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Peds GI

Chronic

QuestionAnswer
Omphacele definition Intestine outside of the abdominal wall contained in the peritoneal sac. Often associated with other anomalies (cardiac, neuro, skeletal, GU) and trisomy 13/18/21
Omphacele detection Prenatal US, discovered at birth
Omphacele initial management Inspection of defect. If bowel covering intact,cover c. nonadherent drsg. If exposed, covered in bowel bag/moist drsg and plastic drape to prevent fluid loss.
Omphacele management cont. Placement of silastic double-lumen cath (NG-OG) for bowel decompression.
Omphacele surgery (closures) Primary closure if small defect (reducing organs). Staged reduction if big. Silo mesh used to house gut. Antibacterial ointment applied on silo and suture lines. Compressed on daily basis. Attempt to close defect within 7-10 days to min. risk of infxn.
Omphacele surgery Tx c. silver sulfadiazine over wks-mo. until epithelial tissue forms. Repair may be late as 1 yr. if large defect. "Paint and wait"
Omphacele post-op Require mechanicalventilation, parenteral nutr. PO feedings delayed until adequate bowel function
Omphacele outcomes Risk for necrotizing enterocolitis, repeated bowel resections, short gut syndrome, ventral hernia
Gastrochisis definition Bowel herniates thru defect in abdm wall to R of umbilical cord and rectus myo. NO MEMBRANE. Not usu associated c. other anomalies.
Gastrochisis possible risk factors Young maternal age, smoking, ETOH use, aspirin/ibuprof/pseudoephedrine, polyhydraminios
Gastrochisis initial management Cover exposed bowel c. transparent plastic bowel bag or loose, moist drsg. Abdm opening enlarged to prevent bowel strangulation. IV fluids, double-lumen NG tube.
Gastrochisis management cont. If can't primary closure then spring-loaded silastic silo covers exposed bowel. Slowly squeeze into belly over four of 5-10 days. Then sew bag closed.
Gastrochisis post-op care Mechanical vent (cos resp distress second to increased abdm pressure), painmanagement, prolonged nutr support d/t poor bowel function.
Gastrochisis Risk for necrotizing enterocolitis, repeated bowel resections and short bowel syndrome (short gut). Risk for oral aversion. Developmental Delay. Prolonged paralytical ileus, hypomotility,vena cava compression, decrease in blood to lower ext
Chron's disease involves ___ Entire GI tract
Chron's s/sx Steatorrhea, abdm pain, fistulas & strictures, intest obstruct/perforation, abscess formation, moderate-severe diarrhea, anorexia, wt. loss, growth delay, anal/perianal lesions
CD Dx tests Upper GI series c. small bowel follow-thru, upper endoscopy or colonoscopy, CT and US ID bowel wall inflamm, intraabdm abcesses, fistulas. Protein, albumin, iron, Zn, Mg, B12, fat-soluble low in CD
Ulcerative colitis involves Colon
UC s/sx Rectal bleeding, severe diarrhea, sometimes abdm pain, mild growth delay, toxic megacolon
UC Dx tests CBC, ESR/CRP Ax system inflamm.
Goal of CD and UC Control inflammation to reduce sx, long-term remission, promote normal nutr and growth, allow normal lifestyle as possible
UC moderate Tx 5-ASAs in induction/maint. of mild-mod UC. Mesalamine,olsalazine, basalazide. Suppository/enema preps of mesalamine used Tx L-sided colitis.
Moderate-severe UC/CD Tx Corticosteroids. Immunomodulators for steroid-resistant. Antibiotics as adjunct therapy. Biologic agents (TNF-alpha) can regulate inflamm process
UC/CD nutrition therapy Enteral, parenteral nutr. Well-balanced, high-protein, high-cal diet recced for pt. whose sx don't prohibit PO intake.
Elemental diet is used for ___ and is regarded as ___ CD, safe and improves nutr status and induces disease remission.
UC/CD surg Tx Subtotal colectomy and ileostomy leaving rectal stump as "blind pouch". Reservoir pouch in J or S shape help improve post-op continence. For CD segmental intestinal resection for small bowel obstruct, strictures, fistulas
Short bowel syndrome definition Decreased mucosal surface area, usu d/t extensive resection of SI. Dependent on parenteral nutr
Short bowel therapy goals Preserve as much length of bowel as possible during surgery, maintain optimum nutr status/growth/develop, stimulate intestinal adaptation c. enteral efeding, and minimize complications
Short bowel nutritional therapy (first and second phase) Initial: primarily PN. Second: introduce enteral feeding (as soon as possible after surg). Elemental formulas (sugars, hydrolyzed proteins, med-chain TRIGLY) usu thru NG or gastrostomy tube. As enteral feeding advanced, PN decreased in cal/fluid/hrs
Short bowel nutritional therapy (final phase) PN D/Ced, exclusively enteral feedings. Use H2 blockers, PPIs, to inhibit gastric secretions.
Short bowel associated with ____ syndrome and ____ Dumping; diarrhea
Complications of short bowel PN therapy -> cirrhosis. Infections, catheter sepsis, bowel atrophy increase permeability to bacteria. Metabolic acidosis and hypersecretion of gastric acid.
T or F: only children c. permanent dependence on PN or severe complications of long-term PN are candidates for transplant T.
Created by: choel