This document discusses several common gastrointestinal defects in children, including cleft lip and palate, exomphalos, and esophageal atresia.
It describes Baby Kunle, a 3-day old with a cleft lip, and provides details on the causes, incidence, pathophysiology, clinical presentation, diagnosis, and treatment of cleft lip and palate. Surgical repair is usually done in the first few months of life. Nursing care involves careful feeding and psychosocial support.
Exomphalos, or omphalocele, is defined as herniation of abdominal contents through the umbilical ring. It has a low incidence. Surgical repair aims to replace organs into the abdomen
A Tracheoesophageal fistula is a congenital disease. It is a acquired communication between the trachea and esophagus. Most of the patient with TEF are diagnosed immediately following after birth.TEF are often associated with life threatening complications.
A Tracheoesophageal fistula is a congenital disease. It is a acquired communication between the trachea and esophagus. Most of the patient with TEF are diagnosed immediately following after birth.TEF are often associated with life threatening complications.
a short demonstration on appendicitis in children describing the anatomy,embryology,anatomical variations,etio-patho-physiology of appendicitis,different presentations in various age groups,diagnostic pathways,differential diagnosis,management,complication and outcome
PYLORIC STENOSIS:
Review the anatomy and physiology of digestive system
Review the incidence of pyloric stenosis
Define pyloric stenosis
Explain the causes and risk factors of pyloric stenosis
Describe the pathophysiology of pyloric stenosis
Enumerate clinical features of pyloric stenosis
Enlist the diagnostic evaluation for pyloric stenosis
Explain the management of pyloric stenosis
Enumerate the complications of pyloric stenosis
A developmental anomaly is a broad term used to define conditions which are present at conception or occur before the end of pregnancy. In the case of cerebral palsy, a small number also occur after birth. this is also a birth defect.
A Tracheoesophageal fistula (TEF) is an abnormal connection (fistula) between the Oesophagus and the trachea. TEF is a common congenital abnormality.
Oesophageal atresia is failure of oesophagus to form a continuous passage from the pharynx to the stomach
TEF is an abnormal connection between the trachea and the oesophagus
Pre-term, Small for gestational age and Post-term InfantLipi Mondal
Due to high risk of pregnancy there are several adverse outcome or poor perinatal outcome we can see.... So most commonly adverse out come should be known by health care providers.
Hypothermia occurs when the newborn’s temperature drops below 36.3°C.
The smaller or more premature the newborn is, the greater the risk of heat loss. When heat loss exceeds the newborn’s ability to produce heat, its body temperature drops below the normal range and the newborn becomes hypothermic.
Early prevention measures are vital.
a short demonstration on appendicitis in children describing the anatomy,embryology,anatomical variations,etio-patho-physiology of appendicitis,different presentations in various age groups,diagnostic pathways,differential diagnosis,management,complication and outcome
PYLORIC STENOSIS:
Review the anatomy and physiology of digestive system
Review the incidence of pyloric stenosis
Define pyloric stenosis
Explain the causes and risk factors of pyloric stenosis
Describe the pathophysiology of pyloric stenosis
Enumerate clinical features of pyloric stenosis
Enlist the diagnostic evaluation for pyloric stenosis
Explain the management of pyloric stenosis
Enumerate the complications of pyloric stenosis
A developmental anomaly is a broad term used to define conditions which are present at conception or occur before the end of pregnancy. In the case of cerebral palsy, a small number also occur after birth. this is also a birth defect.
A Tracheoesophageal fistula (TEF) is an abnormal connection (fistula) between the Oesophagus and the trachea. TEF is a common congenital abnormality.
Oesophageal atresia is failure of oesophagus to form a continuous passage from the pharynx to the stomach
TEF is an abnormal connection between the trachea and the oesophagus
Pre-term, Small for gestational age and Post-term InfantLipi Mondal
Due to high risk of pregnancy there are several adverse outcome or poor perinatal outcome we can see.... So most commonly adverse out come should be known by health care providers.
Hypothermia occurs when the newborn’s temperature drops below 36.3°C.
