12/16/2023

ARBAMINCH UNIVERSITY
COLLEGE OF MEDICINE AND HEALTH SCIENCE

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SCHOOL OF NURSING DEPARTMENT NEONATAL NURSING
ASSIGNMENT DIGESTION AND ABSORBATION DIS ORDER

PREPARED By SELAMAWITE FEKADIE ……PRMHS/078/15

SUMBITTED TO:MR Agegnehu B(BSC,MSC,ASS.PROF)
SUBMITTED DATE 14/14/2023 1
PRESENTATION OUT LINE

Definition of bowel obstruction Definition of diarrhea

Pathophysiology Epidemiology

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Sign and symptom, cause Cause

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Complication Classification

Management Clinical feature

Epidemiology of intussception Management

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Prevention
CONT

Pathophysiology
definition of lactose intolerance
intussception
Pathophysiology

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Classification
Epidemiology

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Sign and symptom
Clinical feature
Management Management

Reference

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OBJECTIVE

At the end of this presentation you will be able to under stand

Under stand the over view of bowel obstruction

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Explain the pathophysiology and etiology bowel obstruction

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Describe the management and complication of bowel obstruction

Recognized the sign and symptom and differential diagnosis of bowel

obstruction

List the sign and symptom ,rick factor, and cause of intussception
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CONT…….
Describe the management of intussception

Definition of lactose intolerance

Explain the pathophysiology &epidemiology of lactose intolerance

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Describe management of lactose intolerance

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Define diarrhea

Describe the epidemiology ,cause ,and classification of diarrhea

Describe the management modality and prevention aspect of diarrhea

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BOWEL OBSTRUCTION
Bowel obstructions is mechanical or functional obstruction of the
intestine preventing the normal transit of the product of digestion.

 It is the most common surgical emergencies encountered in newborn

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infants, requiring early and accurate diagnosis.

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For evaluation and diagnosis, bowel obstruction in neonates can be
divided into either high or low obstruction on the basis of the number of
dilated bowel loops present on the initial abdominal radiographs.

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CON…
Although three or fewer dilated bowel loops are typically seen with high intestinal

obstruction more than three are generally seen with low intestinal obstruction in neonates.

 High intestinal obstructions are defined as occurring proximal to the ileum, resulting in

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various combinations of gastric, duodenal, and jejuna dilatation according to the level of

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obstruction.

In contrast, low intestinal obstructions involve the distal ileum or colon and typically result

in diffuse dilatation of multiple small-bowel loops.

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CONT…

Although neonates with classic radiographic findings of high intestinal

obstruction, such as duodenal atresia, may directly undergo surgery

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without any additional imaging, an upper gastrointestinal series is
typical performed for further evaluation.

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Similarly, an enema examination is used for further investigation of low
intestinal obstruction in neonates.

Neonatal intestinal obstruction occurs 1 in 1500 live births.

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PATHOPHYSIOLOGY
The normal physiology of the small intestine consists of the digestion of food and the
absorption of nutrients.

The large bowel continues to aid in digestion and is responsible for vitamin synthesis,

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water absorption, and bilirubin breakdown.

 Any obstructive mechanism will hinder these physiologic components.

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Obstruction causes dilation of the bowel proximal to the transition point and collapses
distally.

A result of partial or complete blockage of digested products during obstruction is emesis.

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CONT
Frequent emesis can lead to fluid deficits and electrolyte abnormalities.

 As the condition is left untreated and worsens, a bowel wall edema forms, and third-
spacing begins.

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A serious and life-threatening complication of bowel obstruction is strangulation.

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Strangulation is more commonly seen in closed-loop obstructions.

If the strangulated bowel is not treated promptly, it eventually becomes ischemic, and
tissue infarction occurs.

 Tissue infarction progresses to bowel necrosis, perforation, and sepsis/septic shock.

