Elimination Flashcards
Hirschsprung disease ( HD)
•Intestinal obstruction due to lack of ganglion cells in the bowl
- Not enough nerve cells for peristalsis
- bowel fill with fluid and waste
May run in family
More common in boys 
usually an isolated birth defect
Hirschsprung disease symptoms
- swelling around belly
- **vomiting greenish-brown
- constipation / flatulence
- diarrhea ( liquid moving around stool)
- failure to gain weight
- severe fatigue
Diagnostic evaluation of HD
Rectal suction biopsy
quick, painless procedure that can be performed in a doctor’s office. A small instrument is inserted into the rectum to obtain a small tissue sample to check for the presence of nerve cells.
Therapeutic management of HD
Surgery: Pull-through procedure
- remove the diseased section and then pull the healthy portion down
If obstructed- two stages are required
1) temporary ostomy to relieve structure and allow bowel to return to normal size
2) later a complete corrective surgery is performed
if the bowel is not distended only one surgery is required
May recommend increased fluid intake and high fiber diet
Intussusception
- One portion of the bowel folds in (telescopes) into distal portion
- Mesentery also pulled, causing lymphatic and venous congestion
- bowel wall edema can cause infraction and bowel perforation
- more in boys 3-6 year old
Signs of Intussusception
•Sudden acute abdominal pain •Intermittent episodes where the child cries and draws the knees up towards the chest - pain happen w/ peristalsis •Vomiting •Lethargy ** Red, currant jelly-like stools (stools mixed with blood and mucus) •Tender, distended abdomen •Palpable sausage-shaped mass in URQ
•Complication: peritonitis (with fever)
Intussusception management before surgery
Reduction methods:
1) radiologist guided pneumoenema ( Air Enema)
2) ultrasound guided hydrostatic enema

Tube into rectum and insert air or water as fast as cancer try to straighten out bowel 
Surgical (manual) reduction of Intussusception
Cut into abdomen and straighten out bowel with hand
Urinary tract Infection (UTI)
Infection anywhere along the urinary tract, however most commonly affects the bladder
UTI symptoms depending on age
•E Coli – most common
- Newborns:
fever 🥵 or hypothermia 🥶, jaundice, tachypnea, cyanosis - Under 2 years of age:
fever 🥵 , irritability😠, lethargy 😴, poor feeding - Over 2 years of age:
Enuresis, or daytime incontinence in the child who is toilet trained, foul-smelling urine, increased frequency of urination, dysuria, or urgency, fever 🥵
Reasons UTI more common in kids
●Urinary stasis
●Decreased fluid intake
●Alkaline urine permits bacteria to flourish
●Anatomic and physical factors
Preventative education for UTI
●Hygiene (changing diaper more frequently, teaching children to wipe front to back).
●No bubble baths, bath bombs, or sitting in soapy water.
●Increase fluid intake/stay hydrated.
●Discourage child from holding urine & encourage them to empty the bladder completely
Therapeutic Management of UTI in hospital
•Infants and young children with fever may require hospitalization for IV antibiotics and hydration.
•Blood and urine cultures before starting first dose of IV antibiotics.
- Best to obtain urine before blood culture, and to obtain blood at time of IV placement
•Urine specimen is always obtained via straight catheterization in children who are not potty trained.
•Antibiotic prescribed depends on lab urine culture and sensitivity
Vesicoureteral reflux (VUR)
• urine from the bladder flows back up to the ureters with voiding
• associated with reoccurring UTI
• causes renal scarring, leads to hypertension, severe renal insufficiency/failure
-Can effect just one ureter, both ureters or can affect both ureters differently – can
have different stages
Signs of VUR
- Frequent UTI symptoms such as dysuria, urinary frequency, fever, abdominal pain, or back pain.
- Wetting pants/bedwetting (enuresis) in toilet trained children.
- A swollen kidney that appears as a palpable mass in the abdomen.
- Poor weight gain
- High blood pressure
Voiding Cystourethrogram (VCUG)
Radio dye shows where urine is when unclamped catheter to let urine come out and urine well also go back up ureter
Therapeutic Management of VUR depending on grade
Grade 1-2
- Prevention of pyelonephritis and renal scarring
- Antibiotic prophylaxis and hygiene/voiding practices to prevent UTI
- Serial urine cultures to determine recurrence of UTI
- VCUG’s (Biannual or annual)
•Grade III, IV, and V warrant surgical intervention (ureteral implantation)
Postoperative Priority Assessments and Interventions
- Maintain IV fluids
- Monitor urine output via foley catheter
- Monitor urine output from ureteral stents if present
- Administer medication for pain and bladder spasms
- Encourage ambulation
- Prophylactic antibiotics
New born signs of HD
Failure to pass meconium within 24 to 48 hours after birth
Refusal to feed
Bilious vomiting
Abdominal distension
Infancy sign of HD
Failure to thrive Constipation Abdominal distention Episodes of diarrhea and vomiting Signs of enterocolitis o Explosive, watery diarrhea
o Fever
o Appears very ill
Childhood sign of HD
Constipation Ribbonlike, foul-smelling stools Abdominal distension Visible peristalsis Easily palpable mass Undernourished, anemic appearance
Primary VUR
congenital abnormality at the vesicoureteral junction that results in
incompetence of the valve.
Secondary VUR
related to structural or functional problems such as neurogenic
bladder.
Two concerning problems caused by VUR:
1) Urinary stasis causing the reoccurring UTIs and
2) Reflux of urine that can potentially cause renal scarring and permanent renal damage
