9.5 Meckel's, IBD, Pyloric Stenosis, Celiac Disease

Question 1

Meckel Diverticulum

Answer 1

• Remnant of omphalomesenteric duct (usually destroyed between 5-9 weeks of gestation when placenta replaces yolk sac for nutrition)
• A little bulge in lower part of small intestines that is left over
• Symptoms usually occur before age 2
• Most common sign is bleeding (due to peptic ulcers caused by diverticulum containing pancreatic mucosa that produces gastric acid)

Other Signs
- Painless rectal bleeding
- Abdominal pain
- Jelly like bloody stools.

RULE OF 2
- Infects 2% of population, 2 times as likely in males, 2 inches in length, 2 feet proximal from ileocecal valve, 2 years of age, 2 types of mucosa present (gastric and pancreatic)

DIAGNOSIS
- Meckel Scan

Treatment
- Remove the diverticulum

Question 2

IBD

Answer 2

• Overarching term for Ulcerative Colitis and Crohn’s
• Caused by genetics and immune component

UC - Limited to the colon and rectum (continuous segments of lesions in this area)

Crohn’s - Can involve any portion of GI tract (areas of normal bowel with areas of affected bowel - skip lesions)

Question 3

Ulcerative Colitis

Answer 3

• Only affects colon and rectum. Inflammation affects mucosa and submucosa (continuous segments of affected bowel throughout colon and rectum). It is characterized by ulceration, bleeding and edema in this area.

S/S
- Bloody diarrhea
- Fecal occult blood
- Abdominal pain
- May have mild fever and weight loss
- Hematochezia (blood that is passed through anus)

Risks
- Can cause pubertal delay’s and growth failure due to anorexia and malabsorption

Labs
- Elevated ESR (inflammation)
- Arthritis/Skin Lesions
- Lymphadenopathy
- Perineal fissures
- Abscesses

Question 4

Crohn’s Disease

Answer 4

• Can impact any area of GI tract from the mouth to anus
• Involves all layers of bowel wall and discontinuous (skip lesions or areas of normal and infected areas)

S/S
- Diarrhea
- Abdominal pain with cramps
- Fever
- Weight loss

Risks
- Delayed maturation
- Impaired bone accrual (weak bones)
- Malnutrition
- Decreased activity
- Chronic inflammation

Severe Risks
- Ulcers can eat through intestinal walls creating fistulas which connect intestines to bladder, anus, vagina or skin.

Question 5

IBD Treatment

Answer 5

Medications
- 5-Aminosalicytles (MAIN TREATMENT)
- Corticosteroids for inflammation
- Chemo medications

Surgery
- Subtotal colectomy
- Ileostomy

Interventions
- Nutritional support (HIGH CALORIE HIGH PROTEIN)
- Vitamin/Iron supplements
- May require TPN or NG feeds

Question 6

Hypertrophic Pyloric Stenosis (HPS)

Answer 6

• Obstruction of pyloric sphincter in between stomach and small intestines (contents cannot pass)
• Usually develops within first few weeks of life

Diagnosis
- Confirmed with ultrasound

S/S
- Projectile vomiting (main symptom)
- Extreme hunger due to vomiting up all their food
- Significant weight loss
- Nonbilious Vomitus (no bile in vomit)

HALLMARK SIGN - Olive shaped mass in RUQ (distention)

Treatment
- Pyloromyotomy - Open up the valve with a balloon to allow contents to pass through
- KEEP CHILD NPO 8 HOURS BEFORE SURGERY TO PREVENT ASPIRATION

Question 7

Celiac Disease

Answer 7

• Gluten sensitivity (protein in certain grains such as wheat, barley, rye and oats)
• Mucosa is normally lined with villi (due to glucose sensitivity the villi are damaged and flattened which impairs ability to absorb full fats and vitamins due to less surface area)
• Caused by genetics and immune system

S/S
- Usually occur after introduction of gluten into diet (4-6 months when rice cereal is introduced)
- Anorexia
- Chronic Diarrhea
- Steatorrhea
- Foul smelling stool
- Vitamin deficiencies
- Large abdomen due to intestinal distention
- Malnutrition
- Muscle wasting

Interventions
- Malabsorptive screening (to see how well nutrients are being absorbed)
- Biopsy of jejunum (definitive diagnosis)

Management
- Gluten free diet (wheat, barley, rye or oats)
- CAN EAT RICE, CORN, MILLET, SOYBEANS.
- DIET MANAGEMENT WITH DIETICIAN

Question 8

Foods to Avoid for Celiac Disease

Answer 8

• Wheat, barley, rye, oats

Examples
- Pizza, bagels, crackers

Question 9

Foods you CAN eat for Celiac Disease

Answer 9

• Rice, Corn, Millet, Soybeans

Examples
- French fries
- Broiled chicken
- Hard boiled eggs