Cailtin Lesko PRP
Cailtin Lesko PRP
Cailtin Lesko PRP
HIRSCHSPRUNGS DISEASE,
AND ITS NUTRITIONAL
IMPLICATION.
Caitlin R. Lesko
June 5,2016
OUTLINE
The Large Intestine
Normal Gut Function
What is Hirschsprungs Disease
Medical Nutrition Therapy
Study Summary & Review
Summary
PERISTALSIS
The series of wave like muscle contractions
responsible for moving food through the digestive
tract.
What if peristalsis is disrupted?
Can lead to malabsorption
What leads to lack of motility
diet
obstructions
nerve damage
HIRSCHSPRUNGS DISEASE
Occurs when the ganglion cells of the Auerbachs
plexus are missing in sections or all of the large
intestine.
Also known as congenital mega colon.
Discovered by Harald Hirschsprung, a Danish
pediatrician in 1886.
EPIDEMIOLOGY
Congenital disorder
Occurs statistically in roughly 1 in every 5,000
births.
More common in males than females.
More prevalent children with other congenital
disorders.
As a fetus Ganglion cells begin to develop in the
mouth and follow the gastrointestinal tract to the
anus.
Hirschsprungs disease is usually detected early
in infancy or childhood.
DIAGNOSIS
After the rectal biopsy, the patient will have a
Barium Enema.
Shows the location of the affected sections of
colon.
ANORECTAL MANOMETRY.
The next step in the diagnostic process is an
Anorectal Manometry test .
Test is done to test the sphincter muscles and
over all muscle movement.
TREATMENT
Surgical intervention is the only treatment.
Colostomy/ Ileostomy
Pull through procedure, 6-12 months post ostomy.
Swenson
Duhamel
Soave
SURGICAL TREATMENT
CONTINUED.
SWENSON
Orvar Swenson, 1948
The pull-through procedure repairs the colon by
connecting the functioning portion of the bowel to
the anus.
Leaves a small portion of the diseased bowel.
DUHAMEL
1956
SOAVE
Foods to avoid:
yogurt with added fruit, tough meats, dried
beans, whole wheat grains, high fiber cereals, raw
vegetables, dried fruit & fruit skins.
ALTERNATE NUTRITION
Enteral nutrition is the preferred method.
Indications include: prevention of gut atrophy,
supplemental feedings to help patient meet
nutritional needs.
Must monitor for signs of intolerance.
Refeeding syndrome.
No specific formula, but many benefit from an
elemental for semi-elemental.
Hydrolyzed formulas maybe used for patients
with intolerances, easier to digest.
PARENTERAL NUTRITION
Indications, the gut cant be utilized
The gut cant be utilized, NPO for 5 days or
greater.
Formulas made up of Dextrose, Amino Acids,
Lipids, trace electrolytes, and trace minerals.
Adjusted to patients needs & life style.
IMMUNOHISTOCHEMISTRY VERSUS
ACETYLCHOLINESTERASE HISTOCHEMISTRY IN THE
EVALUATION OF SUCTION RECTAL BIOPSIES FOR
HIRSCHSPRUNG DISEASE
SUMMARY
THANK YOU,
Questions??
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