The clinic nurse reviews the record of an infant and notes that the primary health care provider (PHCP) has documented a diagnosis of suspected Hirschsprung’s disease. The nurse reviews the assessment findings documented in the record, knowing that which sign most likely led the parent to seek health care for the infant?
A.
Diarrhea
B.
Regurgitation of feedings
C.
Projectile vomiting
D.
Foul-smelling ribbon-like stools
The Correct answer and Explanation is:
Correct Answer: D. Foul-smelling ribbon-like stools
Explanation:
Hirschsprung’s disease, also known as congenital aganglionic megacolon, is a condition that affects the large intestine (colon) and causes problems with passing stool. It is a congenital disorder, meaning it is present at birth, and occurs when nerve cells, known as ganglion cells, are absent in a segment of the bowel. These nerve cells are crucial for the coordinated muscle contractions that move stool through the intestines. Without these nerve cells, the affected segment of the colon lacks the ability to push stool through, leading to a blockage.
The most telling sign of Hirschsprung’s disease in an infant is the presence of foul-smelling, ribbon-like stools. This stool presentation occurs because of the obstruction caused by the absence of ganglion cells, leading to a narrowing of the affected part of the colon. As a result, stool passes through this area in a thin, ribbon-like form. The foul smell is due to prolonged retention of stool in the bowel, which can lead to bacterial overgrowth and fermentation.
Other Options:
- A. Diarrhea: While diarrhea can be a symptom of various gastrointestinal conditions, it is not characteristic of Hirschsprung’s disease. Infants with Hirschsprung’s disease are more likely to experience constipation rather than diarrhea.
- B. Regurgitation of feedings: Regurgitation, or spitting up, is common in infants and usually associated with gastroesophageal reflux rather than Hirschsprung’s disease. This symptom does not directly relate to the bowel obstruction seen in Hirschsprung’s disease.
- C. Projectile vomiting: Projectile vomiting is more commonly associated with conditions like pyloric stenosis, where the muscle leading from the stomach to the small intestine is abnormally thickened. While severe constipation or obstruction might cause vomiting in Hirschsprung’s disease, projectile vomiting is not the most indicative sign of this condition.
Conclusion:
The most likely reason a parent would seek medical care for an infant with Hirschsprung’s disease is the observation of foul-smelling, ribbon-like stools, which is a classic sign of the condition. Early recognition of this symptom is crucial for prompt diagnosis and treatment, which often involves surgical intervention to remove the affected segment of the colon and restore normal bowel function. Delay in diagnosis and treatment can lead to complications such as enterocolitis, a serious inflammation of the intestines. Therefore, identifying and understanding the key symptoms of Hirschsprung’s disease is vital for effective nursing care.