Chapter 5

• Chapter 5

  5.1 Care of Child With GIT Problems

  • Pyloric Stenosis
  • Umbilical Hernia
  • Omphalocoele and Gastroschisis
  • Congenital Diaphragmatic Hernia
  • Inflammatory Bowel Diseases

  5.2 Care of Child with Cardiac Problem

  • Review of Fetal CirculationDiagnostic Tests for Cardiac Problems/Anomalies

  5.3 Congenital Cardiac Disorders

  5.4 Disorders With Increased Pulmonary Blood

  Flow

  • Disorders With Obstruction to Blood Flow
  • Disorders With Mixed Blood Flow

  5.4 Intraoperative Measures

  5.5 Post-partal Care Measures
• Full Name: hypertrophic pyloric stenosis (HPS)


  • A thickening or narrowing of the pylorus, a muscle in the stomach; When the pylorus thickens, food can’t pass through.
  • Happens to newborn; surgery can repair the problem.

  symptoms include:

  • forceful vomiting, which may cause dehydration.
• Pyloric stenosis affects 3 out of every 1,000 babies born
• Babies usually aren't born with pyloric stenosis. The thickening of the pylorus starts to happen in the weeks after birth
• Pyloric stenosis symptoms usually start when the baby is 2 to 8 weeks old, but can take up to five months for the symptoms to become apparent
• How pyloric stenosis is diagnosed

  1. Healthcare provider asks about eating habits

  2. Physical examination

  3. Blood test to check for dehydration or electrolyte imbalance
• Symptoms of pyloric stenosis

  • Frequent projectile vomiting
  • Abdominal pain
  • Dehydration
  • Hunger after feedings
  • Irritability
  • Small stools
  • Wave-like stomach motion right after eating
• Umbilical hernia


  -Part of the intestine bulges through the opening in the abdominal muscles near the bellybutton.

  
  

  In an infant, an umbilical hernia may be especially evident when the infant cries, causing the bellybutton to protrude. This is a classic sign of an umbilical hernia.

  
  

  Children's umbilical hernias often close on their own in the first two years of life, though some remain open into the fifth year or longer.
• Umbilical hernias that appear during adulthood are more likely to need surgical repair
• Cause of umbilical hernias

  During gestation, the umbilical cord passes through a small opening in the baby's abdominal muscles. The opening normally closes just after birth. If the muscles don't join together completely, an umbilical hernia may appear
• In adults, too much abdominal pressure contributes to umbilical hernias
• Causes of increased abdominal pressure in adults

  • Obesity
  • Multiple pregnancies
  • Fluid in the abdominal cavity
  • Previous abdominal surgery
  • Long-term peritoneal dialysis to treat kidney failure
• Umbilical hernias in infants

  • More common in premature babies and those with low birth weights
  • Slightly more common in black infants
  • Affect boys and girls equally
• Umbilical hernias in adults

  • More common in women
  • More likely to cause complications like intestinal blockage
• Umbilical hernias that appear during adulthood may cause abdominal discomfort
• Complications of umbilical hernias are rare in children, but can be life-threatening if the intestine becomes trapped and loses blood supply
• Diagnosis of umbilical hernia

  1. Physical exam

  2. Sometimes imaging studies like ultrasound or CT scan
• Treatment of umbilical hernias

  1. In babies, most close on their own by age 1 or 2

  2. Surgery is typically reserved for hernias that are painful, larger than 1-2 cm, don't decrease in size, or become trapped

  3. In adults, surgeons often use mesh to help strengthen the abdominal wall
• Omphalocele


  An opening (defect) in the middle of the abdominal wall at the bellybutton, where the intestines spill out and are covered by a thin sac
• Gastroschisis


  An abnormal opening of the abdominal wall near the bellybutton (usually to the right), where the intestines spill out without a sac covering them
• Omphalocele commonly occurs along with other birth defects and genetic syndromes
• Before birth, the exposed intestines in gastroschisis can become damaged by amniotic fluid, causing inflammation and complications
• Diagnosis of omphalocele and gastroschisis

  1. Blood tests

  2. Prenatal ultrasound

  3. Elevated alpha-fetoprotein in mother's blood can indicate gastroschisis
• Treatment of omphalocele and gastroschisis

  1. Exposed intestines are covered and protected after birth

  2. Nasogastric tube is inserted

  3. Surgery is required to replace the intestines and close the opening, often done gradually over days or weeks

  4. If the defect is large, doctors may need to create skin flaps to close it.

  5. If a large amount of intestine is sticking out, it is wrapped in a protective covering (called a silo) and gradually moved back into the abdomen over several days or weeks.
• Congenital diaphragmatic hernia (CDH)


  A hole in the diaphragm muscle that allows abdominal organs to move into the chest cavity
• CDH occurs early in pregnancy when the diaphragm fails to close properly
• CDH can cause the intestines, stomach, liver and other organs to move into the chest, affecting lung and heart development.

  If the intestines are in the chest, they don't develop the typical connections that hold them in place in the abdomen (malrotation). They may twist on themselves, cutting off their blood supply (volvulus).
• Symptoms of CDH

  • Severe breathing difficulties
  • Pulmonary hypertension
  • Heart development problems
  • Damage to abdominal organs
• In most cases, the cause of CDH is unknown, but it can be linked to genetic disorders or random gene mutations
• Complications of CDH

  • Lung problems
  • Stomach, intestine and liver problems
  • Heart disease
  • Recurrent infections
  • Hearing loss
  • Changes in chest and spine shape
  • Reflux
  • Growth and developmental issues
• Diagnosis of CDH


  1. Prenatal ultrasound

  2. Fetal MRI

  3. Fetal echocardiogram

  4. Genetic testing
• Treatment of CDH

  1. Close monitoring during pregnancy

  2. Fetoscopic endoluminal tracheal occlusion (FETO) surgery during pregnancy to help lung growth

  3. Care and surgery after birth to replace organs and close the opening
• Treatment of congenital diaphragmatic hernia

  1. Care before delivery

  2. FETO procedure (first and second procedures)

  3. Special delivery method (EXIT procedure)

  4. Care during delivery

  5. Care after delivery
• Fetoscopic endoluminal tracheal occlusion (FETO)


  an emerging treatment for severe CDH being studied
• FETO procedure

  1. First procedure: Surgeon makes incision, inserts fetal endoscope, places balloon in trachea to expand lungs

  2. Second procedure: Balloon is removed so baby can take air into lungs after birth
• (ex utero intrapartum treatment) EXIT procedure


  Delivery done by C-section with placental support until balloon is removed and breathing tube is in place
• Inflammatory Bowel Diseases

  Crypt abscesses are the accumulation of inflammatory cells within the crypts of the gastrointestinal tract
• Congenital heart defect


  A problem with the structure of the heart that a child is born with
• Types of congenital heart defects

  
  

  Altered connections in the heart or blood vessels

  • atrial septal defect (hole between the upper heart chambers)
  • ventricular septal defect (hole in the wall right and left lower chambers)
  • patent ductus arteriosus (connection between lung artery and body's main artery)
  • total or partial anomalous pulmonary venous connection (all or some blood vessels from lungs attach to wrong areas)

  Congenital heart valve problems

  • aortic stenosis
  • pulmonary stenosis
  • mitral valve stenosis
  • tricuspid valve stenosis
• Aortic stenosis


  A baby may be born with an aortic valve that has one or two valve flaps instead of three, creating a small, narrowed opening for blood to pass through