What is hirschprung's
AKA congenital aganglionic megacolon?
-Failure to pass meconium w'in 24-48h after birth
-Refusal to feed
What are the usually S/S of the
infant w/ Herschprung Disease AKA Congenital Aganglionic Megacolon?
Failure to thrive (FTT)
Episodes of diarrhea and vomiting
S/S of enterocolitis
(explosive water diarrhea, )
Appears significantly ill
What are the usually S/S of the
child w/ Herschprung Disease AKA Congenital Aganglionic Megacolon?
Ribbonlike, foul-smelling stool
Easily palpated fecal mass
undernourished, anemic appearance
history typically includes a chronic pattern of constipation and a barium enema often demonstrates the transition zone between the dilated proximal colon (megacolon) and the aganglionic distal segment. However, this typical megacolon and narrow distal segment may not develop until the age of 2 mos.
simple put: History and barium x-ray
surgically, once the child is stabilized with fluids and electrolytes.
Surgery consist primarily of the removal of the aganglionic portion of the bowel to...
-restore normal motility, and
-preserve fxn of the external anal sphincter
Herschprung Disease AKA Congenital Aganglionic Megacolon?
Anal stricture and incontinence may occur and require further therapy, including dilations or bowel retraining therapy.
Constipation and fecal incontinence are chronic problems is a significant proportion of pts after surgical correction of HD
The main objectives are to...
-help the parents adjust to a congenital defect in their child
-to foster infant-parent bonding
-to prepare them for the medical-surgical intervention
- assist them in colostomy care after discharge
-frequent VS esp. BP for shock
-Monitoring Fluid and electrolytes replacement
-observing for symptoms of bowel perforation...
-Fever, increasing ABD distention
-Vomiting, increased tenderness
-Irritability, dyspnea, and cyanosis
Measure ABD circumference with a paper tap measure...
To reduce stress during frequent ABD measurements leave the measuring tape in place beneath the child
(HPS) occurs when the circumferential muscle of the pyloric sphincter becomes thickened, resulting in elongation and narrowing of the pyloric canal.
This produces an outlet obstruction and compensatory dilation, hypertrophy, and hyperparastalsis of the stomach
-more common in first born children, and boys are 5 X's more likely than girls,
-less frequently in AA than Caucasians
-more likely to affect full term infants than premies
---but may be ass. w/ intestinal malrotation, esophageal and duodenal atresia, and anorectal anomalies.
-may be ejected 3-4 ft. when in the side lying position >= 1 ft. when lying on the back
-usually occurs shortly after a feeding, but may be several hours later
-may follow each feeding or appear intermittently
-nonbilious vomitous that may be blood tinged.
-infant hungry, avid nurser, eagerly accept a second feeding after vomiting episode.
-No evidence of pain or discomfort except that of hunger
-S/S of dehydration, -Distended upper ABD
-Readily palpable olive shaped tumor in epigastrium just to the right of the umbilicus
-Visible gastric parastaltic waves that move from left to right across the epigastrium
"no pee, no K+"
-The infant must be rehydrated and metabolic alkalosis corrected with parenteral fluid and electrolyte administration. The stomach is decompressed by NG tube
inflammation of the vermiform appendix (blind sac at the end of the cecum),
-----most common cause of emergency ABD surgery during child hood
-RLQ ABD pain -Fever -Rigid ABD
-Decreased of absent ABD sounds
-Vomiting (typically follows onset of pain)
-constipation or diarrhea -Anorexia
-Tachycardia, -rapid shallow breathing
-Pallor, -lethargy, -irritability, -stooped posture
McBurney point, located two thirds the distance between the umbilicus and the anterosuperior iliac spine... It is the most common point of tenderness
Tenderness at the point would indicate a positive Mcburney point.
CT scan has become the imaging technique of choice, although may also be helpful in dx.
CT is considered positive in the presence of enlarged appendiceal diameter, appendiceal wall thickening, and periappendiceal infammatory changes
What should the nurse know about laxatives/enema during severe ABD pain
-Sudden acute ABD pain (intermittent)
-Child screaming & drawing the knee onto the chest
-Child appears normal & comfortable btwn episodes of pain
-vomiting -lethargy -tender, distended ABD
-Passage of red, currant jelly-like stools (stool mixed with blood and mucous)
-Palpable sausage shaped mass in URQ
-Empty LRQ (Dance sign)
-Eventual fever, prostration, and other S/S of peritonitis
conservative treatment consist of radiologist-guided pneumoenema W or W/O water-soluble contrast
ultrasound hydrostatic (saline) enema====advantage---no ionizing radiation.
IV fluids, NG decompression, and ABX therapy may be used before hydrostatic reduction is attempted