Altered Gastrointestinal Function II
Terms
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- What are some Congenital / Structural Malformations?
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- Cleft lip / palate
- Tracheoesophageal fistula
- Umbilical / inguinal hernia
- Hydrocele
- Omphalocele / Gastrochesis
- Congenital Diaphragmatic Hernia - Terminology:
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- Stenosis (narrowing)
- Fistula (passage / tunnel) ex. tunneling with wounds if they are not packed properly
- Atresia (closure)
- Agenesis (absence or incomplete development) - ex. absence of kidneys
*can be cause by genetics or toxins - What is Cleft Lip and Cleft Palate?
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- facial malformation (occurs during embroyonic development) *teratogen can cause malformation early in pregnancy
- Cleft LIP: unilateral or bilateral (MORE IN MALES)
- Cleft PALATE: isolated or associated with cleft lip / unilateral or bilateral (MORE IN FEMALES)
- 1 in 750 births
- higher incidence in Native American / Asian
- often associated with other anomalies - What are the S&S of Cleft lip and Cleft palate?
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- recurrent EAR INFECTIONS (eustachian tube can be affected)
- feeding problems
- Nasal regurgitations during bottle feeding
- growth retardation
- misaligned teeth / poor speech (multiple follow up) - Surgical Correction of Cleft Lip or Cleft Palate:
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- closure of lip defect, then correction of the palate
- usually 3-6 MONTHS
- protect suture line with LOGAN BOW (metal bar that goes across the lip so the sutures are not pulled apart)
- Palate repair (Approximately 12 MONTHS)
- effect on speech development
*use pinky finger and go all the way back to the soft palate
*may need special equipment to breastfeed - What postoperative care is required for cleft lip / cleft palate surgery?
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- assess for bleeding & respiratory distress (may be aspirating fluids or blood)
- ensure adequate hydration / nutrition
- incision site care (may tape tongue depressors to elbows so they can\'t bend their arms to touch the site)
- discharge teaching
*avoid spoons and straws after surgery -
What is an
1. Esophageal Atresia
2. Tracheoesophageal Fistula -
1. Malformation that results from failure of the esophagus to develop as a continuous tube
2. Esophagus ends in a blind pouch or develops as a pouch connected to the trachea by a fistula - What are the S&S of Tracheoesophageal Fistula?
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- excessive salivation / drooling
- cyanosis
- choking
- coughing / sneezing
- abdominal distension
- returns fluid through the nose and mouth during feeding
- high risk for aspiration - How is tracheoesophageal fistula diagnosed?
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- S&S
- Inability to insert NG tube
- Xray
- maternal polyhydramnios (excess of amniotic fluid in the amniotic sac) - How is tracheoesophageal fistula managed?
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- elevate HOB
- suction accumulated secretions
- hydration
- gastric decompression
- prophylactic antibiotics - What surgeries and postop care is required for tracheoesophageal fistula and esophageal atresia?
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- Ligation (to bind or tie up)
- Anastomosis (surgical connection between two stuctures)
- respiratory support
- G tube to straight drainage for 24 hours
- G tube feeds progressing to oral feeds
- discharge teaching
- What are Umbilical / Inguinal Hernias?
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- incomplete closure of fascia (fibrous connective tissue that surrounds muscle) of umbilical ring
- incomplete closure of processus vaginalis (outpouching of the peritoneum [serous membrane that forms the lining of the abdominal cavity]
- abnormal protrusion of portion of omentum and intestine through umbilical opening or inguinal canal
- HIGHER among PREMATURE infants
- often associated with other anomalies - What are the S&S of umbilical / inguinal hernias?
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- soft swelling protruding through umbilicus or inguinal region
- size may increase with crying, coughing or straining
- painless
- reducible (can be pushed back into the abdominal cavity) - How are umbilical / inguinal hernias managed?
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- umbilical hernias may resolve spontaneously by 2-4 YEARS of AGE
- surgery (required if large and persistent)
- inguinal hernias repaired IMMEDIATELY
- assess for S&S of incarceration-emergency surgery (intestine becomes stuck in the abdominal opening and blood supply is reduced and can lead to intestinal tissue death)