What are the 2 stages of Hirschsprung’s Disease surgery?
- stage 1 temporary ostomy
- stage 2 is a pull-through procedure: repeated enemas, decreasing bacterial flora with antibiotics (systemic and colonic irritants)
- transfer of gastric contents into esophagus
- occurs in everyone
- frequency and persistence is abnormal
- may occur without regurgitation
GER
What are the diagnostic tests for GER?
upper GI and pH probe
What is the management of GER?
- remove cows milk
- small frequent feeds
- reflux precautions: 1tbsp rice cereal and elevate after
- H2 receptor antagonists
- PPIs
When is no therapy needed for GER?
if the infant is thriving and has no respiratory complications
What is the surgery for GER and who is it reserved for?
Nissen fundoplication reserved for children with: recurrent aspiration esophagitis failure to thrive
-malformation that results from failure of esophagus to develop as a continuous tube during the 4th to 5th week of gestation?
tracheoesophageal fistula or atresia
What is tracheoesophageal fistula or atresia caused by?
-defective separation, incomplete fusion or altered cellular growth
abnormally closed or absent
tracheoesophageal atresia
What is the diagnosis of tracheoesophageal fistula or atresia?
- history of maternal polyhydramnios
- unable to pass NG tube
- abd x-ray
- bronchoscopy
- endoscopy
What are the 3 C’s related to tracheoesophageal fistula or atresia?
coughing
choking
cyanosis
Besides the 3 C’s what are some other clinical manifestations of tracheoesophageal fistula or atresia?
- apnea, resp. distress after feeding
- abd distress
- excessive salivation, difficulty with secretions
- drooling
- 3 C’s: coughing, choking, cyanosis
What will be placed in the meantime if surgical repair is in stages or delayed for a pt with tracheoesophageal fistula or atresia?
gastrostomy tube (G-tube) for feedings
What is the first priority for a pt with tracheoesophageal fistula or atresia?
prevent resp distress: -remove secretions -NPO -positioning (elevate HOB) provide Nutrition: -GT feedings -after repair esophageal may not be normal
