Module 11: Alteration of Gastrointestinal Function in Children Flashcards
1
Q
These are congenital anomalies where the soft tissue or bony structure fails to fuse during embryonic development, leading to abnormal openings.
A
(A) Cleft Lip
(B) Cleft Palate
(May appear separately but more often together)
2
Q
How does cleft lip and palate present at birth?
A
It may appear separately or together and can be unilateral or bilateral.
3
Q
What are the risk factors for cleft lip and palate?
A
(A) Familial tendency (genetics)
(B) Maternal exposure to teratogens (alcohol, cigarette smoking, anticonvulsants, steroids, radiation)
(C) Infection (exposure to rubella virus)
(D) Nutrient deficiency (folate)
4
Q
This is known to help prevent neural tube defects and facial development, thus reducing the risk of a cleft lip or palate.
A
FOLIC ACID
5
Q
When does the lip and palate normally close during fetal development?
A
9 to 12 weeks (AROUND 3 MONTHS)
6
Q
How can cleft lip and palate be detected?
A
(A) Sonogram (prenatal ultrasound)
(B) Inspection at birth
7
Q
What are the physical characteristics of cleft lip?
A
Can range from a slight notch to a complete separation from the floor of the nose.
8
Q
What are the physical characteristics of cleft palate?
A
(A) Nasal distortion
(B) Midline or bilateral cleft
(C) It may extend from the uvula to the soft and hard palate.
9
Q
What are common concerns for infants with cleft lip and palate?
A
(A) Maternal acceptance – Some mothers may struggle with emotional acceptance.
(B) Feeding difficulties – Due to inability to form a proper seal for sucking.
10
Q
When is cleft lip surgery performed?
A
After birth (2 to 3 MONTHS OLD)
11
Q
What surgical techniques are used for cleft lip repair?
A
(A) Tension-Randall Triangular Flag (Z-plasty)
(B) Millard Rotational Advancement Technique
12
Q
When is cleft palate surgery performed?
A
6 to 18 MONTHS OLD
13
Q
What surgical techniques are used for cleft palate repair?
A
(A) Veau-Wardill-Kilner V-Y pushback procedure
(B) Furiow double-opposing Z-plasty
14
Q
What is the Rule of 10s for cleft lip surgery?
A
Surgery is performed when the baby is:
(A) 10 weeks old (2 months and 2 weeks)
(B) At least 10 lbs
(C) Hemoglobin of 10 g/dL
Surgery is done twice (when they are older).
15
Q
How can parents be supported in accepting a baby with cleft lip and palate?
A
Teaching and emotional support to help parents understand the condition and treatment options.
16
Q
What is the proper feeding position for a baby with cleft lip or palate?
A
Upright, cradled in the arm to prevent aspiration.
17
Q
What type of nipple should be used for feeding a baby with cleft lip or palate?
A
Wide-base nipple for better suction (CLEFT LIP FEEDER TO ASSIST IN BOTTLE FEEDING).
18
Q
How does cheek support help during feeding?
A
Squeezing the cheeks together decreases the width of the cleft, improving suction.
19
Q
What additional feeding techniques are recommended for infants with a cleft lip and palate?
A
(A) Bubbling well (burping frequently)
(B) Giving sips of fluid
(C) Introducing soft foods when appropriate
(D) Using a plastic palate guard for cleft palate
19
Q
Can a baby with cleft lip breastfeed?
A
Yes, similar to cheek support, breastfeeding can be possible.
20
Q
What is recommended for breastfeeding in babies with cleft palate
A
Breastmilk pumping and feeding with a cleft palate nurser.
21
Q
What are the different nursing management for a patient with a cleft lip and palate?
A
(A) Assess the ability to suck, swallow, and handle secretions and breathe without distress.
(B) Assess fluid and daily caloric intake.
(C) Monitor daily weight and modify feeding techniques.
(D) Hold in upright position and direct formula to the side and back of mouth to prevent aspiration.
(E) Feed small amounts gradually and burp frequently.
(F) Keep suction equipment and a bulb syringe at the bedside.
(G) Teach parents the ESSR method of feeding.
22
Q
Why is it important to assess fluid and calorie intake daily?
A
The baby needs to be at least 10 lbs before surgery for cleft lip repair.
