Nursing 209

N209: Reproductive Health Study Guide • 10-15% of newborns with biliary atresia will also have another anomaly (heart, spleen, blood vessels, or intestines) • Signs and symptoms: Appear two weeks to two months after birth o Jaundice o Dark urine (bilirubin) o Clay-colored stools due to lack of bilirubin reaching intestines o Weight loss and irritability • Diagnosis: Liver biopsy followed by surgery to confirm • Treatment: Kasai procedure (after surgeon who invented it) o Reestablishes bile flow from the liver to the intestines o Not effective in 15-40% of cases; not considered a cure o Effectiveness of surgery depends upon extent of damage to the liver at the time of surgery o By four months of age, surgery is not usually helpful • Liver transplant can correct problem Diaphragmatic Hernia • Protrusion of contents of abdomen into thorax due to a defect in the diaphragm • Occurs in 1:2200 live births • In 50% of cases there are other congenital anomalies • Occurs on the left in 90% of cases • May have protrusion of bowel, stomach, liver, and spleen with hemithorax; can lead to hypoplastic lung or pulmonary hypertension on the affected side • Diagnosed via chest x-ray; sometimes diagnosed prenatally on an ultrasound • Signs and symptoms: Respiratory distress in the first hours after birth with bowel sounds auscultated in hemithorax • Treatment: Surgical repair • Babies should be intubated at birth for a known diaphragmatic hernia, as bag and mask ventilation can increase respiratory problems Hirschsprung Disease • Congenital anomaly involving the innervation of the lower intestine (usually the distal colon) that results in obstruction • Occurs in 1:5000 births • Affects males to females 4:1 • May not present until later in childhood or adulthood • 20% have another congenital anomaly • Down Syndrome is the most commonly associated genetic anomaly and occurs in approximately 12% of cases

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