Gastrointestinal Disorders

Gastrointestinal Disorders
By:Jan Bazner-Chandler
CPNP, CNS, MSN, RN

Embryonic Development
* Failure to fuse = cleft lip and palate
* Failure to differentiate = duodenal stenosis
* Atresia or abnormal closing of structure:
o Esophogeal atresia
o Anal-rectal malformation
o Biliary atresia

Fetal Development
* Fistula is an abnormal connection
* Incomplete or abnormal placement
Prenatal History
* Birth weight
* Prematurity
* History of maternal infection
* Polyhydramnios
* Down Syndrome
Health History
* Congenital anomalies
* Growth or feeding problems
* Travel
* Economic status
* Food preparation
* General hygiene
* Family history of allergies

Present Illness
* Onset and duration of symptoms
* Weight loss or gain
* Recent changes in diet
Vomiting
Nursing Assessment
* Abdominal distention
* Abdominal pain
* Abdominal assessment
Measuring Abdominal Girth
Bowden Text
Diagnostic Tests
* Flat plate of abdomen
* Barium swallow or UGI
Diagnostic Tests
* Ultrasound
* CT scan = tumors, abscess, obstruction
* 24 hour probe = Gastro esophogeal reflux
* Biopsy of liver, esophagus, stomach, intestine
Stool and Blood
* White blood cells
* Ova and Parasite
* Bacterial cultures
* Blood

FTT
Cleft Lip and Palate
Incomplete fusion of the primitive oral cavity
Feeding
Post Surgery Care
Cleft Lip Repair
Cleft Palate
Palate Repair
ESSR
Devices For Feeding
Whaley & Wong
Post Surgery Repair
Long Term Referrals
Esophageal Atresia
Failure of the esophagus
Clinical Manifestations
X-ray Findings
Pre-surgery Care
Post Surgery Care
Ball & Bindler
Post Operative Care
Long Term Complications
Pyloric Stenosis
Clinical Manifestations
Management Pre-surgery
Feeding Post-operatively
Hernias
Inguinal Hernia
Hydrocele
Umbilical Hernia
Diaphragmatic Hernia
Clinical Manifestations
X-ray Diaphragmatic Hernia
Treatment
* ECMO
* Ventilator support
* Chest tube
* Umbilical artery catheter
* NG tube
* Surgical correction when stable
Long Term Problems
Abdominal Defects
Omphalocele
Gastroschisis
Immediate Nursing Intervention
Gastroschisis Repair
Silastic Silo
Treatment
Prune Belly
Intussusception
Clinical Manifestation
Diagnostic X-ray
Management
Surgical Intervention
Hirschsprung Disease
Definition
Clinical Manifestations
Diagnosis and Treatment
Typical X-ray
Colostomy at Birth
Pull-through Surgery
Long Term Complications
Appendicitis
Pathophysiology
Clinical Manifestations
Appendectomy
Ruptured Appendix
Perforation
Interventions for Perforation
Post Operative Care
Nursing Interventions
Inflammatory Bowel Disease
Ulcerative Colitis
Crohn’s Disease
Diagnostic Tests
Drug Therapy
Gastro-esophageal Reflux
Clinical Manifestations GEF
Conservative Management GER
GERD: Gastro-esophageal Reflux Disease
Diagnostic Work-up for GERD
Pharmacologic Therapy
Surgical Management: GERD
Necrotizing Enterocolitis
NEC
Complications
Celiac Disease
Dietary Restrictions
Lactose Intolerance

Gastrointestinal Disorders.ppt

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Before and after fistula repair

Before and after fistula repair

Tracheoesohpageal fistula

An omphalocele is an abdominal wall defect at the base of the umbilical cord (umbilicus); the infant is born with sac protruding through the defect which contains small intestine, liver, and large intestine.

Gastroschisis:
Surgical repair of abdominal wall defects involves replacing the abdominal organs back into the abdomen through the abdominal wall defect, repairing the defect if possible, or creating a sterile pouch to protect the intestines while they are gradually pushed back into the abdomen.

Anorectal malformations; Anal atresia
Imperforate anus is a relatively common congenital malformation that occurs in about 1 out of 5,000 infants.
signs & symptoms
o absence of anal opening
o misplaced anal opening
o anal opening very near the vaginal opening in the female
o no passage of first stool within 24 to 48 hours after birth
o stool passed by way of vagina or urethra
o Abdomianl distention
o vomiting if infant is fed
o Asymmetry in leg positions
o Asymmetry of the thigh fat folds
o After 3 months of age, asymmetry of rotation of the leg and apparent shortening of the affected leg
o Diminished movement in the affected side

Signs & tests
Pediatricians routinely screen all newborns and infants for hip dysplasia. There are several maneuvers that can detect a dislocated hip or a hip that is able to be dislocated. A hip that is truly dislocated in an infant should be picked up but some cases are subtle and some develop after birth, which is why multiple examinations are recommended. Some mild cases are "silent"; and cannot be picked up on physical exam.

Ultrasound of the hip is the most important imaging study and will demonstrate hip deformity. A hip X-ray joint X-ray) is helpful in older infants and children.

