Digestive Disorders in Children

Intestinal Obstruction:

             Intestinal obstruction is a partial or complete blockage of the small or large intestine resulting in failure to pass intestinal contents through the bowel normally.

             It is one of the most common surgical emergency during childhood and need prompt intervention.

Types:

Mechanical Obstruction:

         Bowel is physically blocked and its contents cannot get passed normal ways.

• May be acute or chronic.
• Common causes are adhesion, hernia, tumor, volvulus, intussusceptions etc.

Non- mechanical Obstruction:

       Also called paralytic ileus because of impairment of intestinal peristalsis activity an common after surgery.

Causes:

• Congenital Cause:

1. Atresia: abnormal narrowing of opening.
2. Incarcerated hernia: occurs when herniated tissue becomes trapped and cannot easily be moved back to place.
3. Imperforate anus.
4. Mackel's diverticulum: congenital abnormality of small intestine caused by incomplete obliteration of vitelline duct. It is an outpouching or bulge in lower part of the small intestine.'
5. Hirschprung's disease.
6. Malrotation of gut. 
7. Stricture.
8. Volvulus.
9. Meconium plug.
10. Annular pancreas.

• Acquired Cause:

1. Pyloric stenosis.
2. Intussusception.
3. Post operative adhesion or stricture.
4. Tumor/ Hematoma.
5. Foreign body/ warm mass.
6. Strangulated Hernia.
7. Inflammatory disease: Appendicitis.
8. Paralytic ileus.

Pathophysiology:

Obstruction of bowel lumen.

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Accumulation of intestinal contents, gas and secretion above the blockage.

Abdominal Distension.

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1. Vomiting

Loss of Hydrochloride and potassium from stomach.

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Metabolic acidosis.

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2. Reduction in absorption of fluid and stimulate more gastric secretion.

3. Temporary increase in peristalsis as the bowel attempts to force the material through the obstruction area.

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Decrease in venous and capillary pressure.

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Edema congestion leading to necrosis.

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Rupture or perforation of intestinal contents into the peritoneum.

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Peritonitis

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4. Due to acute fluid loss.

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Dehydration and shock.

Clinical Manifestation:

1. Failure to pass meconium within first two days of life.
2. Cramping pain: which is due to vigorous contraction proximal to the obstruction as the bowel attempts to move luminal contents.
3. Abdominal distension: related to accumulation of gas and fluid above the level of obstruction. As the distension progresses the abdomen may become extremely tender, rigid and firm.
4. Vomiting that contains bile and fecal matter due to accumulated abdominal contents which may differ according to the location of obstruction.
5. Change in stool patterns: may range from obstipation which is early sign of low obstruction and later sign of high obstruction.
6. Initially hyperactive bowel sound then diminished or ceased.
7. Dehydration and electrolyte imbalance later hypovolemic shock.
8. Respiratory distress.
9. Fever may or may not be present.
10. Peritonitis.

Diagnosis:

1. History taking.
2. Physical Examination.
3. Abdominal X-ray.
4. Barium meal/ enema x-ray shows stricture, tumor etc.
5. Serum electrolytes: decreased sodium, potassium, chlorides.
6. Blood count: increase WBC level.

Management:

Initial management is done with:

• IV fluid therapy to correct fluid and electrolyte imbalance.
• Decompression of bowel through nasogasttric drainage.
• Analgesics and anti spasmodic to relieve pain and provide comfort.
• Antibiotics to treat and prevent infection.

Surgical Management:

• Resection of bowel is done for obstructing lesion or strangulated bowel along with end to end anastomosis.
• Cutting of Ladd's band and lengthening of the roots of mesentry if malformation of the gut.
• Enterectomy is performed to remove foreign bodies in the intestine.

Nursing Management:

• Assess the vital signs, intake and output, level of consciousness, bowel sound, weight, abdominal girth.
• Assess the child for pain.
• Maintain fluid and electrolyte balance.

1. Administer fluid and electrolyte.
2. Maintain intake and output chart.
3. Monitor weight.

• Relive abdominal distension.

1. Keep NPO.
2. Decompression with NG tube.