23
Q
When should daily weight monitoring be done?
A
Before bath, every day.
24
How can feeding techniques be modified for babies with cleft lip or palate?
Use a special needs feeder to assist with feeding.
25
How should the baby be positioned during feeding to prevent aspiration?
Hold in an upright position and direct formula to the side and back of the mouth.
26
What is the ESSR method of feeding for babies with cleft lip and palate?
(A) Enlarge the nipple
(B) Stimulate the sucking reflex
(C) Swallow
(D) Rest to allow the infant to finish swallowing
27
What are the post operative management for cleft lip repair?
(A) Provide lip protection
(B) Position in an upright position to prevent airway obstruction by secretions blood or tongue
(C) Keep the surgical site clean and dry after feeding
(D) Apply antibiotic ointment as prescribed
(E) Use of elbow restraints
28
How can the lip be protected after cleft lip surgery?
Use adhesive tape to secure the cheek and support the surgical site.
29
What is the correct post-operative position to prevent airway obstruction?
Supine (on the back) in an upright position (Avoid prone - on the stomach position).
30
What are the post operative management for cleft palate repair?
(A) Resume feeding per bottle, breast or cup.
(B) Oral packing is secured to the palate.
(C) Do not allow the child brush his or her teeth.
(D) Instruct the parents to avoid offering hard food items (cookies, toast) as well as hard or rigid utensils.
31
What is the purpose of oral packing after cleft palate repair?
(A) Gauze on the soft palate applies pressure to stop bleeding.
(B) It is secured and remains in place for 2-3 days.
32
What are the post operative management for both cleft lip and cleft palate?
(A) Use of soft elbow or jacket restraints.
(B) Avoid use of oral suction or placing objects in the mouth.
(C) Provide analgesics for pain as prescribed.
(D) Instruct the parents in feeding techniques and in the care of surgical site.
(E) Instruct parents to monitor for signs of infection
at the surgical site (redness, swelling, discharge).
(F) Encourage the parents to hold the child.
(E) Comfort and initiate healing.
(F) Initiate appropriate referrals (dental, speech therapy).
33
This is a congenital malformation where the esophagus fails to develop into a continuous passage.
Esophageal Atresia
34
This is a condition where the trachea and esophagus fail to separate into distinct structures, leading to an abnormal connection.
Tracheoesophageal Atresia
35
What is the cause of EA and TEF?
The exact cause is unknown.
36
What prenatal condition is associated with EA and TEF?
Polyhydramnios (excess amniotic fluid) is present in 50% of cases.
37
How does polyhydramnios relate to EA and TEF?
The fetus cannot swallow and digest amniotic fluid, leading to increased amniotic fluid levels.
38
When does EA and TEF develop in utero?
Between weeks 4 to 8 of intrauterine life.
38
What is a major risk factor for EA and TEF?
Exposure to teratogens during pregnancy.
39
What happens in esophageal atresia (EA)?
There is obstruction in the esophagus, preventing food from reaching the stomach.
40
What is a fistula in TEF?
An abnormal opening between the esophagus and trachea.
41
This type of EA occurs when both the upper and lower segments of the esophagus end in a blind sac.
Pure EA (The second most common type. The ends of the upper and lower segment form a blind pouch with no connection to the stomach).
42
What happens when the upper segment of the esophagus ends in atresia and connects to the trachea by a fistulous tract?
(A) The upper segment is connected to the trachea.
(B) Food enters the lungs, causing a risk for coughing, choking, and aspiration.
43
What happens when the upper segment of the esophagus ends in a blind pouch, and the lower segment connects to the trachea by a fistulous tract?
The lower segment of the esophagus is connected to the trachea.
44
What happens when both segments of the esophagus connect to the trachea by fistulous tracts?
The baby may experience aspiration pneumonia due to food and secretions entering the airway.
45
What is the H-type fistula?
(A) The esophagus is continuous, but a fistulous tract connects it to the trachea.
(B) The trachea and esophagus are normal, but there is an abnormal connection between them.
46
What are the key signs of EA and TEF in a newborn?
(A) Frothy saliva in the mouth and nose
(B) Excessive drooling
47
What are the classic "3 C’s" of EA and TEF?
(A) Coughing
(B) Choking during feedings
(C) Unexplained cyanosis
48
What other symptoms indicate EA and TEF?
