Anorectal Malformations - AnswersInterruption in the rectum preventing proper bowel movements.
Includes Anal atresia, Rectal stenosis, Imperforate anus, and rectal fistula.
One of the most common congenital defects
Rectal Stenosis - AnswersNarrowing of rectum
S/S of Rectal Stenosis (4) - AnswersRibbonlike/narrow stools (may not be apparent at birth)
Difficulty pooping
Vomiting
Distended abdomen
Imperforate Anus - AnswersAbsence of anus that may include rectal fistula
Rectal Fistula - AnswersStool from vagina or urethra
Anal atresia - AnswersAnus is present but rectum is incomplete/closed
S/S of Anal Atresia or Imperforate Anus (1) - AnswersNo stools
Diagnostics for Anorectal Malformations (5) - AnswersPhysical Exam
MRI
X-Ray
Ultrasound
IV Pyelogram/voiding cystogram for malformations including the urinary tract
Treatment of Anorectal Malformations - AnswersALL require surgery
New anus: 1st surgery to form colostomy and resect intestine
2nd to remove colostomy and anastomosis
May include manual dilation
Pre-op Interventions for Anorectal Malformations (2) - AnswersNPO
IV maintenance with fluids that include sugar
Post-op Interventions for Anorectal Malformations (8) - AnswersVS
,I&O
pain management
infection control
skin care
monitor stools
NG decompression
PO feedings after bowel sounds become present
Education for Anorectal Malformations (7) - AnswersColostomy care
Manual anal dilation instructions
Dietary fiber
Maintain fluids
Infection prevention
Stool softeners
May need to delay toileting
Hypertrophic pyloric stenosis - AnswersConstriction of the pyloric sphincter with obstruction of the
gastric outlet
Cause of pyloric stenosis - AnswersUnknown, may be ganglion immaturity
Risk factors of pyloric stenosis - Answers1st born white males
Family hx
S/S of pyloric stenosis (6) - AnswersNormal feedings then sudden, projectile, non-bilious vomiting (often
occurs within 16 min of feeding)
Olive shaped mass
Dehydration
Weight loss
Visible reversal peristalsis in LUQ
Constipation
, Diagnostics for pyloric stenosis (4) - AnswersPalpable olive shaped mass
Abdominal x-ray
Abdominal ultrasound
GI series with positive "string sign"
Treatment for pyloric stenosis - Answerspyloromyotomy: laparoscopic procedure to expand pyloric
sphincter
Pre-op interventions for pyloric stenosis (3) - AnswersNPO
IV fluids
Assess hydration (surgery may be delayed to rebalance electrolytes if dehydrated)
Post-op interventions for pyloric stenosis (5) - AnswersVS
I&O
Fluids
Pain
PO Re-feeding: 6 hrs post op, start with 15 mL pedialyte Q2hr x2, if tolerated the 15 mL 1/2 formula x2,
then increase x15 after tolerated for 2 feeds. If vomiting occurs, stay at that level until tolerated x2
Education for pyloric stenosis (5) - AnswersWound care
Infection control
Change diaper often
Monitor after feedings: vomit is normal 48 hrs post-op
*call doc if vomiting after 48 hrs
cleft palate/lip - Answers4th most common congenital defect
Palate/lip is not fully formed in utero
Leads to problems feeding
S/S of cleft palate - AnswersUnilateral/bilateral CP/CL
with or without each other
Uvula may contain cleft