Transcript Malformations of the Lower Gastrointestinal Tract

Malformations of the Lower
Gastrointestinal Tract
Jan Bazner-Chandler
RN, MSN, CNS, CPNP
Hernias
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A hernia is a protrusion of an organ or
part of an organ through the wall of the
cavity in which it is contained.
Inguinal Hernia
Inguinal Hernia
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Inguinal hernia is the most common congenital anomaly
requiring surgical repair in infants: 80%
It is a protrusion of peritoneal sac into the processus
vaginalis
Most common in males and pre-term infants.
Umbilical Hernia
More common in
African
American infants.
Congenital Diaphragmatic Hernia
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Protrusion of abdominal contents into the chest cavity
through a defect in the diaphragm.
Survival rate up to 80% due to advancement in surgical
correction.
Pathophysiology
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Defect may be large or small
Pulmonary involvement:
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hypoplastic lung with decrease in alveoli and arterioles
Pulmonary hypertension
Diaphragmatic Hernia
Bowden & Greenberg
Diaphragmatic Hernia
Note displacement of lung by intestines.
Assessment
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Respiratory distress or within the first few hours of life
Deceased or absent breath sound on affected side
Heart sounds may be shifted to the right
Chest sounds are dull on percussion
Tachypnea and cyanosis
High incidence of pneumothroax
X-ray Diaphragmatic Hernia
Interdisciplinary Interventions
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Pre-surgery
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Surgery
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Repair of the hernia
Postoperative care
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ECMO – extracorporeal membrane oxygenation
Management of pulmonary hypertension
Chest tube
Management of respiratory status
Ventilation support
Nutritional support
Surgical Repair
Long Term Problems
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Gastro Esophageal Reflux
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Respiratory infections
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Obstructions
Abdominal Defects
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Omphalocele
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Gastroschisis
Omphalocele
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Congenital malformation in which abdominal contents
protrude into the base of the umbilical cord.
Omphalocele
Omphalocele
Gastroschisis
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Defect in the abdominal wall that allows the abdominal
contents to protrude outside the body.
There is no covering over the bowel or contents.
Defect does not involve the umbilicus.
Gastroschisis
Immediate Nursing Intervention
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Cover with warm normal saline dressing in the delivery
room.
New standard: put child in small bag to retain heat and
keep intestines warm.
Surgical Repair
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If a small defect can be repaired with one surgery.
If abnormality is large surgeon may use Silastic Silo to
gradually return the bowel to the abdominal cavity.
Silastic Silo
Prune Belly
Weak abdominal wall