structural defects upper gi.pptx

7/29/2019 structural defects upper GI.pptx

1/15

Stephanie Talbot


2/15

AtresiaGastroesophagealreflux/reflux dx

GER= gastriccontents leak

back into

esophagusGERD=

symptoms or

tissue damagethat results from

reflux of gastric

contents into theesophagus.


3/15

Hirschsprung Disease Logan Bar


4/15

CL with/without CP most commoncraniofacial deformity

CL with/without CP more common males,CP females

CL more common Native Americans &

Asians

CL involves external nose, nasal septum,nasal cartilages, maxillary alveolar ridges &

dental anomaliesCP involves nostril & absence of nasal

septal development


5/15

Cleft lip

Result incompletefusion of structures

of primitive oral

cavity

involves external

nose, nasal septum,

nasal cartilages,

maxillary alveolarridges & dental

anomalies

Unilateral orbilateral

Cleft Palate

Primary &secondarypalatine palates

fail to fuseMay involve

soft/hard palate

involves nostril& absence ofnasal septal

development


6/15

EO 1.2: Describe the Etiology &

Pathophysiology for cleft lip & cleft

palate

Etiology

CL with/without CP assocmultifactorial inheritance,environmental factors,family occurrence

CP assoc. chromosomal

abnormalities, familialoccurrence,environmental factors ex.Maternal alcohol,

nutrition, smoking &tetragons

Drugs cause CL/CP=phenytoin, valproic acid,thalidomide & pesticide

digoxin

Pathophysiology

once neck & jawsdevelop, the tongue to

move downward palatine processes

fusing with each otherand the primary plate

Any delay in thisprocess results failure

plates to fuse


7/15

EO 1.2: Describe Diagnostic Evaluation

for cleft lip & cleft palate


8/15

EO 1.2: Describe Therapeutic

Management for cleft lip & cleft palate1. Surgical Repair:Cleft Lip:

Cleft Lip 1st few mths , r

10wk & 10lbs preferred, befree of oral, respiratory orsystemic infection

Staggered suture line (Z-plastymin. scarring &lengthens lip), Steri-stripsor Logans bow used taketension off suture line

Cleft Palate

@ 12-15mths, mostcommon 18mths to

maximize speechproduction & growth ofmid-face

Child should be weaned tocup before repair

2. Speech therapy

3. Othorthodontist

1st

stage 18mths to alignmaxillary segments to

near-normal

2nd (2-5yrs) to reposition

maxillary segments &correct dental cross-bite

3rd (10-11yrs) correct

faulty occlusion

4rth(12-18) tx permanentteeth

4. Audiologist, otolaryngologist

Insertion pressure

equalizing tubes toprevent recurring otitis

media


9/15

EO 1.2: Describe NSG Management for

cleft lip & cleft palate1.Feed upright

2.Frequent burping

3.Use large holed nipple, press cleft liptogether w/ fingers to encouragesucking & strengthen muscles---ifunable suck use rubber-tipped syringe& drip formula into side mouth

4.Admin gavage feeding if necessary

5.Finish feeding w/ water to washpalate

6.Provide emotional support to family


10/15

EO 1.2: Describe NSG Post op

Management for cleft lip & cleft palate

Cleft Lip Repair

-avoid prone position1. Maintain patent airway

2. Assess colour, amt of

swallowing *sign

bleeding & swallowing

blood

3. Anticipate childs needs

to avoid crying4. Elbow restraints

5. Clean suture line after

each feeding w/ saline

to remove crusts

Cleft Palate Repair

1. Place side lying

2. Have sxn avail but useonly in emergency

3. Prevent trauma to suture

line

Use cups only, nostraws, utensils,

popsicle sticks,

chewing gum

Provide soft toys

Elbow restraints

Water after each

feeding to clean

Distract by holding andcuddling


11/15


12/15


13/15

EO 1.7: Describe Tracheoesophageal

Fistula (TEF)

TEF=An open

connection

between thetrachea &

esophagus

EA= failureesophagus to

develop into a

continuouspassage

EO 1 7 D ib Eti l &


14/15

EO 1.7: Describe Etiology &

Pathophysiology for infants with

Tracheoesophageal Fistula (TEF)


15/15

EO 1.7: Describe

Clinical Manifestations & Diagnostic Evaluations for

infants with Tracheoesophageal Fistula (TEF)

1.8. Clinical Manifestations

ES: hx polyhydramnios,inability pass NG tube,increased drooling &

salivation (frothy),

immed. Regurg.Undigested milk,

intermittent cyanosis &

apneic periods

TEF: normal swallowingbut choking &

intermittent cyanosis,

distended abdomen,

aspiration pneumonia

Diagnostic Evaluation

1. Inability pass NGtube

2.Maternal hx

polyhydramnios3.Fluoroscopy w/

contrast material to

I.D type defect4.Chest x-ray-

shows air stomach

structural defects upper gi.pptx

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