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Pediatrics > Anomalies of the GI Tract in Children > Flashcards

Anomalies of the GI Tract in Children Flashcards

1
Q

Cleft Lip and Cleft Palate

A

cleft lip: opening in both lip and in roof of mouth

cleft palate: opening in roof of mouth

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2
Q

Cleft Lip and Cleft Palate: Dx

A

diagnosed in full physical examination if not diagnosed in-utero

*prenatal u/s can dx most cleft lips

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3
Q

Cleft Lip and Cleft Palate: Management

A

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

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4
Q

Cleft Lip and Cleft Palate: Post-Op Care

A
  • 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)
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5
Q

Cleft Lip and Cleft Palate: Nursing Goals

A

short term:
-maintain adequate nutritional and hydration intake

long term:

  • maintain adequate nutritional intake
  • prevent dentition problems
  • counseling (multiple surgeries, scarring, speech problems)
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6
Q

Cleft Lip and Cleft Palate: Feeding Methods

A

Mead-Johnson Cleft Palate Nurser
Haberman Feeder
Pigeon Nipple

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7
Q

Pyloric Stenosis

A

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

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8
Q

Pyloric Stenosis: Clinical Manifestations

A
  • usually no sx for first 2 weeks
  • regurgitation starting 2nd to 3rd week of life
  • projectile vomiting
  • olive mass
  • peristatic waves
  • nonbilious emesis
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9
Q

Pyloric Stenosis: Dx

A

u/s

upper GI

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10
Q

Pyloric Stenosis: Tx

A

surgical repair = pyloromyotomy

small more frequent feedings of fluid and electrolytes started around 4-6hrs after surgery

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11
Q

Pyloric Stenosis: Nursing Considerations

A
  • 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
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12
Q

Esophageal Atresia with Tracheoesophageal Fistula

A

-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

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13
Q

EA w/ TF: Clinical Manifestations

A
  • excessive oral and pharyngeal mucous, thru nostrils
  • drooling, choking, coughing
  • spitting
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14
Q

Atresia

A

absence or abnormal narrowing of an opening or passage to the body

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15
Q

Fistula

A

an abnormal passage between organ or body surface

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16
Q

EA w/ TF: Nursing Priority

A

maintaining patent airway

*infant may become cyanotic and apneic d/t aspiration

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17
Q

EA w/ TF: Tx

A
  • 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)
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18
Q

EA w/ TF: Nursing Management

A
  • airway management
  • g-tube care/drain care
  • humidified O2
  • IVF
  • IV antibiotics
  • monitor F&E, hydration, strict I&Os
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19
Q

EA w/ TF: Postop Care

A
  • monitory respiratory status
  • g-tubes feeds/drains/NG
  • I&Os
  • IVF
  • Spit fistula care
20
Q

EA w/ TF: Discharge Prep

A
  • 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
21
Q

Malrotation and Volvulus

A

A condition where the intestines twist upon itself as a result of gastric or intestinal malrotation.

22
Q

Malrotation and Volvulus: Dx

A

X-ray of upper GI - looking for double bubble

Barium enema

23
Q

Malrotation and Volvulus: Clinical Manifestations

A
  • s/sx of intestinal obstruction
  • vomiting - bilious
  • firmly distended abdomen
  • decreased or absent stools or bloody stools
  • shock
24
Q

Malrotation and Volvulus: Tx

A

surgical release of constricting bands - Ladd’s procedure

free cecum

resect if bowel is necrotic

25
Q

Malrotation and Volvulus: Nursing Considerations

A
  • IVF
  • NG tube for decompression
  • IV antibiotics
  • Close monitoring of VS and strict I&Os
  • assess surgical site
  • assess for return of bowel function
26
Q

Intussusception

A

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
27
Q

Intussusception: Clinical Manifestations

A
  • 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

28
Q

Intussusception: Dx

A

X-ray

barium enema

29
Q

Intussusception: Tx

A

air enema reduction

if that doesn’t work - surgical reduction

30
Q

Intussusception: Nursing Considerations

A
  • NG tube
  • I&Os
  • IVF
  • Return of bowel sounds
  • Assess for recurrence
31
Q

Omphalocele

A

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

32
Q

Gastroschisis

A

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

33
Q

Omphalocele and Gastroschisis: Nursing Considerations (Pre-Op)

A
  • 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
34
Q

Hirschsprung’s Disease

A

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

35
Q

Hirschsprung’s Disease: Clinical Manifestations

A

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
36
Q

Hirschsprung’s Disease: Dx

A
  • barium enema
  • anal manometry
  • rectal biopsy (detects absence of the ganglion cells)
37
Q

Hirschsprung’s Disease: Tx

A

enemas
stool softeners
low fiber, high cal, high protein

surgical tx:

  • repair
  • ostomy
  • pull thru for low segment
38
Q

Hirschsprung’s Disease: Nursing Considerations

A
  • bowel prep
  • NG LIWS
  • NPO
  • Antibiotics
  • Ostomy care
  • Teaching
39
Q

Imperforate Anus

A

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
40
Q

Imperforate Anus: Dx

A
  • check for patency of anus and rectum
  • check for stool
  • x-rays
  • stool in the wrong place
41
Q

Imperforate Anus: Tx

A

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
42
Q

Imperforate Anus: Nursing Considerations

A
  • 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
43
Q

Appendicitis: Clinical Manifestations

A
  • 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
44
Q

Appendicitis: Dx

A

labwork (CBC, CRP)
u/s
CT

45
Q

Appendicitis: Tx

A

surgery
IV antibiotics
drains (if ruptured/perforated)

46
Q

Appendicitis: Nursing Considerations

A
  • pain
  • VS
  • monitor for infection
  • monitor surgical site/dressing
  • bowel sounds
  • C&DB
  • ambulation
  • drain care if one is placed
  • education

Pediatrics (14 decks)

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