Gastrointestinal system is responsible for: Ingestion Digestion Absorption Metabolism Elimination Lower portion is responsible for remainder of digestion, absorption, and metabolism Includes: Small intestine Large intestine Rectum Anus Anorectal Malformations p. 925 Range from simple to complex One of the most common groups of congenital defects Rectal atresia-(closure of the rectal passage) no stool. Initially, anus may appear to be normal in appearance, but it is later determined as an abnormal situation and is a complete obstruction. Immediate surgical intervention is mandatory for rectal atresia.
The upper portion is responsible for nutrient intake Includes: Mouth Esophagus Stomach
Gastrointestinal System Accessory structures: Liver Gallbladder Pancreas
Rectal Atresia
Rectal stenosis -(constriction or narrowing of the rectal passage) includes vomiting, abdominal distension, difficulty passing stool. May present with a ribbon-like or narrow Stool, which is not always apparent at birth. Imperforate anus -- (Absence of a rectal opening) no stool. Surgery is required. Can appear as a Rectal fistula - rectal connection to vagina or urethra through which stool passes Surgery is required to close the fistula.
Physical examination Radiological imaging (x-ray) Magnetic resonance imaging (MRI) Ultrasound IV pyelogram and voiding cystogram for any associated defects of the urinary tract
Surgical Care: Repeated manual dilation to treat anal stenosis Creating a new anal opening for rectal atresia -- two stages First stage is resection and colostomy 2nd stage involves the closure of the colostomy and a pull through procedures with anastomosis of blind pouch to anus. Nursing care: Depends on type of defect and extent of surgical correction- parents need education Pre-op-NPO, maintenance of IV and IV fluids Post-op -- V/s, I & O, pain management, hydration, monitor stools, skin care, infection control, colostomy care. NG decompression. PO feeds begin after positive bowel sounds
Education Discharge Information Colostomy care, wound care, prevention of infection The procedure for anal dilation if appropriate for the defect- may need to do this multiple times Adequate fluids Dietary fiber Stool softeners or bulking agents May need delayed toilet training
Hypertrophic Pyloric Stenosis pg 925 Etiology is unknown. Thickening of the pyloric sphincter, causing an obstruction of the pyloric canal Suggested causal theories include a deficiency in inhibitory neuronal signals or molecular causes Ganglionic cell immaturity has also been suggested as a causative factor More common in Caucasian population. More common in males-especially first born. There may be a family trait Diagnosis
Signs and Symptoms
Pattern of normal feedings and then new onset of non- Palpating pyloric mass (olive-shaped) in the RUQ bilious vomiting. Projectile vomiting-may occur right after Ultrasound usually confirms the Pyloric Stenosis. the feed. Vomit is non-bilious. Then baby wants to eat again. Confirmation by upper GI series demonstrates Other symptoms can be: "string sign," which is caused by barium passing -Weight loss through narrowed pylorus. -Dehydration -Constipation -Olive shaped mass -Visible reverse peristalsis in LUQ Collaborative Care Education & Discharge Instructions Surgical Care Care of incision and observation for signs of Pyloromyotomy-laparoscopic procedure with endoscope infection-change diapers frequently Nursing care Observe infant's respo