Galen NURS 3600 GI disorders (Exam 3)
Anorectal Malformations - correct answer Interruption 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 - correct answer Narrowing of rectum
S/S of Rectal Stenosis (4) - correct answer Ribbonlike/narrow stools (may not be apparent at
birth)
Difficulty pooping
Vomiting
Distended abdomen
Imperforate Anus - correct answer Absence of anus that may include rectal fistula
Rectal Fistula - correct answer Stool from vagina or urethra
Anal atresia - correct answer Anus is present but rectum is incomplete/closed
S/S of Anal Atresia or Imperforate Anus (1) - correct answer No stools
Diagnostics for Anorectal Malformations (5) - correct answer Physical Exam
MRI
X-Ray
Ultrasound
IV Pyelogram/voiding cystogram for malformations including the urinary tract
Treatment of Anorectal Malformations - correct answer ALL 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) - correct answer NPO
IV maintenance with fluids that include sugar
Post-op Interventions for Anorectal Malformations (8) - correct answer VS
I&O
,pain management
infection control
skin care
monitor stools
NG decompression
PO feedings after bowel sounds become present
Education for Anorectal Malformations (7) - correct answer Colostomy care
Manual anal dilation instructions
Dietary fiber
Maintain fluids
Infection prevention
Stool softeners
May need to delay toileting
Hypertrophic pyloric stenosis - correct answer Constriction of the pyloric sphincter with
obstruction of the gastric outlet
Cause of pyloric stenosis - correct answer Unknown, may be ganglion immaturity
Risk factors of pyloric stenosis - correct answer 1st born white males
Family hx
S/S of pyloric stenosis (6) - correct answer Normal 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) - correct answer Palpable olive shaped mass
Abdominal x-ray
Abdominal ultrasound
, GI series with positive "string sign"
Treatment for pyloric stenosis - correct answer pyloromyotomy: laparoscopic procedure to
expand pyloric sphincter
Pre-op interventions for pyloric stenosis (3) - correct answer NPO
IV fluids
Assess hydration (surgery may be delayed to rebalance electrolytes if dehydrated)
Post-op interventions for pyloric stenosis (5) - correct answer VS
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) - correct answer Wound 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 - correct answer 4th most common congenital defect
Palate/lip is not fully formed in utero
Leads to problems feeding
S/S of cleft palate - correct answer Unilateral/bilateral CP/CL
with or without each other
Uvula may contain cleft
Treatment of CL/CP - correct answer Surgery:
CL 1st around 2-3mo, z-plasty
CP 2nd around 6-12mo, pharyngeal flap
May need multiple surgeries
Anorectal Malformations - correct answer Interruption 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 - correct answer Narrowing of rectum
S/S of Rectal Stenosis (4) - correct answer Ribbonlike/narrow stools (may not be apparent at
birth)
Difficulty pooping
Vomiting
Distended abdomen
Imperforate Anus - correct answer Absence of anus that may include rectal fistula
Rectal Fistula - correct answer Stool from vagina or urethra
Anal atresia - correct answer Anus is present but rectum is incomplete/closed
S/S of Anal Atresia or Imperforate Anus (1) - correct answer No stools
Diagnostics for Anorectal Malformations (5) - correct answer Physical Exam
MRI
X-Ray
Ultrasound
IV Pyelogram/voiding cystogram for malformations including the urinary tract
Treatment of Anorectal Malformations - correct answer ALL 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) - correct answer NPO
IV maintenance with fluids that include sugar
Post-op Interventions for Anorectal Malformations (8) - correct answer VS
I&O
,pain management
infection control
skin care
monitor stools
NG decompression
PO feedings after bowel sounds become present
Education for Anorectal Malformations (7) - correct answer Colostomy care
Manual anal dilation instructions
Dietary fiber
Maintain fluids
Infection prevention
Stool softeners
May need to delay toileting
Hypertrophic pyloric stenosis - correct answer Constriction of the pyloric sphincter with
obstruction of the gastric outlet
Cause of pyloric stenosis - correct answer Unknown, may be ganglion immaturity
Risk factors of pyloric stenosis - correct answer 1st born white males
Family hx
S/S of pyloric stenosis (6) - correct answer Normal 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) - correct answer Palpable olive shaped mass
Abdominal x-ray
Abdominal ultrasound
, GI series with positive "string sign"
Treatment for pyloric stenosis - correct answer pyloromyotomy: laparoscopic procedure to
expand pyloric sphincter
Pre-op interventions for pyloric stenosis (3) - correct answer NPO
IV fluids
Assess hydration (surgery may be delayed to rebalance electrolytes if dehydrated)
Post-op interventions for pyloric stenosis (5) - correct answer VS
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) - correct answer Wound 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 - correct answer 4th most common congenital defect
Palate/lip is not fully formed in utero
Leads to problems feeding
S/S of cleft palate - correct answer Unilateral/bilateral CP/CL
with or without each other
Uvula may contain cleft
Treatment of CL/CP - correct answer Surgery:
CL 1st around 2-3mo, z-plasty
CP 2nd around 6-12mo, pharyngeal flap
May need multiple surgeries
