Dr. Hoda Abed El Azim
State common types of congenital anomalies in GIT.
Compare and contrast between cleft lip and palate
Discus pre and postoperative care of CL/CP.
Compare and contrast between the types of hernias.
Identify the clinical manifestation of esophageal
Discus pre and postoperative care of esophageal
Identify Anorectal malformations.
The most common anomalies are:
1. Cleft Lip or Cleft Palate
3. Esophageal Atresia
4. Anorectal malformations
CL and CP are facial malformations
that occur during embryonic
development and they are the most
common congenital deformity of the
head and neck.
They may appear separately or more
often , together.
CL : is a congenital
fissure in the upper lip.
CP: is a midline fissure
of the palate that results
from failure of the two
sides to fuse.
CL may be:
Extending into the base of
Unilateral or bilateral.
CL/CP may be involve the
soft and hard palate.
One or both sides.
Unilateral clefts are 60% to 80% of
nine times more children born with
common than cleft lip and palate
bilateral clefts. are male.
Apparent at birth.
Examining the palate.
Prenatal diagnosis after 13-14 weeks
when the soft tissue of the fetal face
can be visualized.
It interferes more with
feeding and breathing,
more difficult to repair.
The management of CL involves the
cooperative efforts of a multidisciplinary
health care team.
Speech/ language pathology
Nursing and social work
Closure of the clefts.
Prevention of complications.
Facilitation of normal growth and
development in the child.
Even with good anatomic closure most children
Some degree of speech impairment .
Inefficient functioning of the muscles of the
soft palate and nasopharynx.
Improper tooth alignment.
Varying degree of hear loss.
Improper drainage of the middle ear.
Recurrent Otitis media with scarring of the
It is important for nurse to emphasis not only the
infant’s physical needs but also on the parents
CL or CP reduces the infant’s ability to suck,
interferes with compression of the areola.
Feeding is best with the infant’s head in upper
Large , soft nipple with large holes have been
advised and used.
Large syringe with soft rubber tubing can used.
With some infant spoon feeding works best
Breast pump may be useful to stimulate the
let down reflex.
Elbow restrains are used to prevent the
infant from rubbing or disturbing the suture
Older infants who roll over will require a
jacket restraint to prevent rolling on the
abdomen and rubbing the face on the sheet.
Adequate analgesia is required to relieve
Clear liquids are offered when the infant has
fully recovered from anesthesia.
The suture site are is carefully cleansed of
A thin layer of antibiotic ointment.
Genital aspiration of mouth and
An upright or infant set position.
Lie on the abdomen.
Feeding by bottle, breast or cup.
Oral packing, it is usually removed after 2 to3
Instruct the parents to keep the restrained at
home until palate is healed (2 to 6 weeks).
Opioids may be prescribed.
Soft food in discharge plan until the surgeon
directs them otherwise.
Is a protrusion of a portion of an organ or
organs through an abnormal opening.
The abdominal wall, or
The inguinal canal.
1. Diaphragmatic Hernias
Protrusion of abdominal organs through
opening in diaphragm.
Mild to severe respiratory
Tachypnea , cyanosis,
Absent breath sound.
Prenatally as early as 25 week of gestation.
Supportive treatment of respiratory distress
(Use of end tracheal intubation, oxygenation).
Surgical reduction of hernia and repair of
Resuscitation, maintain suction, oxygen.
Positioning head up.
Carry out routine postoperative care and
Protrusion of stomach
through esophageal hiatus.
Weakness in abdominal wall around umbilicus,
incomplete closure of abdominal wall
allowing intestinal contents to protrude
Noted by inspection
and palpation of the abdomen.
High incidence in premature.
The esophagus instead of being an open tube
from the throat to the stomach is closed at
some point. A fistula is common between the
trachea and esophagus.
Coughing, choking, cyanosis,
Maintenance of a patent airway.
Prevention of pneumonia.
Surgical repair of the anomaly.
Avoid oral intake, started IV fluids.
Removal mouth secretion by suction.
Broad spectrum antibiotic therapy.
Gastrostomy AND ligation of the TEF.
`Nursing responsibility for detection of this
malformation immediately after birth.
If feed the infant and swallows but suddenly
coughs, and the fluid return through the nose or
mouth, reported immediately.
The infant placed in incubator, oxygen is
Intermittent or continuous suction of nose.
Oral fluid are withheld, the infant fluid met by IV
fluid or gastrostomy.
The infant is returned to radiant heater or
The gastrostomy tube is connected to gravity
drainage until the infant can tolerate feeding.
Tracheal suction with extreme caution to
avoid injury to the suture line.
The initial attempt at oral feeding to make sure
that the infant can swallow without choking.
Oral feedings are begun with sterile water,
followed by frequent small feeding of formula.
Infants are usually not discharged until they
are taking oral fluids well and the gastrostomy
tube is removed.
Abnormal development of
genitourinary and pelvic
The rectum and urinary tract separate
completely by the seventh week of gestation.
Is the most common congenital
anomaly of GIT in newborn.
There is no anal opening.
The nurse is unable to insert the
No passage of meconium.
Later on abdominal distention and pain
The anal area should be kept dry and clean.
If a colostomy has been done the skin around
the wound must be clean and apply
colostomy clean dressing.