Written Notes Out

Tracheoesophageal Fistula (TEF) Summary

caused by a failure of the tissues of the GI tract to separate properly in prenatal life, the first type is Type A there is no tracheal fistula only esophageal, the esophogus is divided into 2 parts with both parts ending in blind pouches they refer to this a plurel atresia 8% of the cases, type B is a rare form of TEF and it effects about 2% of cases and is when the lower portion of the esophugus ends in a blind pouch and the upper portion is connected to the wind pipe by a tracheal esophogial fistula, Type C is the most common type of TEF and is when the upper portion of the esophugus ends in a blind pouch and the lower portion is connected to the trachea by a TEF about 85% babies are born with this type, And type D is the rarest and is where the TEF connects both the upper and lower portions of the esophogus to the trachea, Type E esopghus connects to the stomach normally and is in tact but however the TEF conncets to the esophagus and the trachea

Earliest Signs: Poly Hedrem, drooling that is present at birth which is related to the atrasia, at birth the infanct with vomit and birth when given first feeding, if the upper esophoigus enters the trachea the first feeding will enter the trachea which will cause the infant to choke and be cyanotic, if the lower esophogus enters the trachea air will enter the stomach each time the infant will breathe and will cause abdomineal distention.

Feeding is usually with water to prevent any aspiration,

Signs and Symptoms:

Treatment:

Hypertrophic Pyloric Stenosis

A uncommon condition in infants that is characterized by abnormal thickening of the pylorus muscle and this leads to gastric outlet obstruction.

Manifestations: They will have projectile vomit because of the pressure on the ……. causing the infant to be dehydrated, olive shaped mass that is felt on the upper right quadrant of the abdomen,

Treatment: Pyloromyotomy: Closing of the, give IV fluids to prevent any dehydration, feeding the infants by teaspoons through a nipple with a large whole, feedings will be thickened so they don’t aspirate, burp the infants before and after feeding to remove gas build up, placed on right side after feeding to facilitate the stomach drainage into the intestines, if possible the infant on high fowlers which is proffered, if the infant vomits you have to refeed, post op monitor IV fluids, I&Os, provide feedings per surgeon prescription, and monitor the surgical site

Celiac Disease

This is when a child is genetically predisposed to this autoimmune disease and is when people ingest gluten and it leads to damage in the small intestine.

Signs and symptoms: are not evident until the child is 2-6 months old

Parents start introducing food such as wheat, barely, rye to the child which is when the symptoms start showing. Which results in malabsorption, you will see abdominal distention with atrophy of the buttocks. The infant because of the problems in the intenstins they will have problems to thrive, they will have large stools that are hardend and brothy,

Treatment: teach the parents what food to avoid, and teach that continue to use gluten food will lead to medical complications and that the use of gluten food doesnt allow absorbtion of nutrients within the child

Hirschsprung’s Disease

Also called

mc

Happens when a infants intest, delays the progression of stool through the intestines, decreased peristalisis which leads to constipation, the stools will be ribbon like and this is because the feces is passing through a narrow space in the colon, is seen in boys more than girls, and is seen with children with down syndrome, can be acute or chronic, a symptom of this megacolon is if the child fails to pass mecolion withing the first 24 hours, abdomen will be distended, the child will be anorexic, they have vomiting, failure to thrive, parents will try everythig over the counter to help the child and the child we continue to be ,

if not treated child will have intestinal obstruction, this will be seen interial colitus or inflamation of the small colon, have fever if has obstruction, explosive stools, become weak,

Diagnosed by barium enima, ct scan, anal rectal enormity

Goal: surgery to remove the section of the intestine that is damaged

Treatment: Depends on child’s age, in newborns detect as soon as possible, as the child grows you want to monitor and pay close attention to history of diarrhea or constipation, monitor for under nutrition, if the child has poor feedings,

Intussusception

Life threatening illness and is when part of the intestine folds like a telescope, with one segment inside another segment, and this will cauwse an obstruction and it prevents the passage of food that is being digested through the intestine, if left untreated it can cause serious damage to the intestines, the child will have intestinal infection, internal bleeding, peritinitus, interception which is, happens in children of 3 months to 6 years

Most common symptom is a sudden onset of intermideate pain in a child that is normall fine/well, can be mistaken for collic, will start happening in frequent intervals, child may strain or draw knees up, may act very irritable, cry very loud, vomiting can also happen, usually starts after pain begins, child may have normal stool but the next stool may look bloody, a red mucus or jelly like stool is usually seen they will call it current jelly,

If it starts

Diagnosed by history and physical, may have a mass in the right upper abdomen that may feel like a sausage shape,

Treatment of choice: barium enema, surgery

Gastroenteritis

Involves inflamation of the stomach and intestines

Treatment: focus on identify and irradicating the cause

Priority goal: includes restoring fluids and electorlytes, oral rehydration, infants recive breast milk for its osmalality, antibiotic, monitoring I&Os, for infants weigh the diaper, monitor for dehydration and over hydration, keep infant warm, teach the parents good hand hygine, teach about safe food handeling, and how to store food properly, teach about princibles of cleanliness, and also about infection control

Cleft Lip

An abnormality where the lip doesnt close during fetal development, depends on child, opening can be as big as going up to the nose or can be small, most cases are hereditary and enviromental, happens more to males than females,

treatment: only thing that can be done is surgery called cheiloplasty and is done by due mass

Infant will have to wear a elbow restraint to stop it from touching area

Be given special bottle to feed until surgery

Postop care: prevent the child from crying or sucking, doctor may apply bow to site, prevent any infection or scarring by cleaning the suture lines gently, prevent any crust from forming, provide the infants emotional needs by cuddling the infant, and give other forms of infection, provide pain relive, fed through medicine droppers until wound is healed in 1-2 weeks, clean infants mouth after each feeding with sterile water,

Gastroesophageal reflux

Infants will Have vomiting, weight lost, failure to thrive, fussy, hungry, respiratory problems can happen, when vomiting stimulates the closing of the epiglottis, the infant will present with

Know when the problem started, are they drinking breast milk or formula, how is the infant being fed (down or upright), tests are barium swallow, checking for the pressure, check the pH, make sure the baby is burped very carefully, prevent over feeding of the infant, teach the parent about proper positioning, the feedings to be thickened (bottle feeding), after baby is fed sit them up, don’t use the infant car seat to sit them because it increase intrabdominal pressure, doctor might order medications to relax the perlorax sphinctor and give them before child is fed

Cleft Palate

Happens when the roof of the mouth doesnt close completly during fetal development, can happen at nasal cavity to the soft pallot, the goal is to close that palate, goal is to improve feedings, improve speech, most of infants with this will have problems with their teeth so they will have braces, make sure to have a positive self image

Post op treatment and care: oral hygine by teaching to use sterile water after feeding, proper cleaning of mouth, speech, diversion to prevent crying which causes pressure, prevent calm playing and no strainious activitys, look for any problems with dental hygine like tooth decay.