Imperforate anus is congenital (present from birth)

defect in which the opening to the anus is missing or

blocked.
Causes
The problem is caused by abnormal development of
the fetus, and many forms of imperforate anus are
associated with other birth defects. It is a relatively
common condition that occurs in about 1 out of 5,000
infants.
Symptoms
Anal opening very near the vaginal opening in girls
Missing or misplaced opening to the anus
No passage of first stool within 24 - 48 hours after
birth
Stool passes out of the vagina, base of penis, scrotum,
or urethra
Swollen belly area
 Gastro esophageal reflux disease
condition in which the liquid content of the stomach
regurgitates (backs up or refluxes) into the esophagus.
The liquid can inflame and damage the lining of the
esophagus although visible signs of inflammation
occur in a minority of patients
Symptoms
Effortless vomiting not projrctile
heartburn, regurgitation, and nausea.
Ulcers, strictures, esophageal cancer
Inflammation of larynx and throat
Inflammation and infection of lungs
Fluid in the sinuses and middle ears
How to diagnosed
Endoscopy (fiberoptic endoscopy) esophagography
Esophageal ph testing
X-ray
Examination of throat and larynx
Esophageal manometry- used to measure the
strength of the esophageal sphincter
Treatment
Formula or breqast milk with rice cereal
Upright position while eating and an hour after
eating
Laparoscopic or surgical myotomy (narrowing of the
esophageal sphincter)
Ranitidine
Omeprazole
Avoid acidic, fatty and alcoholic foods
Eat small portion of foods
 constipation
Difficulty of passing hardened stools, may occur
in children of any age

Distressing to children (painful, and may have

anal fissures)

May experience abdominal pain from force of

intestinal contractions
Assessment
Taking history
Normal ( every other day or every 3 days)
Hard with discomfort in defecating
Examine the cause of constipation
Therapeutic management
Increase fluid intake
Diet high in fiber
Privacy in bathroom
Determine the cause of stress
 diarrhea
Caused by virus which is the major cause of infant
gastroenteritis

Common viral pathogens : rotavirus, adenovirus

Common bacterial pathogens ; campylobacter jejuni,

salmonella, giardia lamblia and clostridium difficile

Acute associated by infection

Chronic associated with malabsorption and
inflammatory cause
Assessment
Frequency- unlimited number
Color- green
Effort of expulsion- effortless; may be explosive
pH- less than 7 (acidic)
Odor- sweet or foul
Occult blood- positive; blood may be overt
Reducing saubstances- positive
Assessment (mild diarrhea)
Anorectic and irritable
Episodes of diarrhea 2-10 loose watery
With fever (38.4-39)
Warm skin
Dry mouth
Rapid pulse
Therapeutic management
Oral rehydration solution
Rest the GI tract
Breastfeeding
Zinc administration (zinc deficiencies)
Assessment (severe diarrhea)
39.5-40 temperature
Pulse and respiration are weak and rapid
Pale and cool skin
May appear apprehensive, listless and lethargic
Depressed fontanelle, sunken eyes and poor skin
turgor
Elevated hemoglobin and hematocrit because of
dehydration
Loss in body weight
Therapeutic management

Oral or IV rehydration therapy

Antibiotic therapy