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GI Alterations
Test #2
| Question | Answer |
|---|---|
| Cheiloplasty | closure of cleft lip usually at 6-12wks for function and cosmetics |
| Logan Clamp (Bow) | a thin arched metal device placed immediately after surgery to prevent tension of suture line and prevent infant from touching |
| In what position should a post-op cheiloplasty be in after feedings? | on right side with HOB elevated |
| Palatoplasty | surgical closure of palate usually done at 1-2 yrs |
| complications of cleft palate | *needed tooth alignment *recurrent otitis *speech impairment (speech therapy) |
| Breathing adjustments with cleft palate | infants need to learn to breath through their nose |
| Diet after palatoplasty | clear liquid diet for 2-3 days then semi-liquid and soft diet |
| GER | the transfer of gastric contents into the esophagus |
| GER etiology | dysfunction of the lower esophageal sphincter (LES) a delay in gastric emptying, poor clearance of esophageal acid and susceptibility of the esophageal mucosa to acid injury |
| Clinical manifestations of GER | Heartburn (pyrosis), abd pain, chest pain, chronic cough, dysphagia, nocturnal asthma, recurrent pneumonia |
| Esophageal pH monitoring | a probe is inserted into the nose to the distal esophagus and is connected to a pH monitoring device |
| Esophageal pH monitoring provides | in a 24hr period: number of reflux episodes |
| Scintigraphy | detects radioactive substances in the esophagus after a feeding of the compound assesses gastric emptying |
| Bethanechol (urecholine) | increases LES pressure, but in probe studies still shouws high acid levels, not used in children with respiratory problems, can cause wheezing |
| Nisssen fundiplication | surgical reduction of the size of the opening in the fundus of the stomach. 360 degree wrap around LES |
| Hiatal Hernia | the protrusion of the stomach through the esophageal opening in the diaphragm, which causes the volume of the stomach contents to be suddenly restricted |
| Clinical manifestations of hiatal hernia | vomiting accompanied by pain and dyspnea |
| Diagnosis of hiatal hernia | hx of symptoms, u/s or barium swallow |
| Management of hiatal hernias | similar to GER; pharmacological and positioning |
| Surgical tx of hiatal hernia | performed if symptoms continue after 6 months of age (reduce size of esophageal opening in the diaphragm) |
| Pyloric Stenosis | obstruction of the outlet of the stomach (sphincter spasms and becomes bypertrophied) |
| Clinical manifestations of pyloric stenosis | symptoms slowly progress: vomit becomes projectile, stools decreases in size and amount, will have olive size mass in apigastric area |
| Diagnostics for pyloric stenosis | vomiting, mass, x-ray, u/s, decreases, increases pH, bicarb, BUN (become more alkaline) |
| Pyloromyotomy | surgical release of the pyloric sphyncter (longitudinal cut) *may have swelling from sx 24-48hrs after and can still be vomiting |
| Enterobiosis | Pinworm infection from ingestion or inhalation |
| Clinical manifestations of Enterobiosis | perianal itching, irritable, sleeplessness, urethral or vaginal infection |
| Management of Enterobiosis | Mebendazole (vermox)*not for <2yrs, Pyranel pamoate one dose tx *use cautiono in <2yrs *tx all household members |
| Enterobiosis diagnostics | tape test and O&P |
| Giardiasis-protozoan infection | most common parasitic infection, begins as a cyst and is activated by stomach acid |
| Giardiasis transmission | person-person, contaminated water, foods, infected animals |
| Giardiasis clinical manifestations | vomiting, diarrhea, failure to thrive, anorexia, stools may be malodorous, watery, pale, and greasy |
| Giardiasis diagnosis | examination of deuodenal fluid (string test), enzyme immunoessay of stool specimens (becoming more commonly used) |
| Therapeutic management of Giardiasis | Metronidazole, Tinidazole (one dose tx), nitazoxanide - tx all household members |
| Biliary atresia | obstruction of absence of a portion of the bile ducts, bile builds up in liver |
| Clinical manifestations of biliary atresia | jaundice (earliest sign), staetorrhea, dark brown urine, fibrotic liver, enlarged spleen, ascities, greenish gray or bronze skin, pruritis, poor weight gain *itchy |
| Biliary atresia diagnosis | liver biopsy is definitive diagnosis |
| Biliary atresia tx | poor prognosis, liver transplant does provide a cure, eat high caloric diet, vitamins |
| Intussesception | obstruction of intestinal contents results in constriction of the blood supply , becomes inflamed, commonly occurs in ileocecal valve |
| Intussesception clincal manifestations | severe and sudden acute abdominal pain and vomiting, current jelly stools |
| Intussesception diagnosis | abd u/s, barium or air enema (may even treat) |
| Appendicitis | inflammation of the appendix that results for lumen obstruction or parasite/pinworm infection |
| Clinical manifestations of appendicitis | severe pain at Mcburneys point, rebound tenderness, fever, decreased or absent bowel sounds, vomiting, constipation or diarrhea, anorexia, tachy, rapid shallow breaths, pallor, lethargy, stooped posture, increased WBC |
| Appendicitis diagnostics | hx, assessment, labs |
| Appendicitis tx | rehydration, abx, appendectomies *do not apply heat before sx *after sx restricted activity 4-6wks |
| Hirschsprungs Disease (congenital aganglionic megacolon) | mechanical obstruction caused by inadequate motility of part of the intestines. Can be treated by removing affecting part of intestines |
| Encopresis | abnormal elimination pattern characterized by repeated voluntary or involuntary passage of feces in places not culturally appropriate |
| Diagnosing encopresis | must happen at least once a month for 3 months, must be at least 4yrs, |
| Primary encopresis | identified by 4yrs of age and child has never been toilet trained, more common in boys |
| Secondary encopresis | most commonly caused by an episode of constipation, voluntary suppression follows |
| Diagnosing ecnopresis | r/o anatomic abnormalities |
| Tx encopresis | lubricants (may need fat soluable vitamins ADE), osmotic laxatives, increased fiber and fluid, behavior modification (no punishing) |
Created by:
jas067
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