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CAUSE OF INTESTINAL OBSTRUCTION
High intestinal obstruction

 Gastric atresia

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 Duodenal atresia

 Duodenal stenosis (with annular pancreas)

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Low intestinal obstruction

 Small bowel involvement

 Ilea atresia
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CONT……
 Meconium ileus

Large bowel involvement

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 Functional immaturity of the colon

 Hirsch sprung disease

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 colonic atresia

 Anal atresia and an rectal mal formation

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SIGN OF BOWEL OBSTRUCTION
Vomiting with or without bile stained material

Increased gastric residuals before feedings

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Failure to pass meconium in the first 24 hours of life

Abdominal distension (particularly with low level obstruction)

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Absent or decreased bowel sounds

Abdominal pain

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DIAGNOSIS

A compressive history and physical examination are needed for the

diagnosis of boweleobstriction.

By sending different imaging procedure and blood test

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DIFFERENTIAL DIAGNOSIS
Differential diagnosis classified on clinical presentation

Intestinal obstruction without bilious vomiting

Duodenal atresia

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Duodenal stenosis

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Annular pancreas

Pyloric stenosis

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CONT……..

Intestinal obstruction with bilious vomiting

Malrotation and volvulus

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Duodenal atresia

Jejunoileal atresia

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Meconium ileus

Meconium plug syndrome

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INTESTINAL OBSTRUCTION WITH MARKED ABDOMINAL DISTENSION

Leal atresia

Hirschsprung's disease

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Meconium ileus

Meconium plug syndrome

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Imperforate anus

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COMPLICATION
Perforation

Infection

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Wound adhesive

pneumonia

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Inter abdominal abscess

Nutritional Deficiencies

Intestinal Fistula
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MANAGEMENT OF BOWEL OBSTRUCTION

 The infant put on incubator for close observation and maintain body
temperature.

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Holding oral feeding until farther evaluation and assessment

Constant monitoring B/p ,glucose level ,electrolytic, and blood gas

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analysis

Administering 10-20ml/kg isotonic saline if the sign of shock

Nasogastric tube insertion

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CONT….
Intravenous fluid resuscitation

Insert catheter

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Medication.

 Surgery

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INTUSSUSCEPTION

Intussusception refers to the invagination (telescoping) of a part of the

intestine into itself.

 It is the most common abdominal emergency in early childhood,

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particularly in children younger than two years of age.

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Intussusception is unusual in adults, and the diagnosis is commonly
overlooked.

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EPIDEMIOLOG
Intussusception occurs primarily in infants and toddlers.

The peak incidence is between 4 and 36 months of age, and it is the most
common cause of intestinal obstruction in this age group.

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Approximately 1 percent of cases are in infants younger than three

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months, 30 percent between 3 and 12 months, 20 percent between one and
two years, 25 percent between two and three years, and 10 percent
between three and four years.

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CONT………….
 Approximately 10 percent of cases are in children over five years, and 3
to 4 percent in those over 10 years

When intussusception occurs outside of the typical age range it is likely

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to be associated with a pathologic lead point, which may include reactive

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lymphoid hyperplasia.

Intussusception appears to have a slight male predominance, with a male:

female ratio of approximately 3:2

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CONT……….
Ileocolic intussusception is the most common type, comprising more
than 90% of cases, while other types include ileoile ocolic,enteroenteric,
and rarely colocolic intussusceptions.

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When to see the prevalence of intussusception high in patient age

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between 3 and 36 month.

Intussusception involves invagination of the proximal bowel into the

distal bowel.

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PATHOPHYSIOLOGY
Upper portion of the bowel invignated in the lower

Menstery is carried into the lumen of intestine

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Blood supply to the affect portion is cut off

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Edema occur

Leading of intestinal obstruction

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CLASSIFICATION OF INTUSSUSCEPTION BASED ON ITS
LOCATION
Ileo-ileal,

ileo-ileo-colic,

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 jejuno-jejunal,

jejuno-ileal,

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 colo-colic

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RISK FACTORS

Age

Children especially young children are much more likely to develop

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intussusception than adults .

