver to the gallbladder is blocked. This can lead to
liver damage and cirrhosis of the liver.

64. Types
• Fetal-embryonic form appears in the first 2
weeks of life and 10-20% of affected neonates
have associated congenital defects.
• The postnatal form of biliary atresia is typically
found in neonates and infants aged 2-8 weeks.
Progressive inflammation and obliteration of the
extra hepatic bile ducts occur after birth. This
form is not associated with congenital anomalies,
and infants may have a short jaundice-free
interval.

65. Sign and symptom
 Develops jaundice at two or three weak
 Dark urine
 Alcoholic stools (clay-colored stools) -- because no
bile or bilirubin coloring is being emptied into the
intestine.
 Abdomen may become swollen from a firm,
enlarged liver.
 Weight loss and irritability.

66. Diagnosis
 Abdominal x-ray
 Abdominal ultrasound
 Blood tests to check total and direct bilirubin
levels
 Liver biopsy to determine the severity of cirrhosis
or to rule out other causes of jaundice
 X-ray of the bile ducts (cholangiogram)

67. Treatment
 An operation called the Kasai procedure is done to
connect the liver to the small intestine, going
around the abnormal ducts.
 It is most successful if done before the baby is 8
weeks old.
 However, a liver transplant may still be needed.

68. Nursing management
 Fluid which are given in ordered to maintain the
correct sugar, salt and water level in body.
 Pain relieving drug are often through drip or
suppositories.
 Antibiotic will be given immediately after
operation and for at least 48 hours.
 Additional vitamins are necessary because poor
bile flow can reduce absorption of vitamins.

69. Amoebiasis
 Amoebiasis refers to infection caused by
the amoeba Entamoeba histolytica.
 About 10 percent of the world's population is
infected with E.Histolytica.
 About 90 percent of infections are asymptomatic
and the remaining 10 percent produces a
spectrum varying from dysentery to amoebic liver
abscess.

70. Etiology
 It is caused by a protozoa, Entamoeba Histolytica.
 It is commonly spread by water contaminated by
faeces or from food served by contaminated hands.
 Even vegetables grown in soil contaminated by
faeces can transmit the disease.

71. Sign and symptom
 Abdominal discomfort
 Diarrhea that may include blood or mucus .
 Other symptoms may also occur, such as:
 Nausea
 Weight loss
 Fever
 Chills

72. Diagnosis
 Stool examination is the commonest examination
done for diagnosis.
 Serology is positive in more than 90 percent
patients with invasive amoebiasis.
 Ultrasound, CT and MRI scans of the abdomen
can be useful in diagnosing amoebiasis.

73. Treatment
 Antibiotic drugs to kill the parasites, the
commonly used antibiotics are:
1. Metronidazole.
2. Tinidazole
 Bed rest and drinking a solution (containing salt
and glucose) to replace losses from the diarrhea
and for rehydration may also be necessary.
 If dehydration is severe, intravenous fluids may
be required.

74. Nursing management
 Administer medications properly
 Boil water for drinking or use purified water;
 Cover leftover food;
 Wash hands after defecation or before eating; and
 Proper collection of stool specimen.
 Instruct patient to avoid mixing urine with stools.
 Mouth care
 Provide optimum comfort.

75. References
 Pediatrics nursing 7th Edition(Barbara F Weller
Sheila Barlow).
 Fry RD, Mahmoud N, Maroon DJ, Belier JIS.
Colon and rectum.
 Wikipedia the free encyclopedia