TUTOR : dr.

Riyani Susan MKT

LEADER : MAYLIA LIE
SECRETARY : VINNA LAURENSIA
NOTULEN : AMANDA I
Batara Sanjaya Ulfa Husni
Corry Ida Hinaya Manasye Alan P
Fahrun Nisa M. Suharso Pane
Debby Iswana Putri Wardhani R
Ozil Fikri Lailatul M
Tiara Vidya M
A newborn 36 hours was born in the midwife was
taken to Royal Primas hospital with the baby's
stomach bloating, vomiting and can not
defecate. What happened to this baby and What
should be done?
1. What caused the baby's stomach,
bloating, vomiting and could not
defecate
2. What is the relation of age infants
with the complaint
- The possibility of milk intolerance
- The possibility of Imperforate Anus
- The possibility of dehydration
- The possibility of premature baby
36-hour-old baby is suspected
suffered imperforate anus
1. Knowing about Definition,Etiology,
Classification, and Epidemiology of Imperforate
Anus.
2. Knowing about fetal development during
pregnancy
3. Knowing about clinical symptoms , Differential
Diagnose and Diagnose of Imperforate Anus
4. Knowing about Management and Prevention of
Imperforate Anus
5. Knowing about Complication, Prognosis and
Education of Imperforate Anus
 Definitions
Disorder caused by growth disorders fusion
and formation of lumps embryogenic anus.
(Mansjoer, Arif; 2000)
1. The breakdown of the upper digestive tract to
the rectal area, so the baby is born without
anus.
2. Impaired organogenesis in utero.
3. In connection with Down syndrome (trisomy
21).
4. Failure of the current growth of the unborn
baby was 12 weeks or 3 months.
5. The presence of interruption or cessation of
development in the area embriologic intestine,
rectum distal portion and the urogenital tract,
which occurs between weeks 4 to 6 gestation.
 Imperforate anus is more common in males
than females. The ratio of atresia ani
disease in men and women is 4: 1
Imperforate anus is a congenital disorder
incidence rates relatively low compared to
other diseases in the digestive tract. Genesis
in the United States 600 children are born
with imperforate anus. The incidence of
anorectal malformations average
worldwide present with a ratio of 1 out of
5,000 live births
This week is actually still a
menstrual period, even
fertilization has yet occurred. For
the approximate date of birth of
the child is calculated based on
the first day of your last period. 5
million sperm cells at once
swam toward their ultimate
goal which is to the egg hiding
in the egg cell lines. Although
troops sperm cells is very much,
but in the end only one who
can penetrate the cells of the
ovaries.
Fertilization occurs at the end of the second week. Cell fertilized egg
splitting in two to 30 hours after fertilization. While continuing to divide, the
egg move in the fallopian hole toward the uterus. After dividing into 32,
the eggs are called morula.
 Until the age of 3 weeks of pregnancy, you
may not be aware if pregnant. Egg cell
that has been split into hundreds will stick
to the wall of the uterus called the
blastocyst. The size is very small, 0.1-0.2 mm
in diameter.

WEEK-4
The fetus begins to form the human
structure. When this has happened
formation of the brain and spinal cord
as well as the heart and the aorta
(large vein that carries blood to the
heart).
Formed three layers, namely
ectoderm, mesoderm and
endoderm. Ectoderm is the
uppermost layer that will form the
fetus' nervous system so that the
form of the brain, spinal cord, skin
and hair. Mesoderm layer is
located on the middle layer that
will form the organ of the heart,
kidneys, bones and reproductive
organs. Endoderm layer is the
innermost layer that will form the
intestine, liver, pancreas and
urinary coffers.
 Embryo size average of 2-4 mm as
measured from the top of the head to
the buttocks. Tuba nerves along the
back of the baby has been shut
down. Although you can not hear the
baby's heart begins to beat at this
week. Digestive and respiratory
systems begin to be formed, tiny tops
that will develop into arms legs started
to appear

WEEK-7
The end of the seventh week, the
length is about 5-13 mm and weighs 0.8
grams, roughly the size of a pea green.
Arm shoots begin to divide into parts of
the shoulder and arm were tiny. The
heart has been divided into the right
ventricle and left ventricle, as well as
the air ducts contained in the lungs
 Length of approximately 14-20 mm.
Many of the changes that happen to
your baby. If you can see, the tip of
the nose and eyelids began to grow,
so does the ear. Brochi, the channel
connecting the lungs to the throat,
began branching. Arm getting bigger
and he had elbow. All this happened
in just 6 weeks after conception.

