Acute GI
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| GER in ___ is usually ____ and resolves by ___ | Infants; self-limiting, end of first yr. of life (or 6-9 mo)
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| GER may result in | Failure to thrive, bleeding, difficulty swallowing, chronic otitis media
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| Risk factors for GER | Premature infants, congenital defects
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| 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
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| 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)
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| 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)
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| 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
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| GERD surg procedures | Surg manipulation, Nissen fundoplication (wraps stomach's fundus around distal esophg to decrease reflux)
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| 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
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| GERD complications | Recurrent pneumonia, weight loss, failure to thrive
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| Hirschsprung's disease causes ___ obstruction and is usually Dx in ____ | Mechanical; infants
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| True or false: Hirschsprung's is strictly an acute D/O | False. Can also be chronic
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| Hirschsprung's s/sx (newborn) | Failure to pass meconium within 24-48h, refusal to eat, episodes of vomiting bile, abdm distension
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| Hirschsprung's s/sx (infant) | Failure to thrive, constipation, abdm distention, ep. of vomiting and diarrhea
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| Hirschsprung's s/sx (older child) | Constipation, abdm distension, visible peristalsis, ribbon-like stool, palpable fecal mass, foul-smelling stool, malnourished appearance
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| Hirschsprung's diagnostic procedures | Rectal biopsy (full-thickness biopsies to reveal absent ganglion cells)
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| Hirschsprung's surgery | Removal of aganglionic section (temp. colostomy). Bowel "pull-through"
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| Hirschsprung's post-op | Daily abdm girths, monitor for sx sepsis/peritonitis/shock caused by entercolitis, admin antibiotics as Px, fluid/elect/blood replacement.
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| Hirschsprung's post-op (cont.) | After surg, may have anal stricture and incontinence. May require dilation or bowel retraining therapy
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| Hirschsprung's complications | Enterocolitis (inflammed bowel -> fever, explosive diarrhea, ill look), constipation, short bowel syndrome
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| Constipation s/sx | Hard pebble-like stool, leaking of stool, palpable fecal mass, leads to mega colon
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| T or F: Constipation is a disease | False. Symptom
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| 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
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| Constipation potential consequences | Incontinence d/t pressure of hard stool against bladder and lack of tone in colon/rectum. Risk: bowel obstruction, peritonitis
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| Gastroenteritis s/sx | Frequent childhood illness by bacteria/virus. N&V, diarrhea
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| 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.
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| Complications of gastroenteritis | Usu benign but if unmanaged can lead to severe dehydration or hypovol shock
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| Appendicitis causes | Obstruction in opening of appendix d/t fecalith, swollen lymphoid tissue, or parasite (rare)
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| 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
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| 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)
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| Appendicitis Dx procedures | CT scan of abdm, US, surgery
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| Appendicitis COMPLICATIONS | Peritonitis (perforated peritoneum; may result from ruptured appendix, 48h within onset of appendicitis).
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| Peritonitis s/sx | Rigid, board-like abdm. Absent BT, severe pain, fever, increased WBC, possible shock & death
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| Peritonitis care | Manage fluids, pain, IV antibiotics, NG tube suction, wound irrigation/drsg care if delayed wound care necessary
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