The smaller or more premature the newborn is, the greater the risk of heat loss. When heat loss exceeds the newborn’s ability to produce heat, its body temperature drops below the normal range and the newborn becomes hypothermic.
Early prevention measures are vital.
PYLORIC STENOSIS
Pyloric stenosis is a medical condition in which the pylorus, the muscular valve between the stomach and the small intestine, becomes abnormally narrowed or obstructed, leading to the obstruction of the gastric outlet. This narrowing of the pylorus prevents the proper passage of food from the stomach to the small intestine.
The exact cause of pyloric stenosis is still unknown, but it is believed to have a multifactorial etiology.
Genetic factors are thought to play a role, as there is a higher incidence of pyloric stenosis among siblings and family members.
Environmental factors may also contribute to the development of the condition, but specific triggers remain unidentified.
The hallmark symptom of pyloric stenosis is projectile vomiting, which occurs shortly after feeding.
Vomitus is often non-bilious and may resemble curdled milk.
Forceful vomiting that may project several feet away from the infant.
Signs of hunger and irritability despite frequent feeding attempts.
Weight loss or poor weight gain.
Dehydration and electrolyte imbalances due to excessive vomiting.
Palpable “olive-shaped” mass in the epigastric region.
Infants appear hungry, irritable, and unsatisfied after feeds.
Physical Examination:
Palpation of the abdomen may reveal a palpable “olive-shaped” mass in the epigastric region, which represents the hypertrophied pylorus.
The “olive” can often be felt when the infant is in a relaxed state and the stomach is empty.
Abdominal Ultrasound:
Abdominal ultrasound is the primary diagnostic tool for confirming pyloric stenosis.
Fluid and Electrolyte Management:
Prior to surgery, infants with pyloric stenosis often require fluid resuscitation and correction of electrolyte imbalances caused by excessive vomiting.
Intravenous hydration and electrolyte replacement may be necessary to restore the infant’s fluid and electrolyte balance.
Atropine Therapy:
In some cases, medical management with intravenous atropine may be attempted as a temporary measure to relieve pyloric spasm and improve the passage of food.
Surgical management of pyloric stenosis involves performing a pyloromyotomy.
This procedure is typically done under general anaesthesia and can be performed as an open surgery or laparoscopically.
Postoperative Nursing Care:
Monitor vital signs, surgical site, and signs of infection, such as fever, redness, swelling, or discharge.
Administer prescribed pain medications and antibiotics.
Observe for complications, such as bleeding or infection, and report any abnormalities to the healthcare team.
Encourage early feeding and monitor for successful feeding tolerance, ensuring the infant is retaining and digesting food properly.
Educate parents about postoperative care, including incision care, feeding techniques, and signs of potential complications, emphasizing the importance of follow-up visits and ongoing care.
Esophageal Atresia (EA) and Tracheo Esophageal Fistula (TEF)puji123456
Esophageal atresia (EA) is the
congenital malformation that
represent the failure of the esophagus
to develop a continuous passage upto
the stomach
Tracheo esophageal fistula (TEF) is
the congenital malformation where the
trachea and esophagus fails to separate
into distinct structures and a passage is
created between the two.
Introduction
• Pyloric stenosis is also known as pylorostenosis or infantile hypertrophic pyloric stenosis. It is the most common cause of intestinal obstruction in infants. It is a form of obstruction in the gastric outlet which means a blockage from stomach to intestine.
• It was First described by Hirschsprung in 1888
• Ramstedt described an operative procedure to alleviate the condition in 1907 – the procedure used to this day to treat pyloric stenosis.
Definition
• Hypertrophic pyloric stenosis is a marked and progressive outgrowth or enlargement of circular muscle fibers of pylorus causing partial or total obstruction of the stomach outlet due to narrowing of lumen.
Anatomy
The stomach sits in the upper abdomen on left side of the body. The top of the stomach connects to a valve called the esophageal sphincter (a muscle at the end of esophagus). The bottom of stomach connects to small intestine.
The stomach is divided into 5 regions:
• The cardia is the top part of the stomach. It contains the cardiac sphincter, which prevents food from traveling back up the esophagus.
