Intestine Problem

1/22/2009

Pediatric Surgery Care

Intestinal Obstruction

The intestine is made up of the small intestine and the large intestine (colon). The small intestine runs from the stomach to the large intestine.

By Susheewa Wichaikull

Bby

The colon runs from the end of the small intestine to the anus. The intestine absorbs nutrients and water from the diet.

Ob t Obstruction ti of f the th iintestine t ti occurs when h f food d and water cannot pass through the intestine. The area of intestine nearest to the obstruction becomes dilated and non-functioning. If the obstruction is not relieved, it can lead to intestinal gangrene and perforation.

The most common causes of intestinal obstruction in adults are adhesions, hernias, and colon cancer. While each reason for intestinal obstruction requires a different treatment, all intestinal obstructions are potentially life-threatening.

Barium Operation In all cases, the intestine involved in the obstruction o struct on iss examined. am n . If f any parts of the th In the case of adhesions, the adhesion is removed, thus relieving the obstruction. In the case of a hernia, the hernia is repaired. If colon cancer is present, cancerous areas are removed, which also relieves the obstruction.

intestine look unhealthy from lack of blood flow during the period of obstruction, they are removed and the healthy ends are reconnected. A patient's recovery depends on several factors, including the cause of the intestinal obstruction and the length of time prior to relief of the obstruction.

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1/22/2009

Meckel's Diverticulum Meckel’s diverticulum is one of the most common congenital abnormalities. It occurs when the connection between the intestine and the umbilical r doesn’t n completely mp y close off ff during ur ng f fetal cord development. This results in a small outpouching of the small intestine, know as a Meckel’s diverticulum. In most cases, Meckel’s diverticula do not cause any problems.

Treatment Treatment of a Meckel’s diverticulum involves resection of the involved portion of the small intestine. Often, symptoms from a Meckel's

The small intestine is found and the Meckel's diverticulum is removed. The intestine is repaired and the incision is closed.

diverticulum are thought to be due to appendicitisand the Meckel's diverticulum is discovered only after the operation has begun.

Congenital megacolon(Aganglionic megacolon ) Hirschsprung’s disease occurs when the specialized nerve cells, called ganglion cells(parasympathetic ganglion cell) , fail to complete their normal Intravenous n r n u f fluids u will be g w given n un until the p patient n

migration for the entire length of the bowel during

is able to eat by mouth (after bowel sounds

fetal development.

are heard). A nasogastric tube may be in place to

The most common causes of Congenital

empty the stomach. Antibiotics may be given to prevent or treat infection. Discharge from the

megacolon(75%) are found in rectosigmoid.

hospital can be expected within a week after surgery, barring complications.

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Diagnosis and treatment •In an infant, failure to pass a bowel movement (meconium) within the first 48 hours of life first suggests Hirschsprung’s disease •severe constipation •If Hirschsprung’s disease is suspected, tests are used to confirm the diagnosis. A barium enema

Barium Enema

may be performed.

The contrast material outlines a bowel segment without ganglions (arrows), above which prestenotic dilatation is visible.

Treatment The operation requires 1-3 days in the hospital. Usually, the operation can be completed in one Patients diagnosed with Hirschsprung’s disease require an operation. The abnormal portion of

stage with no need for a colostomy. In some cases , such as an extremely long segment of abnormal

th b the bowell ((usually ll rectum t and d lower l colon) l ) is i

b bowel l or if serious i iinfection f ti is i present, t a

removed and intestine with normal nerve cells

temporary colostomy may be created, which is

is brought down and attached just above the anus.

reversed at a later operation.

The operations for Hirschsprung’s disease are referred to as "Pull-through procedures," because the normal intestine is "pulled through” the pelvis.

การพยาบาล

Nursing Care Pre-Operation

NPO NG Tube

NSS enema Record I/O

วย 0.9% NSS 300 ml เช้า ก่อนผ่าตัด สวนลางด ้ ้ เย็น ใช้สายยางเยอร์ 10-12 เด็กโตแขวนหม้อไม่เกิน 18 นิ้ว Record Intake Output ใส่ NG ระบายลม การจัดท่า ้ ช๊อค หลังผาตั ่ ด ป้องกันการติดเชือ ท้องอืด สารนํ้าสารอาหาร และความวิตกกังวลของครอบครัว

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A colostomy is performed when the lower

Colostomy

large intestine, rectum, or anus is unable to function normally, or needs rest from normal functions. Intestinal obstruction with associated inflammation, as in diverticulitis, is a common indication for colostomy.

The large intesting (colon) connects the small intestine to the stomach.

A colostomy creates an opening on the abdomen (stoma) for the drainage of stool (feces) from the large intestine (colon). Colostomies are usually performed after resection of the diseased colon. Colostomies may be temporary or they may be permanent. The proximal end of the healthy colon is brought out to the skin of the abdominal wall, where it is sutured in place. An adhesive drainage bag (stoma appliance) is placed around the opening. The abdominal incision is then closed.

More than 90% of colostomy cases are successful. There is considerable pain after surgery as the anus tightens and relaxes, but medications are available to relieve this. To avoid straining, stool softeners are used. Avoid any straining during bowel movement or urination. Soaking in a warm bath also brings additional comfort. Depending on the

Colostomy Care

disease process being treated, colostomies can be "taken down," and the colon is reconnected in a second operation within weeks to months after the first operation.

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1/22/2009

Necrotizing Enterocolitis Necrotizing enterocolitis (NEC) affects mainly premature babies. It is the most common surgical emergency in newborns. NEC accounts for 15% of n pr premature m ur babies w weighing g ng less than n deaths in 1500 grams. Overall death from those babies with NEC is 25%.

What are the signs and symptoms of NEC? NEC is difficult to diagnose. The baby may have lethargy, poor feeding, bilious vomiting, distended abdomen and blood

What causes NEC? It is now thought that NEC is the result of a combination of several factors. The two consistent findings are prematurity and feedings. The premature intestine reacts abnormally and develops an acute inflammatory response to feedings leading to intestinal necrosis (death).

How is NEC managed? Medical management consists of stopping feeds, nasogastric drainage to suction (tube in baby’s stomach to "suck out" contents), 7-14 days of antibiotics and IV nutrition. Close monitoring of

i stools. in l Physical Ph i l examination i i may show h

fluid status, electrolytes, coagulation and oxygen

the baby to have abdominal tenderness,

requirements are also necessary. 60-80% of babies

periumbilical darkening or erythema

with NEC are managed medically and symptoms

(redness, or a fixed loop of bowel that can be felt.

resolve without surgery. Feedings postoperatively are started slowly.

What if surgery is needed? Surgery is necessary if medical management fails or the bowel is perforated (torn). After opening the abdomen, the surgeon may find a swollen, purple bowel with areas of necrosed (dead) bowel.

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