The baby had already been formed including the formation of the
nostrils, lips, mouth and tongue. His eyes were also already visible under
the thin skin membrane. Members also formed hands and feet,
although not perfect
 The outer ear begins to form, the feet
and the hands continue to grow
following the toes and hands begin to
appear. He began to move even if
you do not feel it. With Doppler, you
can hear his heartbeat. This week, the
length is about 22-30 mm and weighs
about 4 grams.

WEEK-10
All the important organs that had
formed began to cooperate. Brain
growth is increasing rapidly, nearly
250,000 new nerve cells are produced
every minute. He began to look like a
small man with a length of 32-43 mm
and a weight of 7 grams.
 Movement for movement of the feet and
hands, including writhing movements,
straightening up and bowed his head,
could be felt mother. In fact, the fetus has
now been able to change position by
rotating, elongated, curled, or even
somersault that are often painful and
gives the sensation of happiness itself

The body length of up to 6.5 cm. Good hair, fingernails and feet began
to grow. Every now and then in this age of the fetus has evaporated.
 Complete baby face shape, there is a
small chin and nose. The fingers and toes
are separate tiny full. Baby's intestines
were inside the abdominal cavity. Due
to the increasing volume of maternal
blood, fetal heart rate can be increased.
Length is about 63 mm and weighs 14
grams.

WEEK-13
At the end of the first trimester, the
placenta evolved to provide oxygen,
nutrients and waste disposal baby.
Baby's eyelids docked to protect eyes
growing. The fetus reaches a length of
76 mm and weighs 19 grams.
 Three months after conception, the length
of 80-110 mm and weighs 25 grams. His
neck is getting longer and stronger.
Lanugo, the fine hair that grows all over the
body and protects the skin begins to grow
in coming weeks. The prostate gland
develops baby boys and ovaries descend
from the abdomen to the pelvis.

WEEK-15 Bone and bone marrow within the

framework of the system continues to
grow. If your baby girl, the ovaries begin
to produce millions of eggs this week.
Baby's skin is very thin so that the blood
vessels visible. This weekend, weighs 49
grams and a length of 113 mm
 The baby has fully formed and needed
nutrients through the placenta. Babies
already have strong bones and began
to hear the sound. In this formation
process circulatory system is the first to
form and function.

WEEK-17
Hair, forehead, eyelashes baby begins to
grow and the skin on the fingertips line
began to form. Fingerprints have started
to form
WEEK-18
Start humming because the fetus is
able to hear this week. He may be
surprised when they hear a loud
noise. The baby's eyes grew. He will
know the light if you paste a
flashlight that lights in the stomach.
Already 14 cm in length and
weighs 140 grams. Baby can see
light coming through the wall of
the mother's womb. Estrogen and
progesterone hormones increase.
WEEK-19
The baby's body covered with
vernix caseosa, a sort of waxy
coating that protects the skin from
the wound. An infant's brain has
reached millions of motor nerve
therefore he was able to make
conscious movements such as
thumb sucking. It weighs 226 grams
with a length of almost 16 cm.
 Halfway been traversed. Now, weighing
up to 260 grams and length 14-16 cm.
Under a layer of vernix, the baby's skin
began to make the dermis, epidermis
and subcutaneous. nails grow at this
week. The refinement process of the
lungs and respiratory system. Skin
pigment begins to look

WEEK-21
Baby's intestines have developed enough
so that he is able to absorb or ingest
sugar from the liquid and then proceed
through the digestive system into colon.
Baby move more slowly because it
weighs 340 grams and length is already
20 cm
WEEK-22
Baby's senses will be used for
learning is growing every day.
Every week, his face increasingly
similar as when born. Comparison
of the head and the body more
proportional
WEEK-23
Although fat is getting
accumulated in the body of the
baby, his skin was sagging so that it
looks wrinkled. This is because the
production of skin cells more than
fat. He has a habit of "exercise",
move the muscles of the fingers
and toes, arms and legs regularly. It
weighs nearly 450 grams Hands
and feet of babies have been
formed, the finger is also formed.
The lungs take in oxygen even though
the baby is still receiving oxygen from
the placenta. For the preparation of
life outside the womb, the baby's
lungs begin to produce surfactant
that keeps the air sac remains
inflated.