It's the most common cause of bowel obstruction in children between the

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ages of 6 months and 3 years.

Sex

 Intussusception more often affects boys.

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CONT……
Certain conditions.

 Some disorders can increase the risk of intussusception, including:

Cystic fibrosis.

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Celiac disease ,etc.

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. Irregular intestinal formation at birth

 Intestinal malrotation is a condition in which the intestine doesn't develop

or rotate correctly this increases the risk of intussusception
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CAUSE
Idiopathic

Approximately 75 percent of cases of childhood intussusception are

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idiopathic because there is no clear disease trigger or pathologic lead
point.

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Idiopathic intussusception is most common in children between three
months and five years of age .

Influence of viral factors

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CONT……..
viral may play a role in some cases.

Lead point

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 lead point is a lesion or variation in the intestine that is trapped by
peristalsis and dragged into a distal segment of the intestine, causing

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intussusception (Meckler diverticulum polyps, duplication cysts,
lymphomas).

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CONT
Underlying disorders

 In approximately 25 percent of cases, an underlying disease causes a

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pathologic lead point for the intussusception, which may be focal or
diffuse.

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SIGN AND SYMPTOM
Stool mixed with blood and mucus.

Vomiting

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Sudden onset of intermittent, severe, crampy, progressive abdominal
pain,

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 irritable crying

palpable mass

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DIAGNOSTIC

The optimal strategy for diagnosis and treatment depends on the clinical

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suspicion for intussusception and compressive history

By sending different imaging tests .

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Differential diagnosis
Meckel diverticulum

Bacterial or amoebic colit

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Gastroenteritis

Appendicitis

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Mesenteric ischemia

Malrotation with volvulus

Peritonitis
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COMPLICATION
Perforation,

 Bowel necrosis

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Short bowel syndrome.

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MANAGEMENT
The treatment option of intussusception depends upon patient
characteristics:

Non operative reduction

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For symptomatic but stable patients with evidence of intussusception by

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imaging (ultrasound or radiographs), we recommend non operative
reduction of the intussusception rather than surgery.

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CONT……..
Surgery

Surgical treatment is indicated as a primary intervention for patients with

suspected intussusception who are acutely ill or have evidence of

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perforation.

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Surgery is necessary for patients in whom non operative reduction is
unsuccessful after one or more attempts, or for evaluation or resection of
a focal pathologic lead point.

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LACTOSE INTOLERANCE
Introduction

Lactose intolerance happens when your small intestine does not produce

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enough amount of a digestive enzyme lactase .

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 Symptoms of lactose intolerance are abdominal pain, flatulence, nausea,

bloating, and diarrhea after ingestion of milk or milk-containing products.

 These symptoms may be associated with lactose mala absorption.

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 TERMINOLOGY
Lactose intolerance – A clinical syndrome in which ingestion of lactose
or lactose-containing food causes symptoms (abdominal pain, bloating,
flatulence, nausea, diarrhea).

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Lactose malabsorption – failure of the small bowel to absorb ingested

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lactose due to lactase deficiency.

Lactose malabsorption can occur with or without symptoms of lactose

intolerance.

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EPIDEMIOLOGY
The prevalence of lactase deficiency varies across racial and ethnic
groups, with the lowest prevalence in Europeans and European Americans
and higher prevalence in African Americans, Asian Americans, and Native

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Americans.

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In Africa, some ethnic groups have high rates of lactase deficiency (South
Nigerian, Hausa, Bantu), while others have low rates (Hima, Tutsi,
nomadic Fulani).

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Pathophysiology
The lactase enzyme is located in the brush border of the small intestinal
mucosa.

Deficiency of lactase results in the presence of unabsorbed lactose within

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the bowel.

