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Imperforate Anus


Finally, the hold is balance. Twain parents are calling their breaths in fluctuation as the mother held out her hands to cuddle her newborn baby. Everything environing the puny angel is ripe, save for one disregard detail: she was not potent to by out meconium on her chief day. The physician did an toll, and it was set out that the baby has no anal inauguration, a equablet of imperforate anus.

Description


Anorectal deformitys embrace a remote spectrum of defects in the product of the lowest interest of the intestinal and urogenital credits.

Imperforate Anus | Pamela Morrison Tangible Therapy, P.C.
  • When a deformity of the anus is give, the muscles and nerves associated behind a continuance the anus frequently possess a congruous station of deformity.
  • The pose and kind of these deformitys made recbalance obscure for forthcoming surgeons; the improbable organs are located abstruse in the pelvis and are not well-behaved-behaved visualized through abdominal incisions.

Pathophysiology


The embryogenesis of these deformitys offscourings unclear.

  • The rectum and anus are believed to amplify from the dorsal interest of the hindgut or cloacal pur-poseeness when colcolsecondary ingrowth of the mesenchyme creates the urorectal septum in the midline.
  • This septum separates the rectum and anal canal dorsally from the bladder and urethra; the cloacal duct is a disregard message betwixt the 2 interests of the hindgut.
  • Downgrowth of the urorectal septum is believed to suppress this duct by 7 weeks’ gestation; during this season, the ventral urogenital interest acquires an exterior inauguration; the dorsal anal membrane opens succeeding.
  • The anus amplifys by a disincorporate of the anal tubercles and an exterior invagination, disshut as the proctodeum, which abstruseens inland the rectum but is divided from it by the anal membrane; this separating membrane should disunite at 8 weeks’ gestation.
  • Interference behind a continuance anorectal edifice product at varying stages leads to several anomalies, ranging from anal stenosis, spoilt disorganization of the anal membrane, or anal agenesis to sufficient insufficiency of the loftier interest of the cloaca to nestle and insufficiency of the proctodeum to invaginate.

Statistics and Incidences


Anorectal deformitys exculpation in almost 1 newborn per 5000 speed origins.

  • Anorectal and urogenital deformitys are sometimes calamitous, although some associated anomalies (cardiac, renal) can be life-threatening.
  • Intestinal bung or postoperative septic complications in a newborn behind a continuance imperforate anus can consequence in lifelessness or cutting morbidity.
  • Malformation-connected morbidity relates to associated deformitys of rectal motility, anorectal innervation, and sphincteric musculature; the most despicable morbidity in this structure is constipation; most offspring possess moderate deformitys that despicablely consequence in constipation for reasons that endure unclear.
  • The most cutting creates of deformity-associated morbidity are fecal and urinary incontinence.
  • No disshut racial partiality has been reputed.
  • No disshut sex partiality has been reputed.
  • Most offspring behind a continuance an anorectal deformity are signed upon settlement newborn tangible establishment.

Clinical Manifestations


Newborns behind a continuance imperforate anus are commbarely signed upon the chief tangible establishment.

  • Absence of stool. Thither is no byage of stool behind a continuancein a day or two of origin.
  • Passing of stools in other inaugurations. The infant may by stools through another inauguration enjoy the urethra in boys or vagina in girls.
  • Swollen belly. The newborn could not by out stools, consequenceing in a turgid belly.
  • Absence of anal inauguration. The inauguration of the anus is privation or not in its common place; in girls, this may be neighboring the vagina.

Assessment and Diagnostic Findings


In the diagnosing imperforate anus the subjoined are intimateed:

An X-ray showing imperforate anus | Orphanet Journal of Rare Diseases
  • Laboratory studies. CBC number, blood typing and screening, and serum electrolyte rolls should be gauged in all offspring behind a continuance imperforate anus who demand operation; urinalysis should be manufactured to mention the influence of a rectourinary fistula in all equablets in which the personality cannot be made based barely on the tangible establishment opinions.
  • Sacral radiography. Two views of the sacrum, posteroanterior and collateral, should be obtained to gauge sacral ratios and to behold for sacral defects, hemivertebrae, and presacral concretiones; this should be manufactured anteriorly surgery.
  • Abdominal ultrasonography. This regard is specifically used to criticize the genitourinary credit and to behold for any other concretiones; hydronephrosis, hydrocolpos, presacral concretion, abdominal concretion, or any congruous opinion can profoundly assume treatment.
A laparoscopically assisted pull-through for (high) imperforate anus | JustRight Surgical
  • Spinal ultrasonography or MRI. All offspring behind a continuance any create of anorectal deformity, equable those regarded hither, should sustain screening for spinal deformitys; these lesions can be diagnosed using ultrasonography earlier to the ossification of the spine.
  • Lateral pelvic radiography at 24 hours. Offspring who could not be diagnosed based barely on tangible establishment opinions, orally lowerwent invertography, which consisted of calling the baby upborder down and using colcolsecondary radiography to note the roll of gas in the distal rectum; a congruous, but excite benevolent, mode is to hold 24 hours behind origin to note for potential maximal pelvic pouch distension and then to use cross-tpotent colcolsecondary pelvic radiography behind a continuance a radio-opaque marker on the anal dimple behind a continuance the branch in the prone pose and the hips partially eminent.
  • MRI. All offspring who possess sacral defects on smooth radiographs should sustain spine ultrasonography to administration out associated deformitys, such as meningocele or meningomyelocele, teratoma, or qualified lesions.
  • CT scanning. CT scanning gively plays no role in the settlement evaluation of offspring behind a continuance anorectal deformitys.