The baby's skin begins to thicken

WEEK-25 WEEK-26 WEEK-27
Baby's bones Your baby may blink The first week of the
hardened and baby besides retinal eye has third trimester, lungs,
be a baby which is begun to take shape. liver and immune
getting stronger. Blood Brain activity system are still to be
vessels in the lungs of associated with finalized. But if he was
the baby is growing. hearing and vision born, has a 85%
The lines around the already functioning, chance to survive.
baby's mouth had the mother can start Taste buds begin to
started to form and play songs light and try form. Babies also
the function of to give more light clever enough to
swallowing is getting around the stomach, thumb sucking and
better. Baby's sense of maybe the mother will swallowing the
smell is getting better feel a little nod of the amniotic fluid that
because this week the head. Baby's weight surrounds it. General
baby's nose section has reached 750- weight infant child's
(nostrils) has started 780gram, while the age 870-890 grams
functioning. Weight height of 35-38 cm. with a height of 36-38
babies has reached cm.
650-670 grams with a
height of 34-37cm.
This week weighs 1100 grams and
length 25 cm. A baby's brain is growing
and expanding. The fat layer was
grown and continues to grow his hair
Fat in the body start to grow.
Although the baby's movement has
begun limited because of the weight
increasing, but the eyes have started to
blink when you see the light through
the mother's abdominal wall. His head
was pointing down. His lungs were not
perfect, but this time if he is born into
the world, the child may have been
likely to survive.
WEEK-29
Baby's adrenal glands begin to
produce hormones such as androgen
and estrogen. This hormone will
stimulating hormone prolactin in the
mother's body so as to make colostrum
(first milk out while nursing). The
sensitivity of the baby is getting clear,
the baby is able to identify changes in
sound, light, taste and smell. Besides the
baby's brain was able to control
breathing and regulate body
temperature of the baby. Posture of the
baby is more perfect as a human
being, his weight 1100-1200 grams, with
height 37-39 cm.
WEEK-30
Body fat and weight babies continue to
grow so that the weight of the baby is
now about 1400 grams and length 27
cm. Because he gets older, his
movement more so Beautiful eyes baby
has started to move from one side to
the other and he started to learn to
open and close his eyes. Currently the
best time for the mother's abdomen
and moving. the flashlight movement
then the baby's eyes were able to
follow the direction in which the
flashlight . membranes (amniotic fluid)
in the mother's womb wane. Now the
child has already started to produce
tears. Baby weight 1510-1550 grams,
with a height of 39-40 cm.
Physical development of babies have
started to slow down at this stage, only the
weight of baby that would accrue. In
addition the fat layer will be growing under
the skin tissue. The bones in the baby's body
has begun to harden, develop and begin to
condense with vital substances such as
calcium, iron, phosphorus. contrary to
physical development, at this phase of
development brain growing very rapidly by
producing billions of cells. If the music is
played, the baby will move. Baby weight
1550-1560 grams with 41-43 cm high.
 Fingers and toes have fully grown, as well
as the eyelashes, eyebrows and hair on
the baby's head is more clear. Lanugo
covering the body start to fall out but
some still exist in the shoulders and back
at birth. Weighing 1800 grams and length
29 cm, the ability to survive outside the
womb have been better if at birth this
week.