Treatment
In early infancy, positioning with a device to keep the legs apart and turned outward (frog-leg position) will usually hold the femoral head in the socket. If there is difficulty in maintaining proper position, a plaster cast may be applied and changed periodically to accommodate growth. Operative management may be necessary if early measures to reduce the joint (put the joint back in place) are unsuccessful, or if the defect is first detected in an older child.

Prognosis
If the dysplasia is picked up in the first few months of life, it can almost always be treated successfully with bracing. In a few cases surgery is necessary to put the hip back in joint.The older the age at diagnosis, the worse the outcome and the bigger the surgery needed to repair the problem.

Talipes equinovarus; Talipes or Clubfoot
Signs & Symtptoms:
The physical appearance of the deformity may vary.
Treatment should be initiated as early as possible.
Polydactyly
Fingers or toes (digits) may be fused together (syndactyly) or the webbing between them (inter-digital webbing) may extend far up the digits. Syndactyly is seen commonly between the 2nd and 3rd toes, and is usually associated with a syndrome.
Signs & symptoms
Treatment
Epispadias
Malignant teratoma
Inborn errors of metabolism
TYPES & OTHER NAMES:
Galactosemia - nutritional considerations; Fructose intolerance - nutritional considerations; Maple sugar urine disease (MSUD) - nutritional considerations; Phenylketonuria (PKU) - nutritional considerations; Branched chain ketoaciduria - nutritional considerations

DEFINATION:
Genetic disorders (numbering in the dozens) in which the body cannot metabolize food components normally. These disorders usually involve minute changes in the breakdown of proteins, fats and carbohydrates. The body can become malnourished even when eating a well-balanced diet. See also galactosemia, PKU, lactose intolerance, and maple syrup urine disease

RECOMMENDATION
Inborn errors of metabolism often demand diet changes. The type and extent of the changes depends the specific metabolic error. Registered dietitians and physicians can help with the diet modifications needed for each disease.

Symptoms
o jaundice (yellowish discoloration of the skin and the whites of the eyes)
o vomiting
o poor feedig
o poor weight gain
o lethargy
o irritability
o convulsions
o pupil, white spots

Signs & tests
o hepatomegaly (enlarged liver)
o hypoglycemia (low blood sugar)
o aminoaciduria (amino acids are present in the urine)
o cirrhosis
o ascites (fluid collects in the abdomen)
o mental retardation
o cataract formation
Galactosemia
PRGNOSIS:
Phenylketonuria
Causes & risks
SIGNS & SYMPTOMS OF PKU
Trisomy 18 also known as Edwards syndrome
SIGNS & SYMPTOMS OF EDWARDS
Down syndrome; Trisomy 21; Mongolism
SIGNS & SYMPTOMS OF DOWNS
Common autosomal aberrations

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Neonatal Surgery

Neonatal Surgery
By:Juan E Gonzalez, CRNA, MS, ARNP
Based on prior lecture by
John P. McDonough, CRNA, Ed.D., ARNP
Professor & Director
Anesthesiology Nursing

Anatomical Differences
Pedi vs. Adult Airway
More Vertical
Less vertical
R mainstem bronchus
V-shaped
U-shaped
Shape of Epiglottis
Glottis
Cricoid
Narrowest Point
C3-C6
C2-C4
Laryngeal location

Head Position
Visual Alignment of Oral/Pharyngeal/Laryngeal axes
Attempt to achieve “sniffing” position will OBSTRUCT pt
Intubation
To intubate or not to intubate…
Is that a question??
Choice of Intubating Technique
Choice of Intubating Technique
(patient factors)
Blood Pressure Control
Emergence
Surgeries in the First Week of Life
* Congenital Diaphragmatic Hernia (CDH)
* Omphalocele & Gastroschisis
* Tracheoesophageal Fistula (TEF) (hrs-days to diagnose)
* Intestinal Obstruction (hr-days to diagnose)
* Meningomyelocele
Confounding Factors
* Prematurity
* Associated Congenital Anomalies
Maternal Cocaine Use in Pregnancy
Congenital Diaphragmatic Hernia
Embriologic features of CDH
CDH scenarios
CDH Clinical Presentations
Surgery & CDH
Anesthesia & CDH
Omphalocele
Gastroschisis
Delivery Room Management of Gastroschisis
Gastroschisis Periop Concerns
Postop Care of Gastroschisis & Omphalocele
Tracheoesophageal Fistula (TEF)
TEF Clinical Presentation
TEF Anesthetic Considerations
Tracheoesophogeal Fistula
“VATER” syndrome
Vertebral defects
Anal atresia
TEF
Esophageal atresia
Renal dysplasia
Intestinal Obstruction (Upper GI obstruction)
Intestinal Obstruction (Lower GI obstruction)
Lower GI obstruction
Meningomyelocele
Meningomyelocele
Hydrocephalus
Hydrocephalus Anesthetic Approach
Surgical Procedures in the First Month of Life
Inguinal Hernia Repair (IHR)
Inguinal Hernia Repair Anesthetic Techniques
Inguinal Hernia Repair Post Op Apnea in Premies
Ligation of PDA
Placement of Central Venous Catheter
References

Neonatal Surgery.ppt

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