AGANGLIONIC MEGACOLON (HIRSCHSPRUNG DISEASE)-ENGLISH
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AGANGLIONIC MEGACOLON
(HIRSCHSPRUNG DISEASE)
•
AGANGLIONIC
MEGACOLON is also known as
Hirschsprung's disease. It is a condition that affects the large
intestine (colon) and causes problems with passing stool. The condition is
present at birth (congenital) as a result of missing nerve cells (ganglions) in
the muscles of the baby's colon.
•
In
this condition normal bowel movement do not take place and the intestine above
the affected area becomes dilated that’s why it is known as Mega colon (Big
colon).
Sign and symptoms of Hirschsprung's
disease
•
Signs
and symptoms of Hirschsprung's disease vary with the severity of the condition.
Usually signs and symptoms appear shortly after birth, but if the condition is
mild they're not apparent until later in life.
•
In
infants-
•
Stools
are not passed.
•
Abdominal
swelling
•
Vomiting,
including vomiting a green or brown substance
•
Constipation
or gas, which might make a newborn irritable.
•
Diarrhea
•
Anorexia
•
In
older children
•
Abdominal
swelling
•
Chronic
constipation
•
Gas
formation >>> pain abdomen.
•
Failure
to thrive
•
Fatigue
•
Diagnostic
Investigations-
•
Rectal
examination- absence of fecal matter.
•
Barium
enema X-ray Examination.
•
Rectal
Biopsy- absence of ganglionic cells.
Treatment -
•
Surgical
repair- Surgery the most effective
treatment for Hirschsprung disease. This is done in one step or two, depending
on how severe it is. Children who are very sick at the time of surgery (from an
inflamed colon or poor nutrition) may need to undergo surgery in two steps.
•
In
first step colostomy is performed and main surgery is delayed until the age of
9-12 months.
•
When
the baby’s condition stabilizes and he gains adequate weight resection of
aganglionic part of colon and anastomosis of remaining coloum is done.
Nursing Management -
Ø
-
Preoperatively daily rectal wash is given with normal saline.
Ø
-
antibiotics may be prescribed to prevent infection that should be given on
time.
Ø
-
Nutritional status should be maintained.
Ø The frequency and type of stool should be noted.
Ø - Parents are explained about the
disorder, treatment procedure and all
questions are answered to alleviate anxiety.
Ø - taking rectal temperature should be avoided to prevent injury to rectal
mucosa.
Ø After surgery proper observation and vital signs monitoring should be
done.
Ø - Watch out for abdominal distension, bleeding at surgical site and
should be reported immediately.
Ø - Regular changing of dressing with aseptic technique.
Ø Proper colostomy care should be provided with aseptic technique.
Ø - Skin care should be provided
around stoma to prevent skin breakdown.
Ø
Other Nursing interventions – includes all nursing
care of hospitalized child that we have discussed in previous lecture under
heading Nursing care of hospitalized child in the lecture “Child Health
Nursing”.
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