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Kamis, 19 Mei 2011
Definition
There is some understanding of Mega Colon, but essentially the same which is a disease caused by a mechanical obstruction caused by inadequate motility of the intestine so that no spontaneous bowel evacuation bases and the inability spinkter rectum relaxation.
Hirschsprung's disease or Mega Colon is not a cell - ganglion cells in the rectum or the rektosigmoid Colon. And the lack of these circumstances lead to abnormality or absence of peristalsis and absence of spontaneous bowel evacuation (Betz, Cecily & Sowden: 2000). Hirschsprung disease or congenital abnormality Mega colon is the cause of intestinal disorders common passage in neonates, and most of 3 Kg, more men - £ aterm occur in infants with birth weight men than women. (Ariel Mansjoeer, 2000).

Etiology
As for the cause of Hirschsprung's or Megan Colon itself is thought to occur because of genetic and environmental factors often occur in children with Down syndrome, failure in embryonic neural cells in the intestinal wall, failure of existence, kranio caudal on myentrik and sub-mucosal plexus wall.
Pathophysiology
The term congenital aganglionic Mega Colon describing the primary damage in the absence of ganglion cells in the distal colonic mucosa wall sub. Aganglionic segment is almost always there in the rectum and the proximal part of the colon. This raises the absence of abnormality or absence of movement of propulsion (peristalsis) and the absence of spontaneous bowel evacuation and the rectum spinkter can not relax, which prevents the normal discharge of feces that causes the accumulation of the intestine and distention of the gastrointestinal tract. Part proximal to the damaged part of Mega Colon (Betz, Cecily & Sowden, 2002:197).
All ganglion on the intramural plexus in the intestine useful for the control of contraction and relaxation of normal peristalsis.
The contents of the intestine leading to aganglionik segments and feces collected in the area, causing terdilatasinya the bowel proximal to the area due to obstruction and causing the widened section Colon (Price, S & Wilson, 1995: 141).
Clinical Manifestation
Newborns can not remove the meconium in a 24-28 first hour after birth. Seemed reluctant to consume liquid, mixed with bile vomiting and abdominal distension. (Nelson, 2000: 317).
Disease symptoms of intestinal obstruction location Hirshsprung is low, babies with Hirshsprung disease may show clinical symptoms as follows. Total obstruction at birth with muntaah, abdominal distension and absence of meconium evacuation. The delay in the evacuation of meconium obstruction followed by constipation, vomiting and dehydration. Rigan Symptoms of constipation for several weeks or months, followed by acute intestinal obstruction. Entrokolitis mild constipation with diarrhea, abdominal distension and fever. The existence of a hose fitting stool on digital rectal is the sign distinctive. When has arisen nikrotiskans enterocolitis occurs severe abdominal distension and foul-smelling diarrhea that may bleed (Nelson, 2002: 317).
1. Children - child
a. Constipation
b. Poop like a ribbon and stink
c. Abdominal Distenssi
d. The existence of time can be palpated difecal
e. Usually appear less nutrition and anemia (Cecily Betz & sowden, 2002: 197).

Complication
a. Intestinal obstruction
b. Constipation
c. Fluid and electrolyte imbalance
d. Entrokolitis
e. Anal structure and inkontinensial (post operation) (Cecily Betz & sowden, 2002: 197)

Examination Support
1. Examination with barium enema, with this examination will be found:
a transition region
b Overview of irregular bowel contractions in the bowel narrows
c Entrokolitis padasegmen which widens
d There is a retention of barium after 24-48 hours (Darmawan K, 2004: 17)
2. Suction biopsy
That took the mucosa and sub mucosa with suction device and find ganglion cells in the sub mucosa (Darmawan K, 2004: 17)
3. Rectal muscle biopsy
That is taking rectal muscle layer
4. Examination of acetyl choline esterase enzyme activity of the biobsi suction on this disease typically have increased, the activity of choline esterase enzimasetil (Darmawan K, 2004: 17)
5. Examination of norepinephrine activity of intestinal biopsy tissue
(Betz, Cecily & Sowden, 2002: 197)
6. Examination of the anal plug
In this examination of the finger will feel the pins and feces during the spraying. This examination determines the shoulders of feces, dirt that accumulate and clog the intestine at the bottom and decay will occur

Management
1. Medical
Penatalaksaan surgery is to repair the portion of the colon aganglionik to free from obstruction and restore normal intestinal motility and also great that ani spinkter function internally.
There are two stages in the medical treatment that is:
a temporary ostomy is made proximal to the segment aganglionik to release the obstruction and normal colon terdilatasinya weakened and to restore the normal size.
b Surgical correction usually done or made more severe when the child reaches about 9 kilograms (20 pounds) or about 3 months after first operation (Cecily Betz & Sowden 2002: 98)
There are several surgical procedures are performed such as Swenson, Duhamel, Boley & Soave. Soave procedure is one of the most frequently performed procedure consists of the withdrawal of the normal colon mucosa aganglionik the end of which was changed (Darmawan K 2004: 37)
2. Treatment
Note the treatment depends on the child's age and type of exercise when the disability is diagnosed during the neonatal period, the main note include:
Helping a parent to know the existence of congenital abnormalities in children at an early stage
b Assist the development of the bond between parent and child
c Preparing parents that there is medical intervention (surgery)
d Assisting parents in the treatment of colostomy after plans to go home (Faculty of medicine, 2000: 1135)
In preoperatively care must be taken into consideration the clinical condition of children - children with nutritional mall could not survive the surgery to increase her physical status. This often involves symptomatic treatment such as enemas.Necessary is also a low-fiber diet, high in calories and high in protein and can be used in situations of total parenteral nutrition (NPT)