Medical Management


Management of an infant behind a continuance imperforate anus embrace:

  • Nothing per orem. Newborns behind a continuance imperforate anus should not be fed and should admit intravenous hydration.
  • Neonatal colostomy. A colostomy is manufactured in offspring who are not amenpotent to chief pull-through either accordingly of deformity entanglement (any urinary fistula in boys, vestibular fistula, and cloaca in girls, no fistula in either sex >1 cm from perineal husk) or associated comorbidity.
  • Primary neonatal pull-through behind a continuanceout colostomy. Many pediatric surgeons opt for chief pull-through in offspring behind a continuance perineal fistulas (or no fistulas) and suppress (< 1 cm) rectal pouches on 24-hour colcolsecondary pelvic radiography.
  • Posterior sagittal pull-through behind a continuance a colostomy. This mode is used in boys behind a continuance rectourinary fistula (bulbar, prostatic, or bladder-neck fistula), in girls behind a continuance cloaca or vestibular fistula, and in resigneds of either sex who do not possess a fistula when the rectal pouch is excite than 1 cm on 24-hour colcolsecondary bent abdominal radiography.
  • Colostomy blocking up. Once the damage has sufficiently adept and postoperative dilations possess achieved their design (i.e., the neoanus is at the desired bigness), the colostomy may be suppressd in oral surgical ceremony.
  • Diet. After the hinderance is distinctive using colostomy, chief pull-through, or dilation, offspring do not demand appropriate viands; offspring should escape constipating foods, such as those embraced in the bananas, rice, applesauce, and toast (BRAT) viands. High-fiber and softening foods (whole-grain foods and viands, dairy, fruits, vegetables, greasy foods, aromatic foods) should be advanced.
  • Activity. Children behind a continuance anorectal deformitys are frequently inadequately wholesome; enthusiasm limitations are commbarely connected barely to the date encircling their surgical processs.

Pharmacologic Management

Many offspring behind a continuance anorectal deformitys demand medications for several reasons.

  • Antibiotic prophylaxis. Urinary prophylaxis is used to hitheren the cause of urinary contagion and urosepsis in offspring behind a continuance cause factors for urinary contagion such as urinary fistula, vesicoureteral refluence, or continent deviation.
  • Laxatives. Common softenings embrace senna products, calm of magnesia, and propylene glycol disconnections (eg, MiraLax, GlycoLax).

Nursing Management


Nursing concern for an infant behind a continuance imperforate anus embrace:

Nursing Assessment

Assessment of an infant behind a continuance imperforate anus embrace the subjoined:

  • History. Prenatal ultrasonography establishment opinions are frequently natural, although the polyhydramnios or intraabdominal cysts may intimate imperforate anus behind a continuance associated hydrocolpos or hydronephrosis.
  • Physical exam. Newborns behind a continuance imperforate anus are commbarely signed upon the chief tangible establishment; deformitys in newborns that are missed upon judicious establishment are frequently discovered behind a continuancein 24 hours when the newborn is noted to possess distention and has failed to by meconium and a excite drastic establishment is manufactured.

Nursing Diagnoses

Based on the toll grounds the main nursing diagnoses are:

Nursing Concern Planning and Goals

The main nursing concern pur-posening designs for resigneds behind a continuance imperforate anus:

  • Maintaining sufficient hydration behind a continuance fresh mucous membranes, husk turgor and capillary enrich amiable.
  • Maintaining stpotent material signs.
  • Achieving sufficient output of urine.
  • Achieving dry and damage-free husk encircling the colostomy.
  • Absence of contagion.

Nursing Interventions

Nursing interventions for a branch behind a continuance imperforate anus are:

  • Avoid contagion. Counsel the concerngivers to repress the area encircling the colostomy upright behind a continuance soap and inspire and to diaper the baby in the common way; mentor clear respect cell (WBC) number; and bathe hands and counsel resigned and SO to bathe hands anteriorly adjunction behind a continuance resigneds and betwixt processs behind a continuance the resigned.
  • Protect husk entireness. A coverive ointment is helpful to cbalance the husk encircling the colostomy; mentor standing of impaired tissue entireness at last once daily for tinge changes, redness, protuberance, vehemence, pain, or other signs of contagion; and repress a infertile verbiage technique during damage concern.
  • Restore balanced melting dimensions. Administer parenteral meltings as prescribed; regard the need for an IV melting investigate behind a continuance an proximate indisincorporate of meltings for resigneds behind a continuance abnatural material signs; counsel family members how to mentor output in the home; edify them to mentor twain intake and output.

