Chn

1. PRESENTED TO:-
Mrs Anita Asrani mam
Ms Pinky pathidar mam
PRESENTED BY:-
JECIKA JOSHWA
Bsc Nursing 3rd year
SUBJECT :- CHILD HEALTH NURSING

3. Anorectal malformation refer to anomalies of the
rectum and distal anus, the urinary tract ,and the
genital tract .
These malformation may range from simple
imperforate anal to include other associated
complex anomalies of genitourinary (GU) and
pelvic organ.
Which may require extensive treatment for fecal
, urinary ,and sexual function .
 Anorectal malformation are frequently associated
with other anomalies .some babies have VACTERL
conditions.

5. Anorectal malformation
are congenital
malformation caused by
abnormal development of
the rectum and anus .

7. The exact cause of these malformation
is not known. It occurs due to the arrest
in the embryonic development of the
anus , lower rectum and urogenital
tract at the 8 th week of embryonic life
The membrane that separatevthe
endodermal hindgut from the
ectodermal and dimple perforates and a
continuous canal is formed, the outlet
of which is the anus.

8. If the membrane separating the
rectum from the anus is not
absorbed, and if the union does not
take place,an anorectal anomaly
results
Approximately 40% of the neonates
with anorectal malformations have
associated anomalies like Down's
syndrome , congenital heart disease
, undescended tests, renal
abnormalities , esophageal atresia

10. A. Infant with out normal anus
 With a visible abnormal opening
1. Anal stenosis
2. Ano perineal fistula
3. Anovestibular fistula
 With an invisible but manifested opening of the bowel
1. Rectovagainal fistal
2. Recto urethral fistula
3. Rectovestibular fistula
 No manifested opening of the bowel
1. Persistent anal membrane
2. Rectal atresia

11.  1) Anal stenosis :- which is narrowing of the canal
that makes it difficult to pass stool , can lead to serious
complications it left untreated. Also referred to as
stricture , this condition occurs when the muscle in the
anus - which expand and contract to regulate the
passage of the fecal material - narrow

12.  The presence of a fistula (abnormal tunnel ) between
the anal canal and the perineum
 3) Anovestibular fistula(AVF) is the most common
form of anorectal anomaly in female infants

13.  1) Rectovagainal fistula :- It is an abnormal
connection between the lower portion of
your large intestine — your rectum—and your
vagina. Bowel content can leak through the
fistula , allowing gas or stool to pass through
your vagina

14. It is a connection between the lower urinary
tract and the distal part of the rectum .RUFs
are rare conditions and can be classified as
congenital or acquired.
 3) Rectalvesicular fistula :- it is an
abnormal connection between the rectum
and the urinary bladder .

23.  No or abnormally formed anal opening .
 Failure to pass meconium within the first 24 hours
of birth may be indicative of imperforate anus.
 Fistula
 Presence of mechonium in urine
 Progressive abdominal distention
 Vomiting
 Rectal tube cannot be inserted
 Imperforate anus

25.  Physical examination by passing the gloves little finger
through the anus and by observing the passage through
which meconium was passed .
 Cystoscopy
 An IV pyelogram and a voiding cystourethrogram are
performed to evaluate associated anomalies involving
the urinary tract .

27.  Newborn is stabilized and kept NPO for
further evaluation
 IV fluids are provided to maintain glucose
and fluid and electrolyte balance
 Current recommendation is that surgery be
delayed at least 24 hours to properly
evaluate for the presence of a fistula and
possibly other anomalies

28.  Various according to the defect
 Low ARM
 Rectal cut back anaplasty or Y-V plasty
 Dialation of fistula
 High ARM
 Colostomy
 Posterior sagittal anorectoplasty (PSARP) or
other pull- through with colostomy .

29.  This surgery generally occur between 3 to 6 months
of age , although timing varies among surgeons.
 When the operative site has healed , approximately 2
weeks after surgery , anal dilations are begun.
 When the desired size of the anal opening has been
achieved, the colostomy is closed.
 In case of imperforate anal membrane , the memy is
perforated with a blunt instrument. Repeated
dilations might be necessary to prevent scar
formation.
 In case of fistulas, the colon can be brought down
through the anal dimple by an abdominoperineal
procedure. The anus is positioned in the area of

46.  Gastric suction may be done
 Withhold oral feedings
 Start parenteral hydration
 Measurements of abdominal girth
 Intake output chart
 Consent from parents
 Pre- medication

48.  Scrupulous perineal care
 Change perineal dressing whenever soiled.
 Apply protective ointments such as zinc oxides to
decrease skin irritation.
 Position baby in a side- lying or a supine position
with the legs suspended at a 90° angle to the
trunk to prevent pressure on perineal sutures.
 Intravenous feedings till the wound heals or until
peristalsis appear.
 Prevention of constipation by exclusive
breastfeeding and proper weaning with stool
softeners or fibers.
 Bowel habit training

49.  Daily enemas until control are achieved if
necessary.
 Do not use diaper in case of anoplasty
 Colostomy care by changing the collection
device and meticulous skin care .
 Family support , discharge planning and
home care

56.  Rectovesicular fistula. Rectourethral fistula

57.  All patients born with anorectal
malformations can be kept clean of stool and
dry of urine , either because they achieve
bowel control or because they are subjected
to a bowel management program

58.  Manoj yadav "A textbook of Child health nsg
 Edition 2011 published by s.vikas and
 Company
 Parul Datta " Pediatric Nursing"
 2nd edition published by Jaypee
Brothers
 Internet :-
 www.slideshare .com
 Wikipedia