(A) Regurgitation and vomiting
(B) Abdominal distention due to air in the stomach (seen in cases where the stomach is connected to the trachea)
(C) Increased respiratory distress during and after feeding
49
What are the therapeutic management for EA and TEF?
(A) Maintenance of patent airway.
(B) Prevention of aspiration pneumonia.
(C) Decompression of gastric or blind pouch
(D) Supportive therapy (symptom relieving)
(E) Surgical repair of anomaly
49
What is the pre-operative nursing management for EA and TEF?
(A) Infant is placed in incubator or radiant warmer in which humidified oxygen is administered.
(B) Maintain NPO Status.
(C) Monitor IV fluids as prescribed.
(E) Monitor respiratory distress.
(E) Suction accumulated secretions from the mouth
and pharynx.
(F) Maintain in a supine upright position (at least 30 degrees upright).
(G) Keep the blind pouch empty of secretions by intermittent or continuous suction as prescribed.
(H) Broad-spectrum antibiotics may be prescribed because of the high risk for aspiration pneumonia.
50
What is the feeding status of an infant with EA and TEF?
NPO (Nothing by Mouth) is automatic to prevent aspiration
51
Why is a gastrostomy tube sometimes left open before surgery?
To allow air from the stomach to escape, reducing the risk of gastric regurgitation into the trachea.
52
How is the blind pouch managed?
Intermittent or continuous suctioning as prescribed to keep it empty.
53
This surgical procedure for EA and TEF involves division and ligation of TEF to separate the trachea and the esophagus.
Thoracotomy
54
What is the purpose of thoracotomy in EA & TEF repair?
(A) Drain fluid and air from the affected area.
(B) Reconnect the upper esophagus to the lower segment.
(C) A chest tube may be inserted to aid drainage.
55
This surgical procedure for EA and TEF involves connecting the upper segment and lower segment.
End to end Anastomosis or End to Side Anastomosis
56
What happens if the esophageal gap is too long for direct anastomosis?
A segment of the intestine is used to bridge the gap.
57
This surgical procedure for EA and TEF is used for feeding when oral intake is not possible. This also supports healing of the anastomosis site.
GASTROSTOMY
58
This surgical procedure for EA and TEF is done when anastomosis is not possible. This is used to drain the saliva to prevent aspiration pneumonia.
Cervical Esophagostomy (Feeding is done through a gastrostomy instead).
59
What vital signs and parameters should be monitored postoperatively for EA & TEF?
(A) Vital signs (especially respiratory status).
(B) Strict intake and output (I&O).
(C) Daily weight to assess for dehydration or fluid overload.
(D) Maintain IV fluids, parenteral nutrition and antibiotics as prescribed.
60
How is pain managed after surgery for EA & TEF?
After 24 to 36 hours
- Pharmacologic: Analgesics (for pain relief).
- Non pharmacologic: Independent nursing interventions (comfort measures).
61
Why is a chest tube sometimes present after surgery for EA & TEF?
To remove air and fluids from the lungs and maintain lung expansion (connected to a bottled drainage)
62
What are signs of anastomotic leaks to watch for after surgery for EA & TEF?
(A) Purulent drainage (pus) from the chest tube.
(B) Fever.
(C) Elevated WBC count in CBC results.
62
How is feeding managed postoperatively for EA & TEF?
Gastrostomy tube attached to a gravity drainage until oral feeding is tolerated (post-op day 5-7).
Gradual introduction of feeds:
(A) Start with water or clear fluids (first 5-7 days).
(B) Small frequent feedings of breast milk.
(C) Normal feeding progression once tolerated
63
When can the infant be discharged from the hospital for EA & TEF?
Once they tolerate oral feedings without complications.
64
What diagnostic test is performed before resuming full oral feeds for EA & TEF?
Esophagogram to check for leaks or strictures.
65
How should the cervical esophagostomy site be monitored for EA & TEF?
Assess for signs of infection (redness, swelling, discharge).
66
Why is non-nutritive sucking important postoperatively for EA & TEF?
(A) Helps reduce secretions.
(B) Provides oral stimulation.
(C) Prevents food aversion in infants on prolonged NPO status.
(D) Pacifiers can be used to satisfy the sucking reflex.
