ch 41: GI dysfunction Flashcards
EXAM 2 content -- all the important things i need to know (imo)
when will we need increased fluid?
- fever
- vomit
- diarrhea
- kidney fail
- diabetic ketoacidosis
- BURNS
- shock
- tachypnea
- radiant warmer
- phototherapy
- post op bowel surgery
when will we need decreased fluids?
- HF
- SIADH