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This results in an influx of fluid into the bowel lumen resulting in osmotic
diarrhea.

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CONT
Colonic bacteria ferment the unabsorbed lactose-producing gas
(hydrogen, carbon dioxide, and methane), which hydrolyzes lactose into
monosaccharide's.

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This results in an additional influx of fluid within the lumen.

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The overall effect of these mechanisms results in various abdominal signs
and symptoms

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ETIOLOGY

Primary lactase deficiency

The most common cause of primary lactose malabsorption is acquired

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primary lactase deficiency.

lactase deficiency, the intestinal brush border lactase enzyme activity is

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lower than that of normal individuals.

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CONT…….
Secondary lactase deficiency

 Secondary LI occurs as a result of small intestinal villous damage and

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decreased lactase expression.

 In young children, the most common causes of secondary LI include

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viral gastroenteritis , giardiasis etc.

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CONT………….
Congenital Lactase Deficiency

 . Congenital lactase deficiency is a rare autosomal recessive disorder.

 It manifests in the newborn after ingestion of milk

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 The disorder is characterized by the absence of lactase activity in the

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small intestine, with normal histologic findings and normal levels of other
disaccharides.

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CONT…………..
Developmental Lactase Deficiency

 It is seen in premature infants born at 28 to 32weeks of gestation have

reduced lactase activates.

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 The infant's intestine is underdeveloped, resulting in an inability to

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hydrolyze lactose.

 This condition improves with increasing age due to the maturation of the
intestine, which results in adequate lactase activity.

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SIGNS AND SYMPTOM
Abdominal bloating

Abdominal Pain

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Nausea and vomiting

Fullness

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Flatulence

stools may be bulky, frothy, and watery

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DIAGNOSTIC
 Lactose intolerance is diagnostic by deep history taking, performing
physical exam, and medical tests.

Some of medical test are list below.

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Hydrogen breath test:

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Stool acidity test

Small bowel biopsy

Genetic test
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CONT………
Hydrogen breath test:

 This test measures the hydrogen content of breath after lactose ingestion.

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 The test is positive for lactose malabsorption if the post-lactose breath
hydrogen value rises >20 ppm compared with the baseline.

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Stool acidity test:

 Unabsorbed lactose is fermented by colonic bacteria into lactic acid,

which lowers the stool ph.
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CONT…..
Small bowel biopsy

 A jejuna biopsy allows for an assessment of lactase enzyme activity.

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 It can also help to distinguish between primary and secondary lactase
deficiency by evaluation of small histology.

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Genetic testing

 Genetic testing only detects primary lactase deficiency and can only be
used in selected populations.
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DIFFERENTIAL DIAGNOSIS
Irritable bowel syndrome

Celiac disease

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Inflammatory bowel disease

Excessive ingestion of laxatives

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Viral gastroenteritis

Bacterial infection

Giardiasis
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MANAGEMENT
Patients with lactose malabsorption and symptoms of lactose
intolerance

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To eliminate symptoms maintaining calcium intake and vitamin D .

Treatment of the underlying disease

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In patients with secondary lactose mala absorption, successful treatment
of the primary disorder can lead to restoration of lactase activity.

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CONT
Dietary lactose restriction

 patients should be advised that restriction of their intake of lactose-

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containing food items.

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CONT……
Calcium and vitamin D supplementation

Encouraged patients to increase their consumption of calcium rich foods

or consider using calcium and vitamin D supplementation.

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Lactase enzyme supplementation

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Administering orally lactose-containing food .

liquid lactase preparations can be added to milk (14 drops/quart), which

is then refrigerated overnight before use.
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DIARRHEA OVERVIEW
Diarrhea refers to the passage of loose or watery stools or an increased
frequency of stools for the child and occurs at some point in the life of
nearly every child.

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Diarrhea can lead to dehydration, which alters the child's natural balance

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of water, and electrolyte (sodium, potassium, chloride) imbalance.