67
What are common symptoms of obstructive disorders?
(A) Abdominal Pain
(B) Nausea and vomiting
(C) Changes in stool pattern (constipation or diarrhea)
68
This condition occurs when there is hypertrophy or hyperplasia of the muscle surrounding the pyloric sphincter resulting into a thickened, elongated and narrowed pyloric channel.
Hypertrophic Pyloric Stenosis
68
What happens to the passage of food in hypertrophic pyloric stenosis?
The food cannot pass into the small intestine.
69
What are the risk factors for hypertrophic pyloric stenosis?
(A) Genetic Predisposition (familial tendency)
(B) More common in males
70
What is the most characteristic symptom of hypertrophic pyloric stenosis?
Projectile vomiting:
(A) 3-4 feet in side-lying position.
(B) 1 foot or more in supine position.
(C) Non-bilious but may be blood-tinged (NO green color).
71
How does an infant with hypertrophic pyloric stenosis behave during feedings?
Always hungry and eagerly accepts feedings, even after vomiting.
72
What is a key visual sign during or after feeding in hypertrophic pyloric stenosis?
Visible peristaltic waves from left to right across the epigastrium.
73
What is a key palpation finding in hypertrophic pyloric stenosis?
Olive-shaped mass in the epigastrium, just right of the umbilicus.
74
What electrolyte imbalances and complications can occur in hypertrophic pyloric stenosis?
(A) Dehydration
(B) Malnutrition
(C) Hypochloremia, hypokalemia, metabolic alkalosis due to prolonged vomiting
75
What diagnostic test is used for hypertrophic pyloric stenosis?
Sonogram (Abdominal Ultrasound)
76
What findings confirm hypertrophic pyloric stenosis on ultrasound?
(A) Thickened pylorus
(B) Narrowed pyloric canal.
77
This surgical procedure for hypertrophic pyloric stenosis is done by making an incision through the muscle fibers of the pylorus.
Pyloromyotomy (may be performed laprascopically)
78
What are the two types of pyloromyotomy?
(A) Fredet-Ramstedt's Pyloromyotomy.
(B) Laparoscopic Pyloromyotomy.
79
What are the pre-operative management of pyloric stenosis?
(A) Monitor hydration status through intake and output, daily weights and urine for specific gravity.
(B) Correcting fluid and electrolyte imbalance.
(C) Maintain NPO status as prescribed.
(D) Monitor the number and characteristic of stools.
(E) Maintain patency of the NG tube placed for stomach decompression.
80
What are signs of dehydration in hypertrophic pyloric stenosis?
(A) Dark yellow urine.
(B) High urine specific gravity (more concentrated).
81
How are fluid and electrolyte imbalances corrected preoperatively?
IV fluids to correct:
(A) Hypochloremia.
(B) Hypokalemia.
(C) Metabolic alkalosis.
82
What are the two functions of an NGT?
(A) Gavage – to give fluids/nutrition.
(B) Lavage – to remove stomach contents.
83
What are the post operative management for pyloric stenosis?
(A) Monitor intake and output.
(B) Begin with small frequent feedings and gradually increase the amount and interval between feedings until a full feeding schedule has been reinstated.
(C) Feed the infant slowly and burp frequently and handle minimally.
(D) Monitor for abdominal distention and signs of infection in the surgical site (redness, inflammation or pus (drainage).
(E) Instruct the parents on proper wound care and feeding.
84
When can feeding begin after surgery in HPS?
4-6 hours postoperatively with small, frequent feedings.
85
What indicates that the infant is tolerating fluids postoperatively in HPS?
No vomiting within 24 hours after surgery (Start with water → then progress to breast milk or formula).
86
What is the best position for the infant after feeding in HPS?
Upright or right side-lying (uses gravity to help food pass through the pyloric valve).
87
A condition where a section of the intestine folds into another section, causing obstruction of intestinal contents.
Intussusception
88
At what age does intussusception most commonly occur?
Usually in infants under 1 year old (idiopathic).
89
What causes intussusception in children over 1 year old?
A "lead point" such as:
(A) Meckel’s diverticulum (sagging of intestine).
(B) Polyps (excess tissue in the ileum).
(C) Hypertrophy of Peyer’s patches (lymphatic tissue flipping the bowel inward).
(D) Bowel tumors.
