Fecal diversions in kids Flashcards
Hirschsprung’s Disease: basic pathology, diagnosis, management (diverting colostomy followed by pull through procedure and stoma closure), recognition/mgmt enterocolitis
Aganglionic megacolon or cogenital megacolon
cogenital absence of ganglion cells (internal anal sphincter and rectum
familial condition autosomal recessive
short-segment disease (~80% rectum/sigmoid colon)
long-segment disease (~10% lengths of colon)
chronic constipation rectal exam finger removal = "explosive elimination of stool/gas" rectal biopsy (absent ganglion cells)
Sx fecal diversion (colostomy)
multiple biopsy
then pull through procedure
colostomy closure
Enterocolitis: Ix small bowel & colon = sepsis/death
S/S diarrhea, abd distension, fever, resp distress
Tx: Abx + diverting colostomy
Necrotizing Enterocolitis: pathologic mechanisms; usual surgical procedure
Bowel mucosal injury (premature neonate, cogenital Heart Disease, asphyxia @ birth, arterial hypoxemia, osmolarity/volume/composition feeding solution) Gut microflora invades bowel = necrosis/perforation Pneumotosis intestinalis (gas gangrene in submucosal layer)
Tx: NPO, NG, IV, Abx, monitoring
Sx: Ileostomy w/ MF (gangrene, perforation, necrotic bowel)
Ileostomy closed when infant stable
Imperforate Anus: prognosis for continence in children w/ low anorectal defects versus high anorectal defects
Distal rectum & anal canal
Low (stenotic anal opening, fistula openings) - anterior to sphincter
puborectalis muscle & external sphincter present
Intermediate (opening terminates at urethra for boys/vagina for girls)
High (distal end rectum above puborectalis muscle)
- either blind pouch or fistula to vagina/urethra
- lack internal anal sphincter/external sphincter partially intact
Basic pouching guidelines
need for Pouching
Lt colostomy (not as enzymatic, option moisture barrier + diapering)
minimize adhesive products/for decreasing risk of epidermal stripping
Petroleum/silicone-based adhesive, no ETOH-based products
change q1-3 days
