Congenital Anomalies of G.I.T

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Congenital Anomalies of G.I.T Powered By Docstoc
					     Prepared by
Dr. Hoda Abed El Azim
   State common types of congenital anomalies in GIT.
   Compare and contrast between cleft lip and palate
    (CL/CP).
   Discus pre and postoperative care of CL/CP.
   Compare and contrast between the types of hernias.
   Identify the clinical manifestation of esophageal
    artesia (EA).
   Discus pre and postoperative care of esophageal
    artesia (EA).
   Identify Anorectal malformations.
The most common anomalies are:

    1.   Cleft Lip or Cleft Palate
    2.   Hernias
    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:
   Small notch
   Extending into the base of
    the nose.
   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.
     Pediatrics
     Plastic surgery
     Speech/ language pathology
     Audiology
     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
  have:
 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
  tympanic membrane.
It is important for nurse to emphasis not only the
  infant’s physical needs but also on the parents
  emotional needs.
 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
    right position.

   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
    line.

   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
    pain.
   Clear liquids are offered when the infant has
    fully recovered from anesthesia.
   The suture site are is carefully cleansed of
    formula.

   A thin layer of antibiotic ointment.
   Genital aspiration of mouth and
    nasopharyngeal secretions.
   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
    days.
   Elbow restrains.
   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.
through
     The diaphragm,
     The abdominal wall, or
     The inguinal canal.
1. Diaphragmatic Hernias
Protrusion of abdominal organs through
 opening in diaphragm.

Symptoms
 Mild to severe respiratory
  distress
 Tachypnea , cyanosis,
  dyspnea
 Absent breath sound.

 shock
Diagnosis
   Symptoms
   Radiographic study.
   Prenatally as early as 25 week of gestation.


Therapeutic
 Supportive treatment of respiratory distress
 (Use of end tracheal intubation, oxygenation).
 Prophylactic antibiotics.
 Surgical reduction of hernia and repair of
  defect.
Preoperative
   Resuscitation, maintain suction, oxygen.
   IV fluids
   Positioning head up.
   Administer medication


Post operative
   Carry out routine postoperative care and
    observation.
 Protrusion of stomach
 through esophageal hiatus.




Symptoms
 Dysphagia, vomiting,
 Bleeding (hematemesis)
3.Umbilical Hernia
Weakness in abdominal wall around umbilicus,
 incomplete closure of abdominal wall
 allowing intestinal contents to protrude
 through opening.

Symptoms
   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.

Clinical manifestation
 Excessive salivation.
 Coughing, choking, cyanosis,
 Apnea
 Abdominal distention.
   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
    administer.
   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
    incubator.
   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
              organs.

  The rectum and urinary tract separate
completely by the seventh week of gestation.
   Is the most common congenital
    anomaly of GIT in newborn.
Diagnosis
 There is no anal opening.
 The nurse is unable to insert the
  thermometer.
 No passage of meconium.
 Later on abdominal distention and pain
  occur.
   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.