The baby's skin is getting red, his eyelids open and the system has also
been formed with perfect hearing. The nails of fingers and toes tiny little
one is already complete and perfect. Her hair even more and more and
getting longer. Babies have started to dream
WEEK-33
Babies already have a face that
resembles his father and mother. A
baby's brain develops more
rapidly. At this time also the baby's
brain has started to coordinate
among other things, the baby is
sucking his thumb and was able to
swallow. Although the baby's
bones had hardened, but the
muscles of the baby has not
completely unified. Your baby can
take a deep breath despite the
breath is still in the water. If the
baby is a boy, the testes baby had
begun to descend from the
abdomen into the scrotum. Baby
weight 1800-1900 grams, with a
height of about 43-45 cm.
WEEK-34
The baby is in the womb door. Your
baby can open and close their
eyes when sleepy and sleep, the
baby also has begun blinked. The
mother's body is sending
antibodies through the mother
blood into the baby's blood that
serves as his immune system and
this process will still continue even
more detailed when the mother
began breastfeeding. Weight
infants 2000-2010 grams, with a
height of about 45-46 cm.
Baby's hearing is functioning
perfectly. Fat of the baby's body has
begun to solidify at the feet and
hands, the fat layer serves to
provide warmth to the body. The
baby is getting bigger and fulfills the
mother's womb. If the mother baby
male testes then at this week has
been perfect. Baby weight 2300-
2350 grams, with a height of about
45-47 cm.
WEEK-36
Baby's skin is getting
smoother and has
become the baby's skin.
The fat layer has begun
to fill the arms and legs of
the baby. Kidneys of
infants is working properly
and the liver has also
been producing dirt. This
time the baby's lungs are
already working well
even ready to meet with
mama and papa. Baby
weight 2400-2450 grams,
with height 47-48 cm
WEEK-37 WEEK-38 until 40
The baby's head down to The formation process
the pelvic area. Baby has ended and the baby
more rounded shape and ready to be born.
her skin became pink.
With bushy hair grow and
grow 5cm. Nails are fully
formed. Babies can
already see the light
outside the womb. Babies
today are learning to
recognize the daily
activities, other than that
the baby is also being
studied to make
breathing even though
her breathing was still
done in the water. Baby
weight in this week 2700-
2800 grams, with a height
of 48-49 cm
 1. Flatulent
2. Vomiting
3. Can not defecate
 Atresia Vagina
Atresia Duodenum
A. Anamnesis
B. Physical examination
C. Examination support
1) Physical examination of the rectum
2) CT Scan
3) Radiology
4) Ultrasound of the abdomen
5) X-ray of the abdomen
6) Pyelografi intravenous
7) Rontgenogram abdomen and pelvis
 Painkillers for surgical procedures
(acetaminofhen 15 mg/kg every 4 hours)
(morphine sulfate of 0,05-0,1 mg/kg iv every
2-4 hours)
Perioperative antibiotics
ampicilin 50 mg/kg every 6 hours
gentamicin 2 mg/kg every 8-12 hours
clindamicin 10 mg/kg every 8 hours
 Monitor regularly defecate
Avoid constipation
IV antibiotics for 3 days
Antibiotic oinment for 8-10 days
Businasi
Diet postoperative
 Health promotion
accessing antenatal care
The specifik protection
acces to antenatal care in women at high
risk,immunization of pregnant women
Early diagnosis and prompt treatment
routine examination at diagnosis assigned
to surgery
Disability limitation
perform investigation to confirm the
diagnosis
Short-term complications that can occur patients with imperforate
anus is:
1. Acidosis Hyperchloraemia
Due to the urine to flow through the fistula to the rectum, the
urine will be absorbed resulting in acidosis hyperchlorae.
2. Urinary Tract Infections
As a result of the flow of feces in the direction of the urinary
tract that makes prolonged urinary tract infections and can
cause damage to the urethra.
Long-term complications that can occur include:
1. eversion anal mucosa,
2. stenosis
3. impaction and constipation due to dilatation sigmoid.
4. anorectal mucosal prolapse
5. recurrent fistula due to tension in the area of surgery and infection.
The prognosis is good if the obstruction symptoms immediately addressed.
Postoperative complications such as anastomotic leakage, anastomotic
stricture generally or insurmountable.

Imperforate anus disease is a disorder of undetermined cause but

suspected a genetic influence parents prior history of the consumption
patterns of parents throughout her age have a greater chance in giving
effect to these disorders. At this stage of Health Promotion, as a
precaution the first level (primary prevention) is the need for attention to
patterns of consumption early age, especially since the early days of
pregnancy prevent meal consumption of foods that are carcinogenic,
access Antenatal Care (ANC), as well as exercise and adequate rest.
From the scenario can conclude 36-hour-old baby experience
imperforate anus . To enforce the type of imperforate anus
should be investigated: inspection of the perianal area,
toucher rectal, rectal temperature measurements, and
invertogram examination.

The management that should be done:

1. Management of liquid.
2. Urethral catheterization.
3. Prevent abdominal distension by installing OGT (Oral
Gastric Tube).
4. Prevent hypothermia baby.
5. Prevent infection.
6. Evaluation of other congenital disorders that may
accompany.
7. And refer to pediatric surgeons.
As well as providing education and disease prevention
information to families, such as:

1. The attention to patterns of consumption early age,

especially since the early days of pregnancy and avoid
eating - the food is carcinogenic.
2. Access antenatal care.
3. Sports and adequate rest.
4. access antenatal care services, especially in screening
pregnant women at high risk (consuming drugs).
5. Immunization of pregnant women.
6. Providing iron tablet.
7. Regular checks as early detection of obstetric
complications
 Elizabeth J.C. 2001. Buku Saku Patofisiologi. Jakarta : EGC
Kurnia, Ade. 2013. Karya Ilmiah Akhir Mengenai Atresia Ani
Levitt M, Pena A. 2007. Anorectal Malformation. Orphanet Journal of Rare Diseases.
2:33
Mansjoer, Arif. 2000. Kapita Selekta Kedokteran Edisi 3 Jilid 2. Jakarta: Media
Aescullapius
Markum A.H. 2002. Buku Ajar Ilmu Kesehatan Anak, Jakarta : EGC
Suriadi, Yuliani R. 2001. Asuhan Keperawatan Pada Anak. Jakarta: CV. Sagung Seto
WHO. 2009. Buku Saku Pelayanan Kesehatan Anak di Rumah Sakit, Pedoman Bagi
Rumah Sakit Rujukan Tingkat Pertama Di Kabupaten/ Kota

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http://lib.ui.ac.id/file?file=digital/20351612-PR-Ade%20Kurniah.pdf
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