Module 4 GASTRO

• Ankyloglossia (Tongue-tie)


  Congenital anomaly that causes restricted tongue mobility and impaired tongue function
• Ankyloglossia


  • Frenotomy release can be performed in the newborn period
• Thyroglossal cysts


  Irregular neck mass or lump that are congenital defects located in or around the midline of the neck, extending to the base of the tongue
• Thyroglossal cysts may occur as an autosomal dominant trait
• Infected thyroglossal cysts


  • Appear swollen and reddened, with drainage of mucus or pus from the anterior neck; requires antibiotic therapy
• Sistrunk procedure


  Common option chosen for the surgery of a thyroglossal duct cyst
• Cleft lip


  Most common orofacial cleft that may be unilateral or bilateral

  
• Causes of cleft lip

  • Transmission of multiple genes
  • Teratogenic factors present during weeks 5 to 8 of intrauterine life (viral infection, seizure medicines, maternal smoking or binge drinking, hyperthermia, stress, and maternal obesity)
  • Folic acid deficiency

  
• Cleft lip repair surgery

  • Usually done when the baby is around 3 months old

  
• Cleft palate


  Process does not close at approximately weeks 9 to 12 of intrauterine life, occurs more frequently in girls, incidence rate: 1 out of every 1,000 births

  
• Cleft palate repair surgery

  • Palatoplasty (10-12 months old)
• Cleft lip can be detected by a sonogram while an infant is in utero

  
• Because cleft palate is a component of many syndromes, assess the child for other congenital anomalies as well

  
• Cleft lip repair surgery

  • If discovered at birth - surgical repair: or between 2 and 12 weeks of age

  
• Rhinoplasty


  • May be necessary when the child reaches 4 to 6 years of age to straighten a deviated nasal septum

  
• Pierre Robin Sequence (Syndrome)

  Congenital birth defects that occur during fetal development, a rare triad of micrognathia (small mandible), cleft palate, and glossoptosis (a tongue malpositioned downward), resulting in severe upper airway obstruction
• Cause of Pierre Robin Sequence is unknown
• Pierre Robin Sequence is associated with Stickler Syndrome
• Therapeutic management of Pierre Robin Sequence

  • Monitor infants for possible airway obstruction, suctioning, maintaining prone positioning, severe cases may require tongue lip adhesion, mandibular distraction, or tracheostomy

  
• Esophageal atresias and tracheoesophageal fistulas

  Incomplete formation of the esophageal lumen, resulting in the proximal (upper) esophagus forming a "blind pouch," which then does not connect to any other structure, and an opening developing between the closed distal (lower) esophagus and the trachea
• Assessment of esophageal atresias and tracheoesophageal fistulas

  • Frothy saliva in the mouth and nose
  • Excessive drooling
  • Inability to swallow feeding
  • Vomiting
  • Abdominal distention
  • Respiratory distress
• Therapeutic management of esophageal atresias and tracheoesophageal fistulas

  • Emergency actions to prevent pneumonia, best position: upright, 60-degree angle, nasogastric tube insertion, gastrostomy tube insertion, IV fluids and parenteral nutrition, IV medications, surgery: closing the fistula and anastomosing the esophageal segments
• Umbilical hernia

  Protrusion of a portion of the intestine through the umbilical ring, muscle, and fascia surrounding the umbilical cord
• Umbilical hernia

  • If the fascial ring is less than 2 cm, closure will usually occur spontaneously after the child begins to walk to around 2 years of age, so surgical repair is often not necessary for mild (small) cases, 3-4 years - closed spontaneously if not, SURGERY will do
• Omphalocele

  Protrusion (herniation) of abdominal contents through the abdominal wall, involving organs like intestines, stomach and liver
• 67% of omphalocele cases are associated with other congenital disorders: cardiac, neurologic, genitourinary, skeletal, and chromosomal abnormalities
• Gastroschisis

  Derived from the Greek word for "stomach cleft" or "fissure", intestinal contents tends to herniate, increasing the potential for volvulus and obstruction, occurs because of failure of the abdominal wall to close, usually during the fourth week of development
• Assessment of gastroschisis

  • Sonogram, elevated maternal serum α-fetoprotein (MAFP) examination during pregnancy, cesarean birth may be performed if identified in utero
• Therapeutic management of omphalocele and gastroschisis

  • TPN, surgery within 24 hours to replace the bowel before the blood supply becomes hampered, small gastroschisis: one-stage repair, large: use of a prosthetic patch repair or replace only a portion of the bowel at one time, omphalocele - if the sac is ruptured, the defect is treated like gastroschisis, if unruptured: external dressing producing mild pressure may be used over the intact membrane
• Intussusception

  The invagination of one portion of the intestine into another, caused by idiopathic reasons or a "lead point" on the intestine like a polyp or bowel tumors
• Assessment of intussusception

  • Severe pain and vomiting (vomitus with bile)
  • Stool - a "red currant jelly" (blood + mucus)
  • Distended abdomen
  • If necrosis occurs: elevated temperature, increased WBC, rapid pulse, peritoneal irritation
  • Episodes of crying are for a short time but repeat every 15 to 20 minutes, the stomach feels "full" and vomitus and diarrhea with blood may occur
• Intussusception is confirmed by an abdominal X-ray, or ultrasound
• Nursing diagnosis for intussusception

  Pain related to abnormal abdominal peristalsis
• Therapeutic management of intussusception

  • Reduction by either instillation of a water-soluble solution, barium enema, or air (pneumatic insufflation) into the bowel or surgery to reduce the invagination, observe for 24 hours for possible recurrence after reduction
• Inguinal hernia

  Protrusion of a section of the bowel into the inguinal ring, occurs more commonly in boys but can also occur in girls due to weakness of the muscle surrounding the round ligament
• Assessment of inguinal hernia

  • Appears as a lump in the groin, apparent only on crying (when abdominal pressure increases), painless, diagnosed by history and physical appearance, herniated intestine can be palpated in the inguinal ring
• Therapeutic management of inguinal hernia

  • Laparoscopy surgery, a surgical emergency, infants may have surgery before 1 year of age, keep the suture line dry and free of urine or feces to prevent infection, assess circulation in the leg on the side of the surgical repair to be certain that edema of the groin is not compressing blood vessels and obstructing blood flow to the leg
• Hirschsprung Disease (Aganglionic megacolon)

  Absence of ganglionic innervation to the muscle of a section of the bowel, usually the lower portion of the sigmoid colon just above the anus, resulting in chronic constipation or ribbonlike stools
• Hirschsprung Disease is caused by an abnormal gene on chromosome
• Assessment of Hirschsprung Disease

  • Become apparent by 6-12 months of age, appear thin and undernourished, history of not having a bowel movement more than once a week of ribbonlike or watery stools, rectal exam shows the rectum is empty because fecal material cannot pass into the rectum through the obstructed portion