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Ch 22 The Child with GI Dysfunction
Terms in this set (107)
-UA - r/o UTI
-Enlarged appendiceal diameter seen on CT - Gold Standard
What does GI dysfunction involve?
entire GI tract
-oral to anal
GI diagnostic tests
CPR, ESR, Plts
-deciphers IBD vs non IBD
fluid and electrolyte balance
major issue in pediatrics
Why are peds more vulnerable to F&E balance?
size and kidney maturity
What does excess water cause in F&E Balance?
Greatest concern with fluid and electrolyte balance in peds?
What is dehydration?
Decreased intake or excessive loss of fluid
S/S of dehydration
increase in pulse rate
flat neck veins
poor skin turgor weight loss
prolonged cap refill
skin cool and mottled with circulatory failure
decreased urine output
decreased or absent tears
Best treatment for dehydration?
Fluid replacement for dehydration?
Slow and low
When is PO fluid replacement not warranted?
excess stool loss
What do you give infants with dehydration?
What do you give toddlers/kids for dehydration?
Peds Gastroenteritis - Remember
Cook and store food properly
Properly dispose of diapers
no antidiarrheals for kids
If vomiting - want them to have diarrhea too
Medications for vomiting with gastroenteritis?
What percentage of deaths are caused from diarrhea and dehydration?
Most severe cause of gastroenteritis in young patients
given at 2 months
antibiotics altering intestinal flora causing overgrowth of bacteria
Flagyl or Vancomycin
When is meconium usually passed?
within 24 hours of birth
When is lack of meconium passing a red flag?
Not passed within first 36 hours
What can be cause of not passing meconium?
Mec Plug or Ileus
-often first sign of CF
-not common with breastfed infants
-occurs when switching to milk
-hard poop/hold/gets harder/ repeat
Treatment for child constipation
Increase fiber and fluids
What is done for severe constipation in children
NG with Golytely for 24-48 hrs
What is Hirschsprung's Disease?
- a congenital anomaly
Hirschsprung's is responsible for how many obstructions?
What causes Hirschsprung's?
congenital abscense of parasympathetic nerve ganglion cells in distal colon
-lack of nervous stimulation; sphincter cant relax to defecate
When is Hirschsprung's diagnosed
in first few months
-failure to pass mec
later in life
How is Hirschsprung's diagnosed?
Anorectal Manometric exam (measures pressure)
Confirmed with rectal biopsy
-abscense of ganglion nerve cells
Nursing Care for Hirschsprung's
Enema therapy until surgery
Skin and Wound care
What is GERD
Gastric content empty into the esophagus.
What percentage of infants have GERD?
How many premature infants have GERD?
When does GERD resolve
Usually by 1 year
-LE sphincter tightens
Which kids get treated?
GERD treatment - Initial
-UGI with contrast
-24 hr pH probe
thicken formula with rice cereal
-upright after feeding
-small freq feeds
Gerd Treatment - 2nd
-zantac-ranitidine or Pepcid and PPI(Prevacid, Prilosec) less often (Reglan)
Surgical mgmt of GERD
-Wrap gastric fundus behind esophagus to encircle distal esophagus
inflammation of the vermiform appendix
What age is most common for pediatric surgery of appendicitis?
10 years old
S/S of appendicitis?
-pain at McBurney Point - RLQ
-fever, double over
Most common cause of appendicitis?
or enlarged lymph tissue or recent gastro
Diagnosis of appendicitis
CT showing enlarged appendiceal diameter is GOLD STANDARD
Elevated WBC, CRP, Bands
What is the main concern with appendicitis?
Rupture and peritonitis
S/S of appendicitis
board like rigid abdomen
rapid shallow breathing
side lying with knees flexed to abdomen
What needs to be avoided with appendicitis?
(Can cause bowel perforation)
Treatment for appendicitis?
IV ABX therapy
-acute uncomplicated only!
Peptic Ulcer Disease
Chronic ulcers affecting stomach or duodenum
S/S of Peptic Ulcer Disease
abdominal pain bleeding hematemesis
-coffee ground emesis
Peptic Ulcer Disease Treatment
H2 receptor antagonists
Progressive inflammation and eventual obliteration of the extrahepatic bile ducts after birth
BLOCKAGE OF BILIARY SYSTEM
s/s of biliary atresia
pale putty like stool
tea colored urine
What surgery is done for biliary atresia?
