Imperforate Anus

Maglanoc, Kirsten Audrey P.

BSN-3A2

Definition
Is structure of the anus, In week 7 of
intrauterine life. The upper bowel
elongates to pouch and combine with
a pouch in from the perineum.

Anaphysiology
The colon and rectum are parts of the digestive system.
They are sometimes called the large intestine or large
bowel. The colon is a U-shaped tube made of muscle
and found below the stomach. The rectum is a shorter
tube connected to the colon. The colon and rectum are
about 2 metres (6 feet) long, and form the end of the
digestive system. They are surrounded by other organs
including the spleen, liver, pancreas, reproductive
organs and urinary bladder.

 The colon and rectum are held in the abdomen by folds of tissue called
mesenteries. The mesocolon is a mesentery that attaches the colon to
the wall of the abdomen. The rectum is also surrounded by a mesentery
called the mesorectum. Mesentery is made of fatty connective tissue
that contains blood vessels, nerves, lymph nodes and lymphatic
vessels. When part of the colon or rectum is removed to treat cancer,
nearby mesentery will also be removed. The lymph nodes within the
mesentery are examined to see if they contain cancer cells.
The colon and rectum are made up of many layers of tissues including:
>mucosa which is the inner lining including the epithelium
epithelium A thin layer of epithelial cells that >makes up the outer
surfaces of the body (the skin) and lines hollow organs, glands and all
passages of >the respiratory, digestive, reproductive and urinary
systems., lamina propria (connective tissue) and >muscularis mucosa
(thin layer of muscle)
>submucosa which is connective tissue containing glands, blood and
lymphatic vessels, and nerves
>muscularis propria, a thick layer of muscle
>serosa which is the outer lining of the colon but not the rectum
Main Function: To excrete Metabolic Waste that came and out of the
Human Body.

Pathophysiology
The embryogenesis of these malformations remains unclear. The
rectum and anus are believed to develop from the dorsal potion
of the hindgut or cloacal cavity when lateral ingrowth of the
mesenchyme forms the urorectal septum in the midline. This
septum separates the rectum and anal canal dorsally from the
bladder and urethra. The cloacal duct is a small communication
between the 2 portions of the hindgut. Downgrowth of the
urorectal septum is believed to close this duct by 7 weeks'
gestation. During this time, the ventral urogenital portion
acquires an external opening; the dorsal anal membrane opens
later. The anus develops by a fusion of the anal tubercles and an
external invagination, known as the proctodeum, which deepens
toward the rectum but is separated from it by the anal
membrane. This separating membrane should disintegrate at 8
weeks' gestation

 Interference with anorectal structure development at

varying stages leads to various anomalies, ranging from
anal stenosis, incomplete rupture of the anal membrane,
or anal agenesis to complete failure of the upper portion
of the cloaca to descend and failure of the proctodeum to
invaginate. Continued communication between the
urogenital tract and rectal portions of the cloacal plate
causes rectourethral fistulas or rectovestibular fistulas.
The external anal sphincter, derived from exterior
mesoderm, is usually present but has varying degrees of
formation, ranging from robust muscle (perineal or
vestibular fistula) to virtually no muscle (complex long
common-channel cloaca, prostatic or bladder-neck fistula).

Clinical Manifestation
Symptoms of Imperforate Anus:
Signs and symptoms of imperforate anus
include:
No passage of stool within a day or two of
birth
Passing stool through another opening, like
the urethra in boys or vagina in girls
Swollen belly
Opening to the anus missing or not in the
usual place (in girls, may be near the vagina)

Assessment
The rectum may end in a pouch that
does not connect with the colon.
The rectum may have openings to
other structures. These may include
the (Urethra, bladder, base of the
penis or scrotum in boys or vagina in
girls.
There may be narrowing (Stenosis) at
the anus or no anus.

Laboratory Test
CBC count, blood typing and screening, and
serum electrolyte levels should be measured in all
children with imperforate anus who require
operation.
Urinalysis should be performed to determine the
presence of a rectourinary fistula in all cases in
which the diagnosis cannot be made based solely
on the physical examination findings. If a child
has a perineal fistula, vestibular fistula, or a single
perineal orifice, urinalysis is unnecessary.
Urinalysis is required in all other affected children.

Diagnostic Procedure
A physical exam after birth is
generally enough to make a
diagnosis. Imaging tests can confirm
the problem and reveal the extent of
the abnormalities. These may
include:
X-rays of the abdomen
Abdominal ultrasound

Nursing
Intervention/Management
Maintaining adequate hydration with
moist mucous membranes.
Assisting with NG tube
Provide Care for patient/child with
colostomy
Check for stable VS.
Adequate output of urine

Medical Intervention/ Surgical

Management
Should not be fed
Receives intravenous for hydration
Life threatening comorbidities take
precedence and must treated first.
Anorectal