 It can be serious if not treated promptly.

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EPIDEMIOLOGY
Globally, there are nearly 1.7 billion cases of childhood diarrheal diseases that
account for one in nine child deaths, making diarrhea the second leading cause
of death in children under five years old.

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Even though diarrhea is both preventable and treatable, it kills 525,000 children

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under five years old each year, and it is a leading cause of malnutrition in
children under five years old.

The majority (42%) of deaths due to diarrheal disease were concentrated in

Sub-Saharan Africa, including Ethiopia (88 per 1000 live births), where hygiene
and sanitation are poor. 56
DIARRHEA DEFINITION
Diarrhea is the passage of unusually loose or watery stools, at least three
times in 24 hours.

However, it is the consistency of stools rather than the number that is

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most important.

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 Frequent passing of formed stools is not diarrhea.

Babies fed only breast milk often pass loose, “pasty” stools; this is also
not diarrhea.
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DIARRHEA CAUSES
 Viral infection
 Viral infection is the leading cause of diarrhea in children and is seen most
commonly in the winter months in temperate climates, although it can

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occur year-round.

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 Bacterial infection
 Bacterial infection is sometimes hard to distinguish from viral infection.
 Bacterial infections are more common in locations where there is unsafe
drinking water and poor handling of sewage.
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CONT……..
Parasitic infection

 parasitic infections are more common in locations where there is unsafe

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drinking water and poor handling of sewage.

Antibiotic-associated diarrhea

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 A number of antibiotics can cause diarrhea in both children and adults.

 The diarrhea is usually mild and typically does not cause dehydration or
weight loss.
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CLASSIFICATION OF DIARRHEA
According to pathogenesis

According to duration

According to the mechanism of diarrhea

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According to clinical type

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ACCORDING TO PATHOGENESIS
 Non infectious

 Anatomic defect-short bowel syndrome ,villus atrophy

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 Mal absorption disaccharides deficiency ,celiac disease

 Food allergy /intolerance

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 Infectious

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 Inflammatory

Usually caused by bacterial that invade intestine directly or produce

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Cytoxan's

 Non inflammatory

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Through enterotoxin production by some bacterial, villus destruction
by viruses or adherence by parasites.

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ACCORDING TO DURATION
 Acute diarrhea < 14 days

 Chronic diarrhea >14 days

ACCORDING TO CLINICAL TYPE OF DIARRHEA

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 Acute watery diarrhea, which may last several hours or days, and includes

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cholera.

 Acute bloody diarrhea, also called dysentery.

 Persistent diarrhea, lasting 14 days or longer

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According to mechanism of diarrhea

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ASSOCIATED CLINICAL MANIFESTATION
Fever

Vomiting

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Effect of diarrhea include dehydration ,metabolic acidosis
,malnutrition&sepis

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APPROACH
Assess the degree of dehydration

Provide fluid and electrolytic

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Prevention of disease transmission

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PREVENTION MEASURE
Breast feeding

Vaccination

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Nutrition support

Proper hygiene

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Early treatment of infection and diarrhea

Hygienic in food preparation

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REFERENCE
IMNCI eth CB 2021

Https://www.Uptodate.Com/contents/acute-diarrhea-in-children-beyond-the-

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basics

Https://www.Safercare.Vic.Gov.Au/best-practice-improvement/clinical-

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guidance/neonatal/bowel-obstruction-in-
https://www.Ncbi.Nlm.Nih.Gov/books/NBK431078

Managing-neonatal-bowel-obstruction-clinical-perspectives-peer-reviewed-
fulltext-article- 71
CONT……..

Rrnhttps://www.Ncbi.Nlm.Nih.Gov/books/NBK532285

Https://www.Hindawi.Com/journals/cjidmm/2021/5547742/#introductio

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n

Https://www.Who.Int/news-room/fact-sheets/detail/diarrhoeal-diseas

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