MCN Final GI tract Flashcards
-AKA aganglionic megacolon, is an absence of ganglionic innervation to the muscle of a section of the bowel.
-The absence of nerve cells means there are no peristaltic waves.
-It is caused by an abnormal gene on chromosome 10.
Hirschsprung’s disease
Hirschsprung’s disease
Signs and symptoms:
-Symptoms generally do not become apparent until 6 to 12 months of age.
-Chronic constipation
-Ribbonlike stools or watery stool (stools passing through such a small, narrow segment look like ribbons).
-Distended abdomen
Hirschsprung’s disease
Diagnostic:
__________ _________ a technique that tests the strength or innervation of the internal rectal sphincter by inserting a balloon catheter into the rectum and measuring the pressure exerted against it.
Anorectal manometry
Hirschsprung’s disease
Therapeutic Management
_______-_______ ________: Dissection and removal of the affected section, with anastomosis of the intestine.
Ø First, a temporary _________ is established, followed by bowel repair at 12 to 18 months of age.
Pull-through operation
colostomy
Nursing Intervention(Colostomy care)
-Promote skin integrity
-Comfort and rest
-Maintain fluid balance
-Invagination of one portion of the intestine into another
-(90% of cases occurring by 2 years of age
-Point of invagination is generally at the juncture of the distal ileum and proximal colon
Intussusception
Intussusception assessments:
-Frank or occult blood in the stool (Red currant jelly)
-distended abdomen
-Sudden drawing up of legs and cry(pain)
-If necrosis occurs in the
invaginated bowel
Ø Elevated temperature,
peritoneal irritation
(guarding behavior) an
increased WBC, and often
a rapid pulse.
Intussusception
Diagnostics:
History taking:
Episodes of crying are for a short time but repeat every 15 to 20 minutes; the stomach feels “full” and vomitus and diarrhea with blood may occur.
Intussusception
Diagnostics
Confirmatory test.
Abdominal X-ray, or ultrasound
AKA Malabsorption syndrome, gluten induced enteropathy, celiac sprue
Celiac disease
An immune-mediated abnormal response to gluten, the protein in wheat, and related proteins in rye, barley and possibly oats, in a
genetically susceptible individual.
Celiac disease
Celiac disease
Manifestations:
• Steatorrhea (bulky, foul-smelling, fatty stools)
• Failure to thrive
• Malnutrition
Intussusception
Therapeutic Management:
For Vomiting and PostSurgical reduction
-Vomiting: IV fluid therapy may be started to reestablish
their electrolyte balance and to supply adequate fluid
to hydrate them.
-NPO status before surgery or nonsurgical reduction.
-Post surgical reduction
NPO for a few hours after and then introduced gradually to regular feedings (once bowel sounds are
present).
Intussusception
Therapeutic Management:
Reduction surgery to reduce the
invagination before necrosis of the affected portion of the bowel occurs
Open/ Laparoscopic surgery
Intussusception
Therapeutic Management:
Reduction of the intussusception
Instillation of a watersoluble solution, barium enema, or air
(pneumatic insufflation) into the
bowel
A stricture or the
absence of the anus.
Imperforate Anus
Imperforate Anus
Incidence:
-Approximately 1 in _______ live births
-More commonly in _________
5000
boys than in girls.
Imperforate Anus
There may be an accompanying fistula to the bladder in boys (____________)
And to the vagina in
girls (___________), further
complicating a surgical repair.
rectovesical fistula
rectovaginal fistula
Imperforate Anus
Diagnostic:
-Prenatal sonogram
-It is discovered at birth when inspection of a newborn’s anal region reveals no anus
Ø A membrane filled with black meconium protrudes
from the anus
Ø If it is impossible to insert a rubber catheter into
the rectum.
Imperforate Anus
Diagnostic:
A “_____” reflex (touching the skin
near the rectum should make the
anus contract) cannot be elicited if sensory nerve endings in the rectum are not intact.
Wink
Imperforate Anus
Diagnostic:
Some instances of the stricture will not detected at birth because the anus appears as usual, and the stricture exists so far inside that it can’t be seen. By ___ hours, no stool will be passed and abdominal distention will become
evident.
24
Imperforate Anus
Diagnostic:
__________ __ ________: Slightly head-down position to
allow swallowed air to rise to the end of the blind pouch
of the bowel.
Ø This method is also helpful to estimate the distance the
intestine is separated from the perineum or the extent of
the correction that will be necessary.
__________ : Presence of meconium to help determine
whether the infant has a rectal-bladder fistula.
An X-ray or sonogram
Urinalysis
Imperforate Anus
Therapeutic Management:
________ surgery, may be given a temporary colostomy, and
the final repair performed when the infant is somewhat older
(____ __ ____months).
Extensive
6 to 12 months
(PSARP)?
a type of pull-through procedure that is used to repair anorectal malformations in some children. This technique surgically creates the child’s anus within the sphincter muscle.
Posterior sagittal anorectoplasty
Stoma Assessment
-Should be pink to red and moist. -Pallor, cyanosis or dusky color indicates poor blood circulation. -Black indicates necrosis.
- Initially there’s some edema
Imperforate Anus
Ostomy complications of stoma
•prolapse
•necrosis
•skin irritation
•retraction