Evaluation

Goals are met as evidenced by:

  • Maintained sufficient hydration behind a continuance fresh mucous membranes, husk turgor and capillary enrich amiable.
  • Maintained stpotent material signs.
  • Achieved sufficient output of urine.
  • Achieved dry and damage-free husk encircling the colostomy.
  • Absence of contagion.

Documentation Guidelines

Documentation in a resigned behind a continuance imperforate anus embrace the subjoined:

  • Individual opinions, including factors assumeing, interactions, kind of political exchanges, specifics of peculiar demeanor.
  • Intake and output.
  • Signs of contagion.
  • Cultural and devotional beliefs, and halt-forations.
  • Plan of concern.
  • Teaching pur-pose.
  • Responses to interventions, counseling, and actions manufactured.
  • Attainment or advancement inland the desired development.

Practice Quiz: Imperforate Anus


Here’s a 5-item taunt for Imperforate Anus regard guide:

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1. The nurse is counseling the concerngivers how to percreate a colostomy irrigation. To repair the productiveness of the irrigation and fecal restores, what gauge should the nurture edify the concerngivers to do?

A. Reduce the whole of irrigation disconnection.
B. Place ardor on the abdomen.
C. Percreate the irrigation in the equableing.
D. Increase melting intake.

1. Answer: D. Growth melting intake.

  • Option D: To repair the productiveness of the irrigation and fecal restores, the concerngivers should advance growth in melting intake and neutralize constipation.
  • Options A, B, C: These options do not emend the productiveness of the irrigation and fecal restores.

2. The nurture is assessing for stoma prolapse in a client behind a continuance a colostomy. The nurture would note which of the subjoined if stoma prolapse exculpationred?

A. Protruding stoma
B. Sunken and mysterious stoma
C. Dark- and sky blue-colored stoma
D. Narrowed and flattened stoma

2. Answer: A. Protruding stoma.

  • Option A: A prolapsed stoma is one which the bowel protruded through the stoma.
  • Option B: A stoma eulogy is characterized by dry-rot of the stoma.
  • Option C: Ischemia of the stoma would be associated behind a continuance lurid or sky blue tinge.
  • Option D: A stoma behind a continuance a narrowed inauguration at the roll of the husk or fascia is said to be stenosed.

3. You’re assessing the stoma of a resigned behind a continuance a wholesome, well-behaved-adept colostomy. You halt-for the stoma to exculpation:

A. Red and fresh.
B. Pale, pink and fresh.
C. Ebon or purple tingeed.
D. Dry and sombre.

3. Answer: A. Red and fresh.

  • Option A: Good vogue causes tissues to be fresh and red, so a wholesome, well-behaved-adept stoma exculpations red and fresh.
  • Options B, C, & D: These stomas do not point-out a wholesome, well-behaved-adept stoma.

4. Annabelle is nature discharged behind a continuance a colostomy, and you’re counseling her concerngivers environing colostomy concern. Which announcement suitably describes a wholesome stoma?

A. “A beaming affection lower the stoma faceplate is natural.”
B. “The stoma should endure turgid afar from the abdomen.”
C. “At chief, the stoma may bleed partially when deranged.”
D. “The stoma should exculpation ebon and possess a sky blue hue.”

4. Answer: C. “At chief, the stoma may bleed partially when deranged.”

  • Option C: For the chief few days to a week, disregard bleeding naturally exculpations when the stoma is deranged accordingly the surgical standing is stagnant new.
  • Option A: A beaming affection in the stoma is not natural and may point-out complications.
  • Option B: Protuberance should lower balance a date of 6 to 8 weeks behind surgery.
  • Option D: A ebon and sky blue stoma point-outs insufficient respect minister to the stoma.

5. Nurse Ron begins to counsel a concerngiver how to percreate colostomy irrigations. The nurture would evaluate that the edifyions were lowerstood when the client states, “The resigned should:

A. Lie on the left border continuance instilling the irrigating disconnection.”
B. Insert the irrigating catheter abstruseer into the stoma if cramping exculpations during the process.”
C. Instagnant a narrowness of 1200 ml of irrigating disconnection to incense diffusion of the bowel.”
D. Repress the irrigating container hither than 18 inches balancehead the stoma.”

5. Answer: D. Repress the irrigating container hither than 18 inches balancehead the stoma.”

  • Option D: This altitude permits the disconnection to stream sloth behind a continuance pigmy sinew so that unreasonable peristalsis is not proximately precipitated.
  • Options A, B, & C: These options are all loose.

See Also


Related topics to this regard guide:

Further Reading


Recommended instrument and books for pediatric nursing:
  1. PedsNotes: Nurse's Clinical Pocket Guide (Nurse's Clinical Pocket Guides)
  2. Pediatric Nursing Made Incredibly Easy
  3. Wong's Essentials of Pediatric Nursing
  4. Pediatric Nursing: The Critical Components of Nursing Care

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