Hernia, Congenital Hydrocele, Cryptorchidism, Hypospadias, Cleft Lip and Palate PDF

Hernia  Definition: o External abdominal hernia is a protrusion of a viscus within a peritoneal sac through a defect in the abdominal wall  Types in infants and children: o Inguinal o Umbilical o Epigastric : rare o Femoral : rare...

Hernia  Definition: o External abdominal hernia is a protrusion of a viscus within a peritoneal sac through a defect in the abdominal wall  Types in infants and children: o Inguinal o Umbilical o Epigastric : rare o Femoral : rare 27  Congenital inguinal hernia o An indirect (oblique) hernia o o Its due to persistent patency of the processus vaginalis but its communication with the peritoneum is wide o The processus vaginalis is a fold of peritoneum that guides the testis from the abdominal cavity down the inguinal canal to the scrotum o It becomes obliterated at birth leaving the distal part unobliterated as tunica vaginalis o Congenital inguinal hernia in females is called “ hernia of canal of Nuck” o (canal of Nuck in females = processus vaginalis in males) o Clinical picture:  Swelling at anatomical site of hernia that appears on straining, crying and disappear on lying down  May be inguinal or inguinoscrotal o Diagnosis:  Based on physical examination 28  o Therapeutic management:  Herniotomy (as soon as diagnosis is made)  Why?? High rate of incarceration o Nursing care  Routine  Umbilical hernia o Gut pushed out at umbilicus during straining, due to defect in the abdominal wall at the site of the umbilicus o Clinical picture:  Inside abdominal cavity  Covered by skin o Therapeutic treatment:  Surgical repair if:  Persistent after 5 years  Strangulated  Continues to grow o Nursing care:  During conservative ttt:  Monitor changes in size  Asses for strangulation  If surgery will be done:  Routine 29  Congenital Hydrocele  Definition: o Collection of serous fluid in some part of the processus vaginalis due to persistent processus vaginalis  Types: o Communicating:  Its communication with peritoneum is narrow o Non-communicating:  Its communication with peritoneum is obliterated o Hydrocele of the cord:  Due to persistence of intermediate part of processus vaginalis N.B hydrocele of canal of Nuck is equivalent to hydrocele of the cord but in females  Clinical manifestations: o communicating and non-communicating:  Scrotal or inguinoscrotal swelling, cystic, translucent, not reducible o Hydrocele of the cord:  Small, oval cyst in inguinal canal or scrotal neck  Diagnostic evaluation: o Based on physical examination 30  Therapeutic management: o After 1 year  Communicating and non-communicating:  Transfixation of processus vaginalis at internal ring through an inguinal incision with distal part of hydrocele left open  Hydrocele of the cord:  Excision through inguinal incision  Nursing care: o Routine Cryptorchidism Undescended Testes  Definition: o One or both testes fail to descend into the scrotal sac  Clinical manifestation: o Empty scrotum o Testis not palpable o And if palpable, not easily guided into the scrotal sac  Diagnostic evaluation: o For impalpable testes 31   Ultrasound  Laparoscopy  Surgical exploration  Therapeutic management: o Orchiopexy at 6 months (taking down the testis and its fixation in the scrotum)  Nursing care: o Knowledge deficit (to parents):  Decrease anxiety concerning fertility and malignancy o In operation:  Routine 32  Hypospadias  Definiton: o Congenital anomly in which the urethral meatus is below its normal site o May be accompanied by chordee (downward curvature of the penile shaft) o In epispadius: the meatus is above its normal site  Clinical manifestation: o Ventral placement of the urethral opening  Diagnostic evaluation: o Based on physical examination  Therapeutic management: o Children with hypospadius should not be circumcised: because the foreskin may be used in the surgical reconstruction o Timing: at 6-18 month (before the age of toilet training) 33  o Aim:  Put the meatus at the tip of the penis  Correct the associated penile curvature  Improve the cosmetic appearance of the penis o Postoperative  Some type of urinary diversion:  Urinary catheter  Urethral stent + suprapubic cystocath  Suprapubic cystostomy  Child activity: restricted several days  Nursing care of child with hypospadias: o Preoperative: routine o Postoperative: varies with each surgeon as regards:  Dressing  Urinary diversion (care of catheter)  Routine :  Report for temp. (infection related to catheter)  Observe urine for infection (cloudiness, foul smell)  Encourage child to drink frequently  Allow child to be “mobile” by transporting him in a wagon or cart (to give rest to the organ) o Home:  Parents should be taught proper care of catheter and stent before discharge 34  Cleft Lip and Palate  Definition: o Defect in the development of the lip or palate o 40% of facial malformations o o May be complete or incomplete  Clinical manifestations: o Cleft lip: inspection o Cleft palate: inspection + milk coming from nose o N.B: children with CP has increased risk for chronic otitis media: So parents should be aware for early diagnosis to prevent hearing loss  Therapeutic management: o Cleft lip repair at 4 weeks of age o Cosmetic modification may be needed at 4 years of age o Cleft palate repair between 6 months and 2 years 35  Nursing care: o Preoperative: teach parents method to feed  Enlarge nipple by cutting hole so that food is delivered to back of throat without suckling  Stimulate sucking by rubbing nipple on lower lip  Swallow  Rest to allow child to finish swallowing o Postoperative:  Keep straws, pacifier, spoons, fingers away from mouth for 7- 10 days  No oral temp.  Advance diet from clear liquids to soft diet within 48 hrs using syringe with rubber tip  N.B: little evidence exists that suckling causes excess suture stress. Nipple may be used postoperatively Without stressing the sutures  For Cleft Lip: RESUME preoperative feeding techniques  For Cleft Palate: provide short nipples that doesn’t rest on palatal sutures  Clean lip repair site with (saline) using cotton swab after feeding ( in a rolling motion from suture line out)  Anti-infective ointment  Rinse mouth with water after feedings  Analgesics and sedatives 36  Wilms’ Tumor Nephroblastoma  Incidence: o Most common renal tumor in children o Arises from renal parenchyma o Unilateral or bilateral o Genetic predisposition exists o 2 histological types:  Favorable (non-metastatic)  Unfavorable (metastatic)  Clinical manifestations: o Abdominal mass o Abdominal pain  Diagnostic evaluation: o Abdominal U/S: solid intrarenal mass o Abdominal CT scan o Chest X-ray: lungs are primary sites for distant metastases o Chest CT scan  Therapeutic management: 37  o Depends upon: staging, histology o Once staging of the tumor is done, the child will be assigned to the appropriate therapeutic protocol (surgery, chemo, radio) o Surgery  Unilateral: Radical nephrectomy  Bilateral: Radical nephrectomy on the more affected side, and partial nephrectomy on the other side  Nursing care: o Parent state that when bathing their child, they noticed the child’s stomach seemed swollen o Parents state that the diaper no longer fits easily around the child’s abdomen o A sign should be placed on the bed warning against palpating the abdomen o Nurse must offer support and reassurance (nephrectomy is serious to parents as well as the diagnosis of cancer and the treatment Plan) o For surgery: routine, preop. And postop. 38