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IMPERFORATED_ANUS IN NEONATE-a congenital abnomalityS[1].pptx

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Congenital Abnormality-Imperforated Anus

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IMPERFORATE ANUS PRESENTED BY: E. KUNGWIMBA TO: 2023 COHORT DATE: 6TH SEPTEBMER, 2024
OBJECTIVES ?Define imperforated anus ?Explain the causes of imperforated anus ?Explain the types of imperforated anus ?Describe the therapeutic management ?Describe the nursing management
DEFINITION ?Imperforate anus or anal atresia is a congenital anorectal malformation (ARM) where a normal anal opening is absent at birth.
IMAGES FOR IMPERFORATE ANUS
IMAGE OF IMPERFORATED ANUS
Pathophysiology ?Anorectal malformations occur during the 8 to 12 weeks of fetal gestation due to the failure to complete the development of the hindgut. ?There is impaired septation, and the cloacal membrane is usually found to be short in its dorsal part; thus, the hindgut retains its attachment to the sinus urogenitalis.
CAUSES ? The causes are not known. However the occurrence is 1 in every 5,000 live births. It is common in males and no racial evidence has been documented ? Studies have also shown that a family with a previous imperforated anus of a sibling, they are more likely to get the condition, however, there is no evidence to determine genetic predisposition
CLINICAL PRESENTATIONS ? Failure to pass meconium during the first 24 hours of birth. ? Abdominal distention ? Examine the perineum thoroughly at birth and after 24 hours. ? There is no anal opening or there could be a small depression (an anal pit).
Clinical presentation ctd NOTE: ? The presence of a small orifice, not at the normal position of the anus, may indicate a perineal fistula. ? This defect is usually present anterior to the anal sphincter complex. ? There may be a fistula to the genitourinary tract if stool is noted coming out of the urethra or vagina instead of the anus.
TYPES OF IMPERFORATED ANUS LOW TYPE ? Opening is present but either in the wrong position or its covered by a membrane HIGH TYPE ? No opening is present
MANAGEMENT ASSESMENT ? Inspect the perineum for location and size of the anal opening ? If no opening, careful inspection of the genital urinary should be done to exclude any other openings ? In males the opening may be found in recto prostatic or recto urinary ? In females the fistula may open at the posterior vestibule or vaginaly
THERAPEUTIC MANAGEMENT management depends on type LOW TYPE ?Surgery is done to open the membrane ?Dilatation of the opening is also done ?Surgery to reconstruct the anus is done
Management cont´.. HIGH TYPE ?First surgery is done immediately to create a colostomy and mucosa fistula ?Ends of the bowel are brought out through the stomach to create one or 2 openings(stoma) then a colostomy bag is connected to collect the stools through the stoma
Management cont´ ?Second surgery is done 3 to 6 months later. ?This is done to rebuild the anal opening ?Third surgery is done 2 t0 3 months later. ?This is aimed at closing the colostomy and the mucus fistula, and the bowels are reconstructed
NURSING MANAGEMENT Infection prevention. ? Teach the mother to keep the area around the colostomy clean with soap and water and to diaper the baby in the usual way; ? monitor white blood cell (WBC) count to rule out infection; and ? wash hands before and after handling the baby and teach the mother to wash hands before contact with the baby and between procedures with the baby.
Nursing management cont´. ? Protect skin integrity. A protective ointment is useful to protect the skin around the colostomy; ? monitor site of impaired tissue integrity at least once daily for color changes, redness, swelling, warmth, pain, or other signs of infection; and ? keep a sterile dressing technique during wound care.
Nsg management cont´. Restore balanced fluid volume. ? Administer parenteral fluids as prescribed; ? consider the need for an IV fluid challenge with an immediate infusion of fluids for patients with abnormal vital signs;
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IMPERFORATED_ANUS IN NEONATE-a congenital abnomalityS[1].pptx

  • 1. IMPERFORATE ANUS PRESENTED BY: E. KUNGWIMBA TO: 2023 COHORT DATE: 6TH SEPTEBMER, 2024
  • 2. OBJECTIVES ?Define imperforated anus ?Explain the causes of imperforated anus ?Explain the types of imperforated anus ?Describe the therapeutic management ?Describe the nursing management
  • 3. DEFINITION ?Imperforate anus or anal atresia is a congenital anorectal malformation (ARM) where a normal anal opening is absent at birth.
  • 6. Pathophysiology ?Anorectal malformations occur during the 8 to 12 weeks of fetal gestation due to the failure to complete the development of the hindgut. ?There is impaired septation, and the cloacal membrane is usually found to be short in its dorsal part; thus, the hindgut retains its attachment to the sinus urogenitalis.
  • 7. CAUSES ? The causes are not known. However the occurrence is 1 in every 5,000 live births. It is common in males and no racial evidence has been documented ? Studies have also shown that a family with a previous imperforated anus of a sibling, they are more likely to get the condition, however, there is no evidence to determine genetic predisposition
  • 8. CLINICAL PRESENTATIONS ? Failure to pass meconium during the first 24 hours of birth. ? Abdominal distention ? Examine the perineum thoroughly at birth and after 24 hours. ? There is no anal opening or there could be a small depression (an anal pit).
  • 9. Clinical presentation ctd NOTE: ? The presence of a small orifice, not at the normal position of the anus, may indicate a perineal fistula. ? This defect is usually present anterior to the anal sphincter complex. ? There may be a fistula to the genitourinary tract if stool is noted coming out of the urethra or vagina instead of the anus.
  • 10. TYPES OF IMPERFORATED ANUS LOW TYPE ? Opening is present but either in the wrong position or its covered by a membrane HIGH TYPE ? No opening is present
  • 11. MANAGEMENT ASSESMENT ? Inspect the perineum for location and size of the anal opening ? If no opening, careful inspection of the genital urinary should be done to exclude any other openings ? In males the opening may be found in recto prostatic or recto urinary ? In females the fistula may open at the posterior vestibule or vaginaly
  • 12. THERAPEUTIC MANAGEMENT management depends on type LOW TYPE ?Surgery is done to open the membrane ?Dilatation of the opening is also done ?Surgery to reconstruct the anus is done
  • 13. Management cont´.. HIGH TYPE ?First surgery is done immediately to create a colostomy and mucosa fistula ?Ends of the bowel are brought out through the stomach to create one or 2 openings(stoma) then a colostomy bag is connected to collect the stools through the stoma
  • 14. Management cont´ ?Second surgery is done 3 to 6 months later. ?This is done to rebuild the anal opening ?Third surgery is done 2 t0 3 months later. ?This is aimed at closing the colostomy and the mucus fistula, and the bowels are reconstructed
  • 15. NURSING MANAGEMENT Infection prevention. ? Teach the mother to keep the area around the colostomy clean with soap and water and to diaper the baby in the usual way; ? monitor white blood cell (WBC) count to rule out infection; and ? wash hands before and after handling the baby and teach the mother to wash hands before contact with the baby and between procedures with the baby.
  • 16. Nursing management cont´. ? Protect skin integrity. A protective ointment is useful to protect the skin around the colostomy; ? monitor site of impaired tissue integrity at least once daily for color changes, redness, swelling, warmth, pain, or other signs of infection; and ? keep a sterile dressing technique during wound care.
  • 17. Nsg management cont´. Restore balanced fluid volume. ? Administer parenteral fluids as prescribed; ? consider the need for an IV fluid challenge with an immediate infusion of fluids for patients with abnormal vital signs;