• The fundus is a rounded section next to the cardia. It's below the diaphragm (the dome-shaped muscle that helps to breathe).
• The body (corpus) is the largest section of the stomach. In the body, stomach contracts and begins to mix food.
• The antrum lies below the body. It holds food until the stomach is ready to send it to your small intestine.
• The pylorus is the bottom part of the stomach. It includes the pyloric sphincter. This ring of tissue controls when and how stomach contents move to the small intestine.
Incidence
• It is more commonly seen in child with 2-5wks of age.
• 2-9 per 1000 livebirths can be born with this condition.
• Predominant sex: Male > Female (6:1). Males are more prone to get
• Genetic predisposition can be an underlying factor for disease causation.
• Full term babies especially first borne are most commonly affected.
• Death from infantile hypertrophic pyloric stenosis is rare and unexpected; the reported mortality rate is very low and usually results from delays in diagnosis with eventual dehydration and shock.
Etiology
• Idiopathic
• Other factors : *maternal stress especially in third trimester *elevated prostaglandin levels *deficiency of nitric acid *immature pyloric ganglion cells with abnormal muscle innervation.
• In adults, it can occur due to history of peptic ulcer in pylorus region and hypertrophic changes in muscle layer of pylorus.
Risk factors
• Sex. Pyloric stenosis is seen more often in boys — especially firstborn children — than in girls.
• Race. Pyloric stenosis is more common in whites of northern European ancestry, less common in Black people and rare in Asian
Similar to Omphalocele/Exomphalos, cleft palate & Oesophageal atresia and Nursing care (20)
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Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
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Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
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Omphalocele/Exomphalos, cleft palate & Oesophageal atresia and Nursing care
1. Medical & Surgical Conditions of
Childhood
Gastrointestinal Systemdefects
CleftLip & Palate, Exomphalosand Oesophageal Atresia
StephanopoulosK. J. Osei
Student nurse(BSN)
2. Introduction
• Congenal anomalies may be caused by genetic or
environmental factors
• Congenital anomalies account for large percentage of
health problems seen in neonates and children
3. Objectives
• Explain some common gastrointestinal system defects
that occur in child including causes, treatment and
pathophysiology
• Discuss with our mates the nursing management of
these conditions focusing on physiological, physical
and psychological nursing interventions
4. • Wait a minute lets check
this out
• Baby Kunle a 3-day old
neonate on delivery
presented with an
indentation formed on
his upper lip.
5. What is Baby Kunle
suffering from?
How many kids like Baby
Kunle suffer such condition?
How do I manage baby Kunle
as a Nurse?
6. Cleft lip and cleft Palate
• Cleft lip is a small gap or an indentation formed
on top of the lip.
• Cleft lip can occur with cleft palate or alone.
• Most common facial malformations that occurs in
newborns
7. Incidence
• Most common facial malformations that occurs in newborns
• Cleft lip; 1 in 1000 births. More in males
• Cleft Palate: 1 in 2500 births. More in females
8. • CAUSES
Not really clear
• Risk factors
Heriditary or genetic disorders
Environmental factors (exposure to
alcohol,anticonvulsants & other teratogens)
9. Pathophysiology
1.Lips closes earlier
than palate
2. cleft lip and palate
occurs due to failure of
maxilliary & premaxilliary
processes to form together
in 5th- 8th weeks
3. Palate form within the 8th-10th
weeks. later bone forms within
the roof tissue to form hard
palate
10. Clinical Picture
• Distended abdominal due to
swallowing air
• Abnormal formation of the lip
• Abnormal formation of the palate
Assesment:
• 1. Use tongue depressor to open
baby's mouth and inspect palate
• 2. wear gloves
• 3. Insert a finger in baby's mouth
• 4. Palpate for Intact palate and
note any indentation
Diagnostic Investigation
• Prenatal ultrasonography
Types
• Partial: small notch on vermiform
border
• Complete: notch continues to
nose
• Unilateral
• Bilateral
11.
12. Treatment
• Surgery
Cheiloplasty: to surgically repair the cleft lip within the first 3 months
after birth to provide adequate sucking.