Growth Concept
The concept of child development that focused on todler ages 1-3 years can also be included in the pre-operational stage of the age of 2-7 years. According Yupi. S (2004) based on the theory peaget that this period is a picture of internal kongnitif children about the outside world with a variety of complexity that grows in stages is a time when the mind is rather limited. Children can use the symbol over the word - the word, considering the present and future. Children are able to distinguish itself with the object in the world around him both language and the thought is characterized by egesenterisme, he did not master the idea of ​​equality mahu mainly deals with the problems logically, but in free play situations it tends to show a logical and sensible behavior at this stage will began to recognize her
Growth issues related to major changes in the number, size or dimensions of the level of cells, organs and individuals that can be measured by the size of the weight (grams, pounnd, kilograms). Length (cm, m). Age bone and metabolic balance (potassium and nitrogen retention of the body). The development is the increasing ability of the structure and function are more complex in a pattern of regular and predictable as a result of the maturation process (Soetjiningsih, 1998: 1).
On physical growth can be assessed weight gain of 2.2 kg / year and height will increase about - about 7.5 cm / year. The proportion grew to change the arms and legs grow faster than the head and body lorosis lumbar spinal cord in less visible and have the appearance of a crooked leg. Head circumference increased 2.5 cm / year and anterior fontanella closed at the age of 15 months. First molars and second molars and canine teeth begin to appear (Betz & Sowden, 2002: 546).

1. Impact Reduction Strategy hospitalitation At Age Todler
At age children tend egocentric todler then explain the procedure in relation to the way what will the child see, hear, smell, touch and feel. Tell your child it's OK to cry or use verbal expression to say uncomfortable.
At this age also have limited ability to communicate more often using behaviors or attitudes. Few simple approach using a small example of equipment (allow the child to hold the equipment) using the game.
At this age makes the difficult relationship between children and parents nurse required in these circumstances, no matter how that is done anaka must be a first consideration. Mothers should be encouraged to stay or at least visit their children as often as possible (Yupi, S 2004).

2. Intervention Focus
a. Constipation associated with colon obstruction inability to evacuate stool (Wong, Donna, 2004: 508)
Objectives:
1. children can perform elimination with some adaptation to the normal function of elimination and can be done
Criteria Results
1. Patients can perform elimination with some adaptation
2. There is increasing elimination patterns better
Intervention:
1. Provide assistance enema with 0.9% NaCl physiological fluid
2. Observation of vital signs and bowel sounds every 2 hours
3. Observations expenditure per rectal stool - forms, consistency, amount
4. Observations intake that affects the pattern and consistency of stools
5. Suggest to a diet that has been recommended

b. Changes in nutrients the body needs less and associated with nausea and vomiting digestive tract
Objectives:
1. Patients receive an adequate nutritional intake in accordance with the recommended diet
Criteria Results
1. Weight of patients according to age
2. Patients with moist skin turgor
3. Parents can choose the recommended foods
Intervention
1. Provide adequate nutritional intake in accordance with the recommended diet
2. Measure the weight of children every day
3. Use an alternative route of nutrition (such as NGT and parenteral) to anticipate patients who have started to feel nausea and vomiting

c. Risks associated with lack of volume of fluid intake that is less (Betz, Cecily & Sowden 2002:197)
Objectives:
1. Hydration status of patients to meet the needs of the body
Criteria Results
1. Moist skin turgor.
2. Fluid balance.
Intervention
1. Provide adequate fluid intake in patients
2. Keep track of the sign - a sign of adequate body fluids turgor, intake - output
3. Observations adanay increased nausea and vomiting in anticipation devisit body fluids immediately
d. Lack of knowledge about the disease process and pengobatanya. (Whaley & Wong, 2004).
Objective: The knowledge of patients about to be more adequate penyakitnyaa
Criteria results:
1. Knowledge of patients and families about penyakitnyaa, treatments and drugs - drugs. For patients with Mega Colon increased distinction patient or family is able menceritakanya back
Intervention
1. Give families the opportunity to ask for things - things that are known sehubunagndengan ingn penyaakit experienced patients
2. Assess family knowledge about Mega Colon
3. Assess the family background
4. Explain about the disease process, diet, treatments and drugs - drugs on the patient's family
5. Explain all procedures to be implemented and the benefits for patients.

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