Exam 12: Peds Gastrointestinal Conditions
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| Gastrointestinal System of a Child (Infant) | Small & empties rapidly. Poor fat absorption r/t ↓ pool of bile acid.
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| Gastrointestinal System of a Child (Newborn) | Resistance to bacterial & viral infection is incompletely developed. Produce very little saliva until 3 months of age. Immature livers, sometimes causing jaundice. Swallowing is a newborn reflex for the first 3 months.
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| Isotonic Dehydration | when electrolytes and water deficits are present in balanced proportions. This reduces the plasma volume and the circulating blood volume which affects the skin, kidneys and muscles. Watch for hypovolemic shock.
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| Hypotonic Dehydration | This occurs when the electrolyte deficit exceeds the water deficit creating hypotonic serum. The physical signs are more severe with smaller fluid losses.
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| Hypertonic Dehydration | results from water loss in excess of electrolyte loss and is usually caused by a proportionately larger loss of water or a larger intake of electrolytes.
This type is the most dangerous and requires more specific therapy.
Shock is less apparent.
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| Diarrhea. | caused by abnormal intestinal water and electrolyte transport.
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| Constipation. | alteration in the frequency, consistency or ease of passing stool.
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| Obstipation | there are long intervals between stools
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| Encopresis | constipation with fecal soiling
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| Hirschsprung's Disease | Involves an absence of ganglionic innervation to the muscle segment of the bowel.
Results in lack of normal peristalsis.
More common in boys.
Familial tendency.
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| Hirschsprung's Disease: Manifestations | Failure to pass meconium within 24 to 48 hours after birth.
Constipation.
Ribbon-like stools.
Abdominal distention.
Anorexia.
Vomiting.
Failure to thrive.
Shock.
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| Enterocolitis | an inflammation of the small bowel and colon. A serious complication when left untreated which may manifest with fever, explosive stools and depletion of strength.
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| Vomiting | common in childhood and is usually self-limiting. However complications occur when the vomiting leads to dehydration and electrolyte disturbances, malnutrition, aspiration & Mallory-Weiss syndrome.
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| Antiemetic drugs | ondansetron (Zofran).
metoclopromide (Reglan).
promethazine (Phenergan).
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| Gastroesophageal Reflux (GER) | transfer of gastric contents into the esophagus. It occurs when the lower esophageal sphincter is relaxed or not competent and allows stomach contents to be easily regurgitated into the esophagus.
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| Infants and children who are especially prone to reflux include: | Premature infants.
Infants with bronchopulmonary dysplasia.
Children who have had tracheoesophaeal or esophageal atresia repair.
Kids with neurologic disorders, cystic fibrosis or cerebral palsy.
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| Gastroesophageal Reflux (GER): Meds | H2 Agonists. Proton Pump Inhibitors.
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| H2 Agonists | cimetidine (Tagamet).
ranitidine (Zantac).
famotidine (Pepcid).
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| Proton Pump Inhibitors | esomeprazol (Nexium).
lansoprazol (Prevacid).
pantoprazol (Protonix).
rabeprazole (Aciphex).
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| Appendicitis | Inflammation of the appendix, located on the RLQ of the abdomen. The appendix can become obstructed after a viral illness or with parasites. The appendix may become gangrenous or rupture, which may lead to peritonitis or septicemia.
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| McBurney's point | located midway between the anterior superior iliac crest and the umbilicus.
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| Meckel's Diverticulum | A small blind pouch near the ileocecal valve fails to disappear completely and may be connected to the umbilicus by a cord.
A fistula may form.
Susceptible to inflammation.
More common in boys.
The most common congenital malformation of the GI tract.
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| Meckel's Diverticulum Manifestations | Symptoms usually occur before 2 years of age but can also occur in children up to age 10 years.
Painless bright red or dark red blood; rectal bleeding.
Abdominal pain might be present.
Barium enema is more useful to diagnose than X-ray.
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| Crohn's Disease. | a chronic intestinal inflammation that involves all layers of the bowel wall.
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| Crohn's Disease: Manifestations | Abdominal pain with cramps and diarrhea.
Weight loss.
Fever.
Anorexia.
Rectal bleeding.
Anal fissures or fistulas.
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| Crohn's Disease: Diagnostic Evaluation | Laboratory tests including a CBC, protein, albumin and iron studies.
Stool studies for detecting blood, leukocytes and infectious organisms.
An upper GI series with small bowel examination will detect strictures and narrowing of the small bowel.
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| Crohn's Disease: Medical Management | Corticosteroids.
Sulfasalazine.
ABx.
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| Crohn's Disease: Nursing Interventions | Preparing high-protein, high-calorie foods such as eggnog, milkshakes, cream soups, puddings or custards if the child is able to tolerate lactose.
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| Peptic Ulcer Disease | a chronic condition that affects the stomach or duodenum.
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| Peptic Ulcer Disease: Common Toxins Include | Exogenous factors such as aspirin or NSAIDS.
Bile acids.
Infection with H. pylori.
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| Peptic Ulcer Disease: Focus on symptoms such as | Epigastric abdominal pain.
Nocturnal pain.
Oral regurgitation.
Heartburn.
Weight loss.
Hematemesis.
Melana.
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| the most reliable procedure to diagnose PUD | Endoscopy
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| Esophageal Atresia with Tracheoesophageal Fistula | rare malformations that are believed to result from failed separation of the esophagus and trachea that result in a septum that forms by the fourth week of gestation.
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| and lower esophagus end in a | Blind pouch
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| Upper esophagus ends in a blind pouch and the lower esophagus connects to the | Trachea
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| Upper and lower esophagus connect to the | Trachea
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| Upper esophagus connects to the trachea and the lower esophagus ends in a | Blind pouch
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| Less frequently, an otherwise normal trachea and esophagus are connected by a | common fistula
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| Three C of tracheoesophageal fistula | Coughing.
Chocking.
Cyanosis.
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| Pyloric Stenosis | Narrowing of the lower end of the stomach occurs related to hypertrophy of the circular muscles of the pylorus or by spasms of the sphincter. A congenital anomaly that is more common in boys and has a hereditary tendency
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| Pyloric Stenosis: Manifestations | Vomiting 30 to 60 minutes after a feeding which then progresses to Projectile vomiting occurring immediately after feeding.
Constant hunger even after vomiting.
Dehydration observed.
Olive-shaped mass in RUQ of abdomen.
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| Pyloric Stenosis: Treatment and Nursing Care | Pyloromyotomy.
IV therapy to correct fluid and electrolyte imbalance.
Thickened feedings.
Burp before and during feedings.
Daily weights.
I&O.
Frequent position changes.
Monitor VS.
Avoid overfeeding.
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| Intussusception | slipping of one part of intestine into another portion of the intestine below it ("telescoping of the bowel").
The intestinal obstruction can strangulate and burst causing peritonitis.
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| Intussusception: Manifestations | Sudden onset of severe pain in ABD.
Baby cries very loudly.
Vomiting of bile.
Diminished flatus and bowel movements.
Currant jelly stools (blood and mucus pass without feces).
Febrile (as high as 106 degree).
Shock.
Rigid ABD.
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| Celiac Disease | The leading malabsorption disorder in children.
Inherited disposition.
Symptoms occur at 1 to 5 years of age when foods containing gluten are introduced (wheat, barley, oats, rye).
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| Celiac Disease: Manifestations | Failure to thrive.
Large, bulky and frothy stools.
Abdominal distention with atrophy of the buttocks are classic signs.
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