Palatoplasty: to surgically repair the cleft palate between 12 months
and 18 months of age before the child begins speaking
• Management team: pediatricians, nurses,
orthodontists,prosthodontists, otolaryngologists, speech therapists, and
occasionally psychiatrists
13. Nursing management
• Nursing diagnosis Prior to surgery
1. Imbalanced Nutrition: Less than Body Requirements related to
inability to suck secondary to cleft lip
2. Compromised Family Coping related to visible physical defect
3. Anxiety of family caregivers related to the child’s condition and
surgical outcome
4. Deficient Knowledge of family caregivers related to care of child
before surgery and the surgical procedure
14. • Nursing diagnosis post surgery
• Risk for Aspiration related to a reduced level of consciousness after
surgery
• • Breathing Pattern related to Ineffective anatomical changes
• Risk for Deficient Fluid Volume related to NPO status after surgery
• • Imbalanced Nutrition: Less than Body Requirements related to difficulty
in feeding after surgery
• • Acute Pain related to surgical procedure
15. • Nursing diagnosis post surgery
• Risk of Injury to the operative site related to newborn’s desire
to suck thumb or fingers and anatomical changes
• • Risk for Infection related to surgical incision
• • Risk for Delayed Growth and Development related to
hospitalizations and surgery
• • Deficient Knowledge of family caregivers related to long-term
aspects of cleft palate
16. Nutrition
1. Breastfeeding more sucessful as breast can mold and cover
indent
2. Bottle feeding: A soft nipple with crosscut tip or large nipple with
holes to aid free flow of milk
3. child with cleft palate only or early repair learns how how to suck
early
4. lamb nipple and aspeto tube
5. child should be kept upright. if unilateral feed at unaffected side.
child must be upright during feeding
6. monitor coughing,sputter, choking and aspiration (careful feeding)
17. • Psychosocial support for family
1. encourage family to verbalize feeling and reassure them pointing
out that their feelings are valid
2. provide explanation on disease condition and perioperative care
3. show behaviour of acceptance towards child
18. • Post operative care
• Immediate Op
• lateral position to drain mucus and prevent aspiration
• Position child to aid nasal breathing (mouth-nasal breathing change)
• continous observation for aspiration
• finger and elbow restraints to prevent child undoing the repair. Monitor
restraints
• Monitor IV site, fluid flow rate every 2hrs,I&O
• Administer prescribed analgesic ot only for comfort but to prevent child from
crying which may cause repair suture damage due to tension
19. Post-op
• Gently clean baby's mouth with clear or tepid water after feed
• clean sutures with sterile cotton and N/S. May apply bactriban. Open dressing
• Teach family how to care for sutures
• Provide sensoy stimulation: talk,cuddle and respond to child when crying aids in
stimulating suckle reflex
• Post- nutrition
• start clear fluid if child is no longer nauseated
• breastfeeding
• if palate repair avoid nipples,spoons or straws
• surgeon determines progression of diet from liquid to solid foods
21. Intro
• Atresia is the abscence of a normal body opening or
abnormal closure of a body passage
• Fistula is an abnormal connection between hollow organs
or connection between an organ and the skin.
• Eesophageal atresia with or without fistula into the tracheal
is a serious and common anomaly that causes respiratory
distress.(An Emergency)
• Most occurs 5 weeks of gestation when the forgut normally
23. Clinical presentation
• Frothy saliva
• Excessive drooling (overfilled pouch)
• Coughing due to excessive secretions
• Gagging when feeding
• Feedings exiting the mouth and nose
• Aspiration
• Difficulty breathing (choking & cynosis)
• Distended stomach
This child's life depends on your careful
observation
Diagnostic invesitgation
Barium oesophagogra
24. Why this could lead to severe complications
• Any mucus or fluid ends in blind pouch which become filled and
overflows resulting in aspiration into the trachea
• The newborn may have frothing and excessive drooling and periods of
respiratory distress with choking and cynosis
• If there is a fistula at the distal portion of the esophagus, gastric content
may reflux into the lungs and cause chemical pneumonia
• DO NOT FEED this child. Feeds could be aspirated and lead to
aspiration pneumonia
25. Treatment
• Suction the contents of the blind pouch.