Malabsorption syndrome caused by the inability to digest and utilize products with gluten
Gluten induced allergic disease
s/s of celiac disease
When are symptoms of celiac disease seen?
6 months - 2 years when solids are introduced
How is celiac disease diagnosed?
blood test or intestinal biopsy
Celiac disease treatment
NO gluten in diet (continuation of gluten consumption can lead to cancer)
read food labels
Inflammatory bowel disease
Cause of IBD
-genetic factors involved
-immune dysfunction involved
Diagnosis of IBS
colonoscopy with biopsy - GOLD STANDARD
Ulcerative Colitis vs Crohn's
UC= mainly inner lining @ specific location
Crohn's= throughout GI tract
developmental differences between UC and Crohn's
UC-uniform progression spread from rectum through the colon
Crohn's - uneven spread. Inflamed areas of intestines between healthy
Disease development between UC and Crohn's
UC-uniform progression spread from rectum through colon
Crohn's-uneven spread, inflamed intestinal segments between healthy intestinal areas
S/S intestinal differences in UC and Crohn's
UC-bloody diarrhea, abd pain, weight loss, ulceration & bleeding
Crohn's-Diarrhea, abd pain, weight loss, perforation of colon, toxic megacolon
S/S extraintestinal differences in UC and Crohn's
UC-Liver disease, anemia, fever, arthritis, skin changes
Crohn's-fistulas, abscesses, anemia, fever, arthritis, skin changes
Is rectal bleeding common in UC or Chron's?
Is diarrhea more severe in UC or Crohn's?
Is pain more frequent with UC or Crohn's?
Is anorexia more severe in UC or Crohn's?
Is weight loss more severe in UC or Crohn's?
Is growth restriction more common in UC or Crohn's?
Are fistuals more common in UC or Crohn's?
Treatments for UC and Crohn's
Promote normal growth and development
Allow normal lifestyle when poss
congenitally malformed palate with a fissure along the midline
Midline cleft palate defects can mean what?
What is a hernia
A bulging of an organ or tissue through an abnormal opening.
Biggest concern with a hernia
strangulation impairing blood supply to organ
complete obstruction of one or both nares with either membrane or bone
Bilateral atresia causes
respiratory obstruction and failure
Are infants obligate nasal or mouth breathers
How is choanal atresia diagnosed?
inability to pass NG tube through one or both nares
Intestines are found outside of the body exiting anywhere but the umbilicus
Intestines protrude into the umbilcus
S/S of esophageal atresia and tracheoesophageal fistula
What GI conditions are midline issues?
How are esophageal atresia and tracheoesophageal fistulas diagnosed?
Inability to insert NG tube into stomach
What are pre-op instructions prior to surgery for esophageal atresia and tracheoesophageal fistulas?
Removing mucus and saliva
What is a diaphragmatic hernia?
A surgical emergency in the newborn caused by herniation of abdominal contents into the chest cavity. Usually unilateral on the left. Symptoms: increased left sided breath sounds, heart sounds on the right, and severe respiratory distress at birth. The abdomen may have a concave appearance. Bag and mask will make it worse.
What is hypertrophic pyloric stenosis?
thickening of the pyloric sphincter which creates an obstruction
usually occurs the first 5 weeks of life
Symptoms of hypertrophic pyloric stenosis
Vomiting that often occurs following a feeding
Vomit becomes projectile as obstruction worsens
Blood tinged vomit
Failure to gain weight
Signs of dehydration
How is hypertrophic pyloric stenosis diagnosed?
Olive-shaped mass in RUQ of abdomen
Treatment for hypertrophic pyloric stenosis
Feeding starts within 24 hours post-op - clear, low and slow
May vomit for up to 48 hours due to edema/inflammation
What is intussusception?
telescoping of 1 bowel segment into a distal segment
What does intussusception cause?
circulatory compromise and ischemia
(Red currant jelly stools=ischemic bowel)
What is the most common intestinal obstruction in 5 month-3 year olds?
What are the symptoms of intussusception?
Acute abdominal pain
abdominal mass (sausage shaped in RUQ)
periodic pain and irritability
Treatment for intussusception
Radiologist guided air enema can dx and treat
What is malrotation and volvulus?
abnormal rotation of intestine around superior mesenteric artery during embryonic development
volvulus=twisting of intestine around itself, thereby compromising blood supply to intestines
S/S of Malrotation/Volvulus
-Drawing up legs in discomfort
-lower GI bleeding
-Volvulus will have ACUTE onset of pain
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