1. Congenital Anomalies of G.I.T
Prepared by
Dr. Hoda Abed El Azim

2. Objectives: State common types of congenital anomalies in GIT.
Compare and contrast between cleft lip and palate (CL/CP).
Discus pre and postoperative care of CL/CP.
Compare and contrast between the types of hernias.
Identify the clinical manifestation of esophageal artesia (EA).
Discus pre and postoperative care of esophageal artesia (EA).
Identify Anorectal malformations.

3. Congenital Anomalies in GIT
The most common anomalies are:
1. Cleft Lip or Cleft Palate
2. Hernias
3. Esophageal Atresia
4. Anorectal malformations

4. 1. Cleft Lip (CL) or Cleft Palate (CP)
CL and CP are facial malformations that occur during embryonic development and they are the most common congenital deformity of the head and neck.
They may appear separately or more often , together.

5. Definitions: CL : is a congenital fissure in the upper lip.
CP: is a midline fissure of the palate that results from failure of the two sides to fuse.

6. CL and palate

7. CL may be:
Small notch
Extending into the base of the nose.
Unilateral or bilateral.
CL/CP may be involve the soft and hard palate.
One or both sides.
Unilateral clefts are nine times more common than bilateral clefts.
60% to 80% of children born with cleft lip and palate are male.

8. Diagnostic evaluations
Apparent at birth.
Examining the palate.
Prenatal diagnosis after weeks when the soft tissue of the fetal face can be visualized.

9. Why CP more serious than CL?
It interferes more with feeding and breathing, more difficult to repair.

10. Therapeutic Management
The management of CL involves the cooperative efforts of a multidisciplinary health care team.
Pediatrics
Plastic surgery
Speech/ language pathology
Audiology
Nursing and social work

11. Management is directed toward:
Closure of the clefts.
Prevention of complications.
Facilitation of normal growth and development in the child.

12. Prognosis Even with good anatomic closure most children have:
Some degree of speech impairment .
Inefficient functioning of the muscles of the soft palate and nasopharynx.
Improper tooth alignment.
Varying degree of hear loss.
Improper drainage of the middle ear.
Recurrent Otitis media with scarring of the tympanic membrane.

13. Nursing consideration
It is important for nurse to emphasis not only the infant’s physical needs but also on the parents emotional needs.
CL or CP reduces the infant’s ability to suck, interferes with compression of the areola.
Feeding is best with the infant’s head in upper right position.
Large , soft nipple with large holes have been advised and used.
Large syringe with soft rubber tubing can used.

14. With some infant spoon feeding works best
Breast pump may be useful to stimulate the let down reflex.

15. Postoperative care for CL
Elbow restrains are used to prevent the infant from rubbing or disturbing the suture line.
Older infants who roll over will require a jacket restraint to prevent rolling on the abdomen and rubbing the face on the sheet.
Adequate analgesia is required to relieve pain.

16. Postoperative care for CL cont.
Clear liquids are offered when the infant has fully recovered from anesthesia.
The suture site are is carefully cleansed of formula.
A thin layer of antibiotic ointment.
Genital aspiration of mouth and nasopharyngeal secretions.
An upright or infant set position.

17. Postoperative care for CP
Lie on the abdomen.
Feeding by bottle, breast or cup.
Oral packing, it is usually removed after 2 to3 days.
Elbow restrains.
Instruct the parents to keep the restrained at home until palate is healed (2 to 6 weeks).
Opioids may be prescribed.
Soft food in discharge plan until the surgeon directs them otherwise.

18. 2. Hernias The diaphragm, The abdominal wall, or The inguinal canal.
Is a protrusion of a portion of an organ or organs through an abnormal opening.
through
The diaphragm,
The abdominal wall, or
The inguinal canal.

19. 1. Diaphragmatic Hernias
Protrusion of abdominal organs through opening in diaphragm.
Symptoms
Mild to severe respiratory distress
Tachypnea , cyanosis, dyspnea
Absent breath sound.
shock

21. Diagnosis Therapeutic Symptoms Radiographic study.
Prenatally as early as 25 week of gestation.
Therapeutic
Supportive treatment of respiratory distress
(Use of end tracheal intubation, oxygenation).
Prophylactic antibiotics.
Surgical reduction of hernia and repair of defect.

22. Nursing role Preoperative Post operative
Resuscitation, maintain suction, oxygen.
IV fluids
Positioning head up.
Administer medication
Post operative
Carry out routine postoperative care and observation.

23. 2. Hiatal Hernia Protrusion of stomach through esophageal hiatus.
Symptoms
Dysphagia, vomiting,
Bleeding (hematemesis)

24. Hiatal Hernia

25. 3.Umbilical Hernia Symptoms
Weakness in abdominal wall around umbilicus, incomplete closure of abdominal wall allowing intestinal contents to protrude through opening.
Symptoms
Noted by inspection and palpation of the abdomen.
High incidence in premature.

26. 3. Esophageal Atresia
The esophagus instead of being an open tube from the throat to the stomach is closed at some point. A fistula is common between the trachea and esophagus.
Clinical manifestation
Excessive salivation.
Coughing, choking, cyanosis,
Apnea
Abdominal distention.

27. Types of TEF

28. Nursing alert
Any infant who has an excessive amount of frothy saliva in the mouth or difficulty with secretions and unexplained episodes of cyanosis should be suspected of having an EA/TEF and referred immediately for medical evaluation

29. Therapeutic Management
Maintenance of a patent airway.
Prevention of pneumonia.
Surgical repair of the anomaly.
Avoid oral intake, started IV fluids.
Removal mouth secretion by suction.
Broad spectrum antibiotic therapy.
Gastrostomy AND ligation of the TEF.

30. Nursing role
`Nursing responsibility for detection of this malformation immediately after birth.
If feed the infant and swallows but suddenly coughs, and the fluid return through the nose or mouth, reported immediately.
The infant placed in incubator, oxygen is administer.
Intermittent or continuous suction of nose.
Oral fluid are withheld, the infant fluid met by IV fluid or gastrostomy.

31. Postoperative care
The infant is returned to radiant heater or incubator.
The gastrostomy tube is connected to gravity drainage until the infant can tolerate feeding.
Tracheal suction with extreme caution to avoid injury to the suture line.

32. Postoperative care cont.
The initial attempt at oral feeding to make sure that the infant can swallow without choking.
Oral feedings are begun with sterile water, followed by frequent small feeding of formula.
Infants are usually not discharged until they are taking oral fluids well and the gastrostomy tube is removed.

33. 4. Anorectal malformations
The rectum and urinary tract separate completely by the seventh week of gestation.
Abnormal development of genitourinary and pelvic organs.

34. 1. Imperforate anus
Is the most common congenital anomaly of GIT in newborn.
Diagnosis
There is no anal opening.
The nurse is unable to insert the thermometer.
No passage of meconium.
Later on abdominal distention and pain occur.

35. Imperforate anus

36. Postoperative care The anal area should be kept dry and clean.
If a colostomy has been done the skin around the wound must be clean and apply colostomy clean dressing.

37. Thank you