424--Quiz 3 (GI & GU) Flashcards
Outline for GI disorders
•Variations in peds •GI tract abnormalities o Cleft Lip/Palate o Omphalocele/Gastroschisis o Analrectal Malformation •Hernias •Acute GI disorders o Vomit/diarrhea—dehydration o Constriction of GI tract Meckel’s Diverticulum Pyloric stenosis o Intussusception o Malrotation/Volvulus o Necrotizing Enterocolitis o Appendicitis o GI reflux o Constipation/Encoporesis o Hirschsprung’s Disease o Celiac Disease o Recurrent Abdominal Pain •Hepatobiliary disorders o Pancreatitis o Gallbladder Disease o Jaundice o Biliary Atresia o Portal Hypertension o Liver Transplant
GI variations in peds
LES–not fully developed until 1 mo.
Stomach–NB 10-20 ml, age 16 1500ml
Liver–large at birth
Fluid balance–>body water than adults, increased risk dehydration
Cleft Lip and Palate
Most common craniofacial anomaly.
Complications: feeding, dentition, otitis media.
Omphalocele/Gastroschisis
Omphalocele = intestine herniate into the umbilical cord. Gastroschisis = intestine and stomach herniate through the abd wall.
Analrectal Malformation
“Imperforate Anus.”
Nx: assess NB for meconium.
Hernias (2 types)
Inguinal = bulging of intestine into the inguinal area
Tx: surgery
Umbilical: incomplete closure of the umbilical ring-stomach contents herniate through
Tx: observation/should close by 5 years old
Vomiting/Diarrhea–Dehydration
Vomiting: usually d/t some other condition.
Diarrhea: usually d/t viruse (ex: Rotavirus),
Nx: give probiotics to reduce risk of C-Diff.
Dehydration ==> hypovolemic shock.
Tx: restore fluid balance, start oral fluids SLOWLY.
Meckel’s Diverticulum
A constriction of the GI Tract: incomplete fusion causing a fibrous band to connect small intestine to the umbilicus.
Pyloric stenosis
A constriction of the GI Tract: circular muscle of the pylorus becomes hypertrophied and thickens.
S/S: forceful vomiting; hunger soon after;
Intussusception
Segment of the bowel “telescopes “ upward.
S/S: Pain (draw knees up), “current-jelly” stool.
Malrotation and Volvulus
Intestine abnormally attaches causing the mesentery to narrow and twist on itself.
Volvulus = is the twisting on itself.
Necrotizing Enterocolitis (NEC)
Ulceration and necrosis of the distal ileum and proximal colon.
3 factors for developing: Intestinal ischemia, enteral feedings, bacterial infections.
Tx: ABX, bowel rest, surgery?
Appendicitis
Most common reason for 911 abd surgery in peds.
S/S: unable to climb exam table without help.
Tx: surgery, if perf: IV ABX 7-14 days.
GI Reflux
Outgrow 6 mo.
Tx: upright after feeding, small frequent/thickened feedings, drugs (histamine blockers, PPI, prokinectics).
Constipation/Encoporesis
Constipation: passing hard or small marble stools.
Encoporesis: soiling of fecal contents beyond the age of toilet training.
Tx: behavior modification, increasing fiber and fluids, laxative therapy.
Hirschsprung’s Disease
Lack of ganglion cells in the small intestine to colon with inadequate motility (constipation in newborns).
S/S: no meconium in 24 hrs.
Tx: resection + colostomy.
Complication: short bowl syndrome.
Celiac Disease
Gluten in grains causes damage to the villi of the small intestines.
S/S: distended abdomen and wasted extremities.
Tx: gluten-free diet for life.
Recurrent Abdominal Pain
Common complaint.
Integrated neurotrasmitter pathways.
“Does not wake up at night with pain”
Tx: coping with the pain/diet modification.
Pancreatitis
S/S: persistent midepigastric pain & periumbilical pain with radiation to the back or chest.
Tx: NPO, NG tube.
Gallbladder Disease
Cholelithiasis/cholecystitis.
S/S: RUQ pain radiating to shoulder.
Tx: NPO, IV fluids & ABX, surgical removal.
Jaundice
Most common reason for readmission in the 1st week.
Physiological = 24 hours post birth/ go by 1 week.
Pathologic = Comes and goes/ lasts > 1 week.
Tx: eat, phototherapy.
Biliary Atresia
Absence of some or all biliary ducts causing obstruction of bile flow.
S/S: persistent/recurring jaundice.
Tx: vit/caloric support, Kasai procedure (surgical bypass).
Portal Hypertension
Resistance of blood flow to/through/from liver.
S/S: jaundice, spider angiomas, palmer erythema.
Liver Transplant
Monitor for infect.
Monitor for rejection: fever, increasing liver function test results, increasing pain, redness, swelling.
Fam risks: possible job loss, finances, transportation, lodging.
Outline for GU Disorders
•Ped A&P •Structural o Bladder exstrophy o Hypospadias/epispadias o Obstructive uropathy o Hydronephrosis o Vesicoureteral reflux •Urinary o UTI o Enuresis •Renal disorders o Nephrotic Syndrome o Acute Glomerulonephritis o Hemolytic-Uremic Syndrome o Renal Failure: Acute Renal Failure End-stage Renal Disease Renal Transplant •Reproductive organ disorders o Female: Labial adhesions Vulvovaginitis Pelvic Inflammatory Disease Menstrual Disorders o Male: Phimosis/paraphimosis Circumcision Cryptorchidism Hydrocele/varicocele Epididymitis
GU variations in peds
Urine concentration–slower blood flow ==> increased risk dehydration.
Output–0.5-2ml/kg/hr.
Kidneys–large.
Reproductive organs–immature until puberty.
Bladder exstrophy
Bladder located on outside.
Tx: surgery, urinary reservoir made in small intest (stoma created to drain the bladder 4X’s a day)
Nx: Keep bladder moist with sterile covering, mucus-like urine from stoma.
Hypospadias/Epispadias
Hypospadias = urethral opening on lower (ventral) portion of the penis
Epispadias = urethral opening on top (dorsal) of the penis
Chordee = fibrous band causing penis to curve downward.
Nx: ed. about double-diapering & care of stent at home.
Obstructive Uropathy
Obstruction of upper/lower urinary tract, unilateral/bilateral ==> partial/complete obstruction.
S/S: Recurrent UTI’s, incontinence, fever, foul smelling urine, flank/abdominal pain, urinary frequency/urgency.
Hydronephrosis
Dilation of pelvis and calyces of the kidneys; d/t obstruction or VUR.
S/S: failure to thrive, intermittent hematuria, s/s of UTI, sepsis.
Vesicoureteral Reflux (VUR)
Reflux of urine into ureters during bladder contraction.
Graded I-V depending on severity (I & II generally resolve, III-V usually assoc. with recurrent UTI, hydronephrosis & progressive renal damage).
Nx: prophylactic ABX, ed. empty bladder completely & hygiene.
UTI
85-90% E-Coli.
Infants: irritability, fever, vomiting, failure to thrive.
Children: vomiting, fever, dysuria, frequency, pain, enuresis, constipation/incontinence.
Enuresis
Incontinence beyond the age of toilet training.
4 types:
Primary—Never achieved bladder control
Secondary—previous bladder control 3-6 mos; may be d/t Diabetes Insipidous, obstruction, etc.
Diurnal—during day; loss of bladder control
Nocturnal—nighttime wetting. Usually subsides by age 6.
Nephrotic Syndrome
Golumerular membranes become permeable to proteins.
Lifelong illness.
S/S: protienuria, hypoalbuminemia, altered immunity, (periorbital) edema, n/v.
Labs LOW protein and albumin, urine HIGH protein.
Nx: fluid & Na+ restrict, daily weights, corticosteroids, diuretics.
Acute Glomerulonephritis (APSGN)
Strep infection gets stuck in the golmerulus causing decreased blood flow (immune process injured glomeruli)
One-time illness.
S/S: fever, edema, crackles, protienuria, hematuria, tea-colored urine.
Nx: fluid & Na+ restrict, daily weights, antihypertensives.
Hemolytic-Uremic-Syndrome (HUS)
3 features: hemolytic anemia + thrombocytopenia + acute renal failure.
S/S: Usually preceded by watery diarrheal illness (E. Coli).
Nx: bact shed up to 17 days after resolution.
Renal Failure
Kidneys cannot concentrate urine, excrete wastes or maintain electrolytes.
Acute Renal Failure
D/t hypovolemia, septic shock, hemolytic anemia, nephrotoxic meds.
Tx: underlying cause, F&E, BP control, diuretics
Chronic Renal Failure (ESRD)
D/t congenital structure defects, obstructive uropathy, infect.
S/S: low birth weight, failure to thrive, dry/itchy skin, bone/joint pain.
Nx: renal diet, EPO, GH, dialysis–assess fistula for bruit/thrill.
Labial adhesions/labial fusion
Partial or complete adherence of labia minora, usually 3 mo-4 yrs.
Tx: topical estrogen cream.
Vulvovaginitis
Inflammation of vulva and vagina as a result of bacteria or yeast overgrowth.
Pelvic Inflammatory Disease
Inflammation of upper female genital tract and nearby structures.
Mittleschmerz
Pain associated with release of the egg from the ovary
Phimosis
Cannot retract the foreskin
Paraphimosis
retraction of the foreskin causes constricting band behind the glans of the penis ==> incarceration if not surgically corrected.
Circumcision
Abnormal attachment to scrotum that is twisted. Usually adolescents.
Cryptorchidism
Undescended testicle
Hydrocele/Varicocele
Hydrocele = fluid in the scrotum.
Varicocele =venous varicosity along the spermatic chord causing swelling.
Epididymitis
Inflammation of epididymis (lies on top of testicle inside) d/t bacteria.