90
Where does intussusception usually occur?
At the juncture of the distal ileum and proximal colon.
90
Why is intussusception considered a surgical emergency?
It can cause edema, compression, decreased blood flow, infarction, and necrosis if untreated.
91
What are the key signs and symptoms of intussusception?
(A) Colicky pain (severe, intermittent episodes every 15 minutes).
(B) Bile-stained (green) vomitus.
(C) Palpable sausage-shaped mass in RUQ.
(D) Empty lower right quadrant (Dance sign).
(E) Red, currant jelly-like stool (12 hours after onset, due to blood vessel rupture).
(H) Abdominal distention.
92
What are the key signs and symptoms of intussusception if necrosis occurs?
(A) Elevated temperature.
(B) Rapid pulse.
(C) Peritoneal irritation.
(D) Increased WBC count.
93
What diagnostic tests confirm intussusception?
(A) Sonogram:
1. Coiled spring sign.
2. Bull’s eye (target) sign (indicates invagination).
(B) Rectal examination:
1. Presence of mucus and blood (suggests low intussusception).
93
What are the treatment options for intussusception?
(A) Hydrostatic reduction
(B) Reduction by enema (water soluble contrast enema, barium enema, and air (pneumatic insufflation where it pushes the telescoped bowel out).
(C) Surgical interventions
94
What are the different surgical interventions for intussusception?
(A) Straightening the invaginated portion.
(B) Resection (removal of the affected area if necessary).
95
What are the nursing responsibilities before surgery or non-surgical reduction for intussusception?
(A) NPO (before the procedure).
(B) Pacifier use (to provide comfort and reduce pain).
(C) IV fluid therapy (to maintain hydration).
96
What is the post operative management for intussusception?
(A) NGT Care (Attach to low intermittent suction).
(B) Maintain IV fluid therapy until suture line heals and peristalsis occurs.
(C) Monitor for recurrence (first 24 hours is critical - if it does happen, additional reduction or surgery is needed).
97
What are the possible nursing diagnosis for intussusception?
(A) Pain related to abnormal peristalsis
(B) Risk for deficient fluid volume related to bowel obstruction
(C) Risk for impaired parenting related to infant's illness
98
It is a neuromuscular disturbance where the gastroesophageal sphincter and the lower part of the esophagus are lax, allowing gastric contents to easily regurgitate into the esophagus.
Gastroesophageal Reflux (Achalasia)
99
What is the main problem in gastroesophageal reflux?
The easy regurgitation of stomach contents back into the esophagus.
100
When does gastroesophageal reflux usually start in infants?
It usually begins within one week after birth.
101
What anatomical condition is associated with gastroesophageal reflux?
Hiatal hernia, where the upper portion of the stomach herniates into the thorax or diaphragm,
102
Which children are at higher risk for gastroesophageal reflux?
(A) Those with cerebral palsy (CP)
(B) Those with neurological involvement
(C) Those with obesity (more acid reflux)
(D) Pregnant individuals (due to abdominal pressure)
103
What is the main symptom of gastroesophageal reflux in infants?
Frequent spitting up, regurgitation, and vomiting that is effortless and non-projectile.
104
Why might an infant with gastroesophageal reflux become irritable?
Due to discomfort from acid reflux.
105
How can reflux affect a child's growth?
It can lead to weight loss or failure to thrive.
106
What is a serious complication of gastroesophageal reflux in infants?
Episodes of apnea
107
What diagnostic test involves inserting a probe or catheter through the nose into the distal esophagus?
Esophageal pH monitoring.
108
What diagnostic procedure uses a fiberoptic endoscope to assess the esophagus?
Fiberoptic endoscopy.
109
What findings can fiberoptic endoscopy reveal in gastroesophageal reflux?
Erosion and edema
110
What imaging tests are used to diagnose gastroesophageal reflux?
(A) Esophagography
(B) Barium swallow
111
What are the two main types of medications used to treat gastroesophageal reflux?
(A) H2 receptor antagonists (e.g., Ranitidine/Zantac)
(B) Proton pump inhibitors (PPIs) (e.g., Omeprazole/Prilosec, Esomeprazole/Nexium, Lansoprazole/Prevacid)
112
When should proton pump inhibitors (PPIs) be given?
Before meals to decrease acid production.
113
Why is thickened food recommended for infants with gastroesophageal reflux?
it makes regurgitation more difficult.
114
What surgical procedure may be performed for severe gastroesophageal reflux?
Laparoscopic surgery.
115
What is the role of a nasogastric tube (NGT) after surgery?
It is attached to low suction to prevent aspiration and manage gastric secretions.
116
What is the surgical procedure used to prevent gastric contents from refluxing into the esophagus?
Nissen fundoplication.
117
How does Nissen fundoplication help with gastroesophageal reflux?
It tightens the lower esophageal sphincter so that not all gastric contents can flow back into the esophagus.
118
What are the key nursing responsibilities in managing gastroesophageal reflux?
(A) Identify symptoms of GERD.
(B) Educate parents on feeding, positioning, and medications.
(C) Provide care for a child undergoing surgical intervention.
119
What feeding and positioning advice should be given to parents of infants with GERD?
(A) Use thickened formula or food.
(B) Keep the child upright after feeding.
(C) Administer H2 receptor antagonists and proton pump inhibitors (PPIs) as prescribed.
120
What foods should be avoided in children with gastroesophageal reflux?
(A) Chocolate
(B) Citrus fruits
121
It is a congenital condition where ganglion cells or innervation are absent in a section of the bowel, leading to chronic constipation and bowel obstruction.
Hirschsprung's disease (Aganglionic megacolon)
122
What part of the bowel is commonly affected in Hirschsprung’s disease?
The lower portion of the sigmoid colon, just above the anus.
123
What is the genetic cause of Hirschsprung's disease?
A mutation in the RET Proto-Oncogene located on chromosome 10.
124
In which population is Hirschsprung’s disease more common?
It is more common in females and in Asian countries.
125
What is the incidence rate of Hirschsprung's disease?
It occurs in approximately 1 in 5,000 live births.
126
Which group of children has a higher risk of developing Hirschsprung's disease?
Siblings of children with the disorder have an increased risk.
127
What are the key symptoms of Hirschsprung’s disease?
(A) Chronic constipation (due to absence of peristaltic waves)
(B) Ribbon-like stools
(C) Dilated proximal bowel
128
What is the main difference between intussusception and Hirschsprung’s disease?
(A) Intussusception affects the small intestine.
(B) Hirschsprung’s disease affects the large intestine.
129
What is a key sign of Hirschsprung’s disease in a newborn?
Failure to pass meconium within 24 hours after birth.
130
What other symptoms may be present in a newborn with Hirschsprung’s disease?
(A) Abdominal distention
(B) Refusal to suck
(C) Bile-stained vomitus
131
When do symptoms of Hirschsprung’s disease typically become apparent?
Between 6 to 12 months, once the baby starts feeding.
132
What bowel history may be noted in affected infants?
A history of constipation or alternating constipation and diarrhea.
133
What are common symptoms of Hirschsprung’s disease in infants and children?
(A) Failure to gain weight (Failure to thrive)
(B) Chronic constipation
(C) Abdominal distention
(D) Episodes of diarrhea and vomiting
(F) Ribbon-like, foul-smelling stools
134
What are signs of enterocolitis, a serious complication of Hirschsprung’s disease?
(A) Explosive, watery diarrhea
(B) Fever
(C) Significantly ill appearance
135
What key questions should be asked during history-taking for suspected Hirschsprung’s disease?
(A) How long has the constipation been present?
(B) What do the parents mean by constipation?
(C) What is the consistency of the stool?
(D) Is the child experiencing other illnesses or symptoms?
136
What finding is expected during a digital rectal exam (DRE) in a child with Hirschsprung’s disease?
An empty rectum, even if the child is constipated.
137
What procedure is done to confirm the diagnosis in Hirschsprung’s disease?
Barium enema, which will show a narrow, nerveless portion of the bowel and dilated proximal portion of bowel.
138
What is the definitive confirmatory test for Hirschsprung’s disease?
Biopsy of the affected segment, which shows a lack of ganglion cells (no innervation).
138
What is the purpose of anorectal manometry in Hirschsprung’s disease?
It measures the pressure and nerve function of the internal rectal sphincter.
139
What is the difference in rectal sphincter response between a normal child and a child with Hirschsprung’s disease?
(A) Normal: Relaxation → Contraction
(B) Hirschsprung’s: Contraction → No relaxation
139
What is the recommended therapeutic management for a child with Hirschsprung’s disease?
(A) Maintain a low-fiber, high-calorie, high-protein
diet; parenteral nutrition may be necessary in
extreme situations.
○ Via IV therapy
(B) Administer stool softeners as prescribed.
○ Laxatives, glycerin
(C) Administer daily rectal irrigations with normal
saline to promote adequate elimination and
prevent obstruction as prescribed.
140
A surgery that removes the affected portion of the intestine and reconnects the healthy sections.
Transanal Soave Endorectal Pull-Through Procedure
141
What is the two-stage surgical approach for Hirschsprung’s disease?
(A) Temporary colostomy to allow the affected area to heal.
(B) Bowel repair at 12–18 months of age.
142
When is a permanent colostomy needed?
If there are no nerve endings in the anus, making normal bowel movements impossible.
142
What is an anastomosis in Hirschsprung’s disease surgery?
The process of removing the affected (aganglionic) bowel segment and surgically connecting the healthy intestine.
143
What are the key assessments before surgery for Hirschsprung’s disease?
(A) Assess bowel function (quantity, consistency of output)
(B) Auscultate bowel sounds
144
What preparations are done to clear the bowel before surgery for Hirschsprung’s disease?
(A) Administer enemas or laxatives as prescribed
(B) Maintain NPO status
(C) Monitor hydration and electrolytes (IV fluids may be needed)
(D) Administer antibiotics or colonic irrigations with
an antibiotic solution.
145
Why are antibiotics or colonic irrigations administered preoperatively for Hirschsprung’s disease?
To clear the bowel of bacteria and reduce infection risk before surgery.
146
What measurements and monitoring are required before surgery for Hirschsprung’s disease?
(A) Strict intake and output monitoring
(B) Daily weight measurement
(C) Daily abdominal girth measurement
(D) Avoid rectal temperature taking (to prevent trauma)
(E) Monitor for respiratory distress due to abdominal distention
147
What is the post operative management for Hirschsprung disease?
(A) Attach NGT with low suction.
(B) Maintain IV Infusion and attach foley catheter.
(C) Observe for abdominal distention, passage of flatus and stool.
(D) If with peristalsis: Remove NGT and start with small frequent feedings with gelatin and water.
(E) Gradually advance to a full fluid and soft diet (low residue).
148
A true congenital diverticulum (small bulge) in the small intestine, present at birth.
Meckel’s diverticulum
149
What causes Meckel’s diverticulum?
It is a vestigial remnant of the omphalomesenteric duct.
150
Why does Meckel’s diverticulum cause complications?
Misplaced gastric mucosa secretes gastric acid into the intestine, leading to:
(A) Irritation of the bowel wall
(B) Ulceration
(C) Bleeding
151
What serious complication can Meckel’s diverticulum lead to?
Intussusception (telescoping of the intestines).
152
What is the most common symptom of Meckel’s diverticulum?
Painless rectal bleeding.
.
153
What other symptom may be present in Meckel’s diverticulum?
Abdominal Pain
153
Does Meckel’s diverticulum always cause symptoms?
No. Many cases have no signs or symptoms.
154
What is the first step in diagnosing Meckel’s diverticulum?
A detailed history suggesting the condition.
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Why are X-ray and sonogram not always useful in diagnosing Meckel’s diverticulum?
The condition is often not visible on imaging, requiring exploratory surgery for confirmation.
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What is the definitive treatment for Meckel’s diverticulum?
Surgical removal of the vestigial structure.
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What is the purpose of surgical exploration in Meckel’s diverticulum?
To confirm the diagnosis and rule out other causes of rectal bleeding.
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What laboratory tests are done in suspected cases?
(A) Rule out bleeding disorders
(B) Evaluate the severity of anemia
159
What is a life-threatening complication of Meckel’s diverticulum?
Hypovolemic shock due to hemorrhage or fluid volume deficit.
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What are the key interventions to prevent hypovolemic shock?
(A) IV fluid therapy for hydration
(B) Blood replacement if there is significant blood loss
161
When are antibiotics given for Meckel’s diverticulum?
Both preoperatively and postoperatively to prevent infection.