• Insert NG tube to decompress the stomach.
Surgery: Repair the fistula and/or blind pouch.
First stage: Gastrotomy and drainage of proximal pouch
2nd stage: resection and end to end anastamosis
Surgical repair is complex and is done in stages
Chest tube may be inserted to drain chest fluid
Broad spectrum antiobiotics for risk of pneumonia
26. Nursing management
• Pre-op
• Nil per Os. Insert NGT as orderd
• Semi fowlers supine positioning to facilitate gastric
drainage
• Suction the contents of the blind pouch as ordered.
• No pacifier because this increases saliva production.
27. Postoperative care:
• Monitor vital signs and repiratory status closely.
• Monitor IV fluids, mediations (antibiotics) & parenteral nutrition closely
• Nutrition:
• monitor I&O, and daily weight,
• Proper gastromy feeding till anastamosis heal (usually postoperative
day 5 to 7); removal of chest tube is done first and esophagogram is
performed to check anastamosis integrity.
• before oral feeding take precautions,
• oral feeding start with sterile water first then small feeding of formula or
breastmilk.
28. Post Op
• Nutrition:
• Inspect cervical esophagostomy site and apply protective
ointement, barier dressing.Monitor anastomotic leak
evidenced by purent chest tube drainage
• Use pacifier during NPO to stimulate suckling
• Parent teaching: identifying behavious that indicated need
for suctioning like respiratory distress signs during feeding
or when mucus is excess
30. Intro
• Omphalocele is the herniation of abdominial content through the
umbilical ring usually with an intact peritoneal sac
• The transculent sac contains bowel and other abd. contents
• Rupturing of the sac results in eversceration (gushing out) of
abd. content
• In gastroschisis however the hernia is lateral to the umblical ring
and theres no membrane covering the exposed abd. content
32. Diagnostic investigation & Treatment
• Investigations
Prenatal Ultrasonography
• Treatment
Surgery
Replacement of the organs into the abdomen could
be difficult since theres limited space. this mostly
happens with large exomphalos
suture skin over defect and as child grows the
abdomen would be enlarge enough for
replacement
33.
34. Nursing mgt
• Cover defect immidaitely after bith with
gauze mostened with sterile saline to
prevent heat loss and drying
• Monitor vital signs frequently very (2-
4 hrs) especially temperature for heat
loss or fever
35. Pre op
• NPO status
• IV fluids administration for fluid and electrolyte balance
• Monitor signs of infection
• Handle infant carefully to prevent rapture of sac
36. post-op
• pain mgt
• infection prevention
• fluid and elctrolyte balance
• adequate nutrition
• In gastroschicis the exposed bowel is covered loosely
with saline soaked pads
37. Gastroschisis
• In gastroschicis the exposed bowel is covered loosely
with saline soaked pads and the abdomen is losely
wraped with plastic (rubber) bag or drape or silo bag
• Tight wrapping causes pressure on the expanding organs
and could result in necrosis]
38. Care in gastroschisis
• Surgery is done within several hours after birth
• Pre o and post op mgt similar to that of exomphalos
• Instruct childs parent to avoid tub bath until incision heals
• strenous activity should be avoided...WHY?
39. Conslusion
• Gastrointestinal defects poses challenges to child's
nutrtion and elimination
• Care nursing observation promotes early detection
• Proper nursing interventions are live saving also
contributes quality of life
• Y da mo nyinaa ase
40. References
• Hatfield, N.T. 2008. Broadribb's Introductory Pediatric Nursing (7th
ed.). Retrieved www.pdfdrive.net of February 14, 2019
• Johnson J.Y. & Keog J. 2010 Pediatric Nursing Demystified.
Retrieved www.pdfdrive.net of February 14, 2019
• Sylvestri L. A. 2017 . Saunders Comprehensive Review for the
NCLEX-RN (7th ed.) Retrieved www.pdfdrive.net of February 14,
2019
• Google images
