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Peds GI

Acute GI

GER in ___ is usually ____ and resolves by ___ Infants; self-limiting, end of first yr. of life (or 6-9 mo)
GER may result in Failure to thrive, bleeding, difficulty swallowing, chronic otitis media
Risk factors for GER Premature infants, congenital defects
GER s/sx (infants) o Excessive spitting up, forceful vomiting, irritability, excessive crying, blood in stool or vomit (melena/hematochezia, hematemesis), arching of back and stiffening, apnea or apparent life-threatening event
GER s/sx (older child) Reports of heartburn, abdm pain, dysphagia, chronic cough, Sandier syndrome (repetitive stretching and arching of head/neck that may mimic seizure activity)
GER diagnostic procedures Upper GI series (structural abnorm), 24hr intraesophag pH monitoring study (amnt gastric reflux into esophg), endoscopy c. biopsy (strictures, esphgitis), scintigraphy (IDs gastric content aspiration)
GER Tx Offer small, frequent feedings of thickened formula, position child c. head elevated @ 30 degree after meals, place infants in prone position for sleep (prevent asprtn in severe GERD), admin PPI or H2-r antagonist, place on wedge
GERD surg procedures Surg manipulation, Nissen fundoplication (wraps stomach's fundus around distal esophg to decrease reflux)
GERD post-op actions Increment feedings beginning c. clear liquid/glucose/electrolytes and Ax readiness to progress back to breast milk/formula. May cont. vomit 24-48hr post-op
GERD complications Recurrent pneumonia, weight loss, failure to thrive
Hirschsprung's disease causes ___ obstruction and is usually Dx in ____ Mechanical; infants
True or false: Hirschsprung's is strictly an acute D/O False. Can also be chronic
Hirschsprung's s/sx (newborn) Failure to pass meconium within 24-48h, refusal to eat, episodes of vomiting bile, abdm distension
Hirschsprung's s/sx (infant) Failure to thrive, constipation, abdm distention, ep. of vomiting and diarrhea
Hirschsprung's s/sx (older child) Constipation, abdm distension, visible peristalsis, ribbon-like stool, palpable fecal mass, foul-smelling stool, malnourished appearance
Hirschsprung's diagnostic procedures Rectal biopsy (full-thickness biopsies to reveal absent ganglion cells)
Hirschsprung's surgery Removal of aganglionic section (temp. colostomy). Bowel "pull-through"
Hirschsprung's post-op Daily abdm girths, monitor for sx sepsis/peritonitis/shock caused by entercolitis, admin antibiotics as Px, fluid/elect/blood replacement.
Hirschsprung's post-op (cont.) After surg, may have anal stricture and incontinence. May require dilation or bowel retraining therapy
Hirschsprung's complications Enterocolitis (inflammed bowel -> fever, explosive diarrhea, ill look), constipation, short bowel syndrome
Constipation s/sx Hard pebble-like stool, leaking of stool, palpable fecal mass, leads to mega colon
T or F: Constipation is a disease False. Symptom
Constipation care Bowel cleanout (Miralax/ducolax PO and enema). Once clear, repeat 3x in 2-wk increments. Mashed potato consistency of stool for 12 mo. to establish norm colon tone
Constipation potential consequences Incontinence d/t pressure of hard stool against bladder and lack of tone in colon/rectum. Risk: bowel obstruction, peritonitis
Gastroenteritis s/sx Frequent childhood illness by bacteria/virus. N&V, diarrhea
GastroenteritiS CARE: Oral rehydration guides. Daily wt. Consume small amounts of liquid several times a day to prevent vomiting. Avoid antiemetics since usu resolve c. rehydration.
Complications of gastroenteritis Usu benign but if unmanaged can lead to severe dehydration or hypovol shock
Appendicitis causes Obstruction in opening of appendix d/t fecalith, swollen lymphoid tissue, or parasite (rare)
Appendicitis s/sx Abdm pain: begin peri-umbilical and localized to RLQ. Pain increase c. movt, rigid abdm. Fever, tachycardia, possible vomiting, constipation, diarrhea, anorexia, pallor, lethargy, and/or irritability
Appendicitis signs Rovsings: if palpate LLQ, increased pain felt in RLQ. Rebound: pain upon REMOVAL of pressure. (Aggravation of parietal layer of peritoneum by stretching/moving)
Appendicitis Dx procedures CT scan of abdm, US, surgery
Appendicitis COMPLICATIONS Peritonitis (perforated peritoneum; may result from ruptured appendix, 48h within onset of appendicitis).
Peritonitis s/sx Rigid, board-like abdm. Absent BT, severe pain, fever, increased WBC, possible shock & death
Peritonitis care Manage fluids, pain, IV antibiotics, NG tube suction, wound irrigation/drsg care if delayed wound care necessary
Created by: choel