Anomalies of the GI Tract in Children Flashcards
Cleft Lip and Cleft Palate
cleft lip: opening in both lip and in roof of mouth
cleft palate: opening in roof of mouth
Cleft Lip and Cleft Palate: Dx
diagnosed in full physical examination if not diagnosed in-utero
*prenatal u/s can dx most cleft lips
Cleft Lip and Cleft Palate: Management
craniofacial multidisciplinary team: plastics, ENT, orthodontist (NAM), SLP, audiology, social work
NAM molding - nasoalveolar molding
- nonsurgical mold to reshape gums, lips, and nose before surgery to lessen severity of cleft and improve shape of nose
cleft lip: surgery w/in 2-3 months for correction
cleft palate: surgery w/in 6-12 months for correction
Cleft Lip and Cleft Palate: Post-Op Care
- proper positioning (no prone positioning to prevent suture damage)
- no sucking (no hands in mouth)
- pain meds
- protect surgical site - tongue suture
- excessive swallowing may be sign of bleeding
- no toothbrush for 3 wks if they have erupted teeth (use gauze pads dipped in plain water or small amount of mouthwash mixed with water, surgeon may also prescribe mouthwash for child)
Cleft Lip and Cleft Palate: Nursing Goals
short term:
-maintain adequate nutritional and hydration intake
long term:
- maintain adequate nutritional intake
- prevent dentition problems
- counseling (multiple surgeries, scarring, speech problems)
Cleft Lip and Cleft Palate: Feeding Methods
Mead-Johnson Cleft Palate Nurser
Haberman Feeder
Pigeon Nipple
Pyloric Stenosis
opening of the pylorus - the lower portion of the stomach that connects to the small intestine - thickens > severe narrowing of the pyloric canal
*etiology of this is unknown in medicine
Pyloric Stenosis: Clinical Manifestations
- usually no sx for first 2 weeks
- regurgitation starting 2nd to 3rd week of life
- projectile vomiting
- olive mass
- peristatic waves
- nonbilious emesis
Pyloric Stenosis: Dx
u/s
upper GI
Pyloric Stenosis: Tx
surgical repair = pyloromyotomy
small more frequent feedings of fluid and electrolytes started around 4-6hrs after surgery
Pyloric Stenosis: Nursing Considerations
- f&e imbalances - careful regulation of fluid therapy
- IVF
- s/sx of dehydration
- R side lying to promote gastric emptying
- post op feeding (gradual increase)
- strict I&O
Esophageal Atresia with Tracheoesophageal Fistula
-abnormal development of the esophagus in-utero
esophageal atresia the upper portion of the esophagus does not connect to the lower esophagus and the stomach
EA w/ TF: Clinical Manifestations
- excessive oral and pharyngeal mucous, thru nostrils
- drooling, choking, coughing
- spitting
Atresia
absence or abnormal narrowing of an opening or passage to the body
Fistula
an abnormal passage between organ or body surface
EA w/ TF: Nursing Priority
maintaining patent airway
*infant may become cyanotic and apneic d/t aspiration
EA w/ TF: Tx
- G-tube for nutrition
- Trach placement
- single or multi-staged repair
- colonic interposition may be done to replace the damaged or under-developed esophagus, using tissue from the large intestine
- fistula ligation
- cervical esophagostomy (AKA spit fistula)
EA w/ TF: Nursing Management
- airway management
- g-tube care/drain care
- humidified O2
- IVF
- IV antibiotics
- monitor F&E, hydration, strict I&Os
EA w/ TF: Postop Care
- monitory respiratory status
- g-tubes feeds/drains/NG
- I&Os
- IVF
- Spit fistula care
EA w/ TF: Discharge Prep
- must be tolerating feeds orally or by G-tube
- parents perform care of G-tube, surgical site or mucous fistula
s/sx of esophageal stenosis:
- dysphagia
- drooling
- increased secretions
- decreased intake
- weight loss
Malrotation and Volvulus
A condition where the intestines twist upon itself as a result of gastric or intestinal malrotation.
Malrotation and Volvulus: Dx
X-ray of upper GI - looking for double bubble
Barium enema
Malrotation and Volvulus: Clinical Manifestations
- s/sx of intestinal obstruction
- vomiting - bilious
- firmly distended abdomen
- decreased or absent stools or bloody stools
- shock
Malrotation and Volvulus: Tx
surgical release of constricting bands - Ladd’s procedure
free cecum
resect if bowel is necrotic
Malrotation and Volvulus: Nursing Considerations
- IVF
- NG tube for decompression
- IV antibiotics
- Close monitoring of VS and strict I&Os
- assess surgical site
- assess for return of bowel function
Intussusception
condition which one segment of the intestine telescopes inside another, causing an intestinal obstruction
- most common cause of intestinal obstruction in children 3 months to 6YO
- more common in males
- more common in children <2YO
Intussusception: Clinical Manifestations
- severe paroxysmal abdominal pain
- bilious emesis
- lethargy
- tender, distended abdomen
- palpable mass in the RUQ
- current jelly-like stools
*in older children, usually associated w/ polyps
Intussusception: Dx
X-ray
barium enema
Intussusception: Tx
air enema reduction
if that doesn’t work - surgical reduction
Intussusception: Nursing Considerations
- NG tube
- I&Os
- IVF
- Return of bowel sounds
- Assess for recurrence
Omphalocele
birth defect which an infant’s intestine or other abdominal organs are on the outside of the body because of a hole that is not closed in the umbilical area
intestines are covered by a thin layer of tissue and can easily be seen
Gastroschisis
birth defect which is an opening in the baby’s abdominal wall > bowels push through this hole and the bowel is outside the baby’s body
no layer of tissue covering it
Omphalocele and Gastroschisis: Nursing Considerations (Pre-Op)
- prevention of anything happening to the abdominal organs
- prevention of infection
- bowel bag w/ warm saline
- IVF
- IV antibiotics
- TPN for nutrition
- NG tube to LIWS to decompress
- educate parents on what to expect post op
Hirschsprung’s Disease
a congenital anomaly that results in a mechanical obstruction
inadequate motility of part of the large intestine r/t an absence of ganglion cells in the affected intestines
Hirschsprung’s Disease: Clinical Manifestations
newborn:
- delay or no passage of meconium
- distended abdomen
- bilious emesis
infant/older child or adolescent:
- history of delayed passage of meconium
- enterocolitis
- abdominal distention
- large foul-smelling stool
Hirschsprung’s Disease: Dx
- barium enema
- anal manometry
- rectal biopsy (detects absence of the ganglion cells)
Hirschsprung’s Disease: Tx
enemas
stool softeners
low fiber, high cal, high protein
surgical tx:
- repair
- ostomy
- pull thru for low segment
Hirschsprung’s Disease: Nursing Considerations
- bowel prep
- NG LIWS
- NPO
- Antibiotics
- Ostomy care
- Teaching
Imperforate Anus
missing the anal opening
- anal stenosis: narrowing of the anal canal that makes it difficult to pass stool
- anal membrane: membranous partition occluding the anal opening
- anal agenesis: blind rectal pouch that lies on the floor of the pelvis
- rectal atresia: rare condition, the anus and sphincter muscles are normally developed, with no fistula communication with the urinary tract
- so newborn presents w/ abdominal distention and failure to pass meconium
Imperforate Anus: Dx
- check for patency of anus and rectum
- check for stool
- x-rays
- stool in the wrong place
Imperforate Anus: Tx
anal stenosis: repeated dilations of the anus
anal membrane: membrane removed
anal agenesis and atresia:
- low defects - pull through with anaplasty
- high defects - temporary colostomy > correct any fistulas > position bowel correctly > reanastamosis about 1 year out
Imperforate Anus: Nursing Considerations
- assess for malformations
- lack of stool or in the wrong place
- teach parent to use dilator
- post-op ostomy care
- potty training is often difficult, reassure parents
Appendicitis: Clinical Manifestations
- colicky peri-umbilical pain at first then shifts and refers to RLQ (McBurney’s point)
- n/v
- guarding
- significant pain to walk/jump
- fever
- increased WBC
- diarrhea or constipation
- hunched over posture
- rigid abdomen
- decreased or absent bowel sounds
Appendicitis: Dx
labwork (CBC, CRP)
u/s
CT
Appendicitis: Tx
surgery
IV antibiotics
drains (if ruptured/perforated)
Appendicitis: Nursing Considerations
- pain
- VS
- monitor for infection
- monitor surgical site/dressing
- bowel sounds
- C&DB
- ambulation
- drain care if one is placed
- education
