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1. Assessment of child with GIT Disorders

2. Content :
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Congenital anomalies of mouth
cleft lip and cleft palate
Congenital anomalies of esophagus
Esophageal atresia
tracheo- esophageal fistula
Congenital anomalies of stomach
pyloric stenosis
Congenital anomalies intestine
Hernia
Intussusception
Hirschprung’s disease
Anorectal malformations

3. INTRODUCTION
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The GIT includes of the structures from mouth to anus
Neonate are born with GIT that are not fully mature until age of
2years.
Oral behavioral of children
Oral behavioral of children increase risk of acquiring infection
New born have a small capacity, so they tolerate small frequent
feeding. HCL that aids in digestive reach pick level at 6 months.
Pancreatic enzymes reaching adult level at 2 years of age

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The GIT supports bacterial growth and has a role in antibody
formation
Intestinal bacteria synthesize Vit. K required for production of
clotting factors

5. Diarrohea

6. What is Diarrhoea
• Diarrhoea is defined by the World Health Organization (WHO) as
passage of three or more loose or liquid stools per day or more
frequent passage than is normal for the individual. Based on the
duration of the presentation, it can be acute or chronic. When
symptoms last for more than 2–4 weeks, the diarrhoea is
termed as persistent or chronic

9. Red Flags

10. Poisoning
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Poisoning is the condition or physical state produced when a substances ,
in relatively small amount is applied to body surfaces , ingested , injected ,
inhaled or absorbed and subsequently causes structural damage or
disturbances .
The most common route of poisoning is by ingestion .
It can be caused by :
Soaps
Cleaners
Kerson
Some Drugs

11. Management :
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Try and identify the poison if possible
Induce vomiting if poison swallowed .
Do not Induce vomiting if the child has impaired consciousness ,
or if the child drink kerosene .
Gastric lavage(gastric wash) with 15ml/kg of 0.9 % normal
saline.
If the vomit falls on the skin, wash it thoroughly

12. Cleft lip
• Is a congenital fissure in the upper lip, it is generally located at
one side or the other of the midline in the center of the nares. It
may be unilateral or bilateral.

13. Cleft palate
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The roof of the mouth (palate) is formed between the sixth and ninth
weeks of pregnancy. A cleft palate happens if the tissue that makes up the
roof of the mouth does not join together completely during pregnancy.
Cleft palate may occur in connection with cleft lip.

14. Etiology
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Maternal drug exposure
unknown, or genetic.
Both may occur sporadically.
Problems associated :
Feeding difficulties:
Respiratory infection(aspiration pneumonia ).
Recurrent serous otitis media.
Dental problem:
The voice/speech problems

15. Treatment
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Feeding by using a soft and long teat with an
enlarged hole
The usual practice is to repaired the cleft lip at 3
months of age and the palate at 6 months or later.
Too early a repair may interfere with mid-facial
growth.
Speech therapy.

17. Pre-operative care
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Consent must be taking prior to surgery.
All the investigation reports must be entered in file
The infant must be kept NPO at least 6 hours prior to surgery. IV
fluids.
Remind parents that defect is operable-showed photographs of
corrected clefts.

18. Post- operative care
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Observe for any bleeding from site of operation
Turn the baby face to one site, for drainage of secretion and
prevention aspiration.
Administration the prescribe analgesic, to minimize pain.
Don't allow the child to put any object in the mouth.
Arched devise called a logan bar is used to prevent tension on
suture site for one week .

19. Anomalies of the Esophagus
•Esophageal Atresia

20. Esophagus atresia with
tracheoesophageal fistula
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Esophagus atresia is an abnormality in which the middle
portion of the esophagus is absent
Signs and symptoms :
Excessive secretions
Intermittent unexplained cyanosis
The infant coughs and chokes.
Fluid returns through nose and mouth
Inability to pass N.G tube through nose or mouth into
stomach
Infant usually premature, and pregnancy complicated by
polyhydramnios

21. Three C’s–signs and symptoms
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Choking,
coughing
Cyanosis
Management :
Immediate Treatment
Gastrostomy tube
Surgical Management.

22. Complications
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Death from asphyxia
Pneumonia

23. Anomalies of the stomach
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Pyloric stenosis:
Is the hypertrophy of the muscle surrounding the pylorus that
leads to narrowing of the pyloric canal and makes it difficult for
the stomach to empty.
It occurs mainly in male infant.

24. Clinical manifestation
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Projectile vomiting
Weight loss or failure to gain weight
Dehydration.
Reduced frequency and amount of stool.
Olive like shape when examine abdomen (stomach))

25. Management
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Surgical management, an
operation called
Pyloromyotomy

26. Post-operative care
1. The nurse must observe the site of incision for sings of
infection&
Inflammations.
2. Keep the incision site clean and dry.
3. Use aseptic techniques while dressing.
4. Don't bath the infant until incision site heals.
5. Infant usually resume oral feeding after 1 to 2 days(bowel
sounds)

27. Omphalocele
Its intraabdominal contents herniated though umbilical cord.

28. Management
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initial steps of airway stabilization
Maintain IV fluids
Cover omphalocele with non-adherent sterile dressing to preserve body
heat and moisture
Prophylactic antibiotic may be given
insertion of an orogastric tube for bowel decompression, and the
establishment of peripheral intravenous access.
Surgical :repair

29. Intestinal Obstruction
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Types of IO:
Anorectal Malformation- Imporferted anus
defect in which the opening to the anus is missing or
blocked.
Hirschsprung's Disease
Intussusception

30. Hirschsprung's Disease
A, Normal; B, Hirshprung’s Disease/
Megacolon
A

31. Intussusception is the most common cause of intestinal obstruction in children
between 3 months and 6 years of age.
It occurs when a portion of the bowel "telescopes" into itself, causing intestinal
obstruction.

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Intussusception is one of the most common causes of acute abdomen in infancy
This condition usually occurs in children between 6 months and 2 years of age. In this
age group, intussusception is idiopathic in almost all cases.

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The vast majority of childhood cases of intussusception are ileocolic; that
is, the ileum becomes telescoped into the colon.
In the past, intussusception was a severe condition with high morbidity
and mortality rates.
Currently, prompt diagnosis and effective treatment lead to a favorable
outcome in most cases.

34. • Without prompt treatment, necrosis of the involved segment leads to
perforation, peritonitis and shock,.

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Signs and symptoms:
1-Paroxysmal abdominal pain; legs drawn up
A previously healthy infant who develops intussusception will suddenly become cry
sharply, and draw up the legs in a severe colicky spasm of pain.
2-Blood in stool, or later “currant jelly” stools containing blood, and mucus
3- vomiting
4-constipation .
5-Abdominal distention, bowel sound diminished, absent or high pitch.
6-Sausage like mass palpable in abdomen (Dance’s sign).
7-Dehydration and fever
8-Shock like state with rapid pulse, pallor, and marked sweating

36. How is Intussusception Treated?
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Surgery Laparotomy : colostomy

37. Nursing management
Pre operative:
Provide NG tube attached to suction.
Administer IV fluids to decompress bowel and maintain hydration status.
Monitor vital signs frequently.
Record intake and out put.
Post operative :
Assess pain /administer pain conrrol
Provide colostomy care.
Administer antibiotics as prescribed.
Check vital signs : signs of infection (fever).
Assess for presence of bowel sounds to evaluate return of bowel function.

38. Colostomy care
It is a surgical opening in the abdomen where the intestine is brought up onto the
skin and sutured in place to form a stoma.
the most common types of colostomy
Colostomy
Ileostomy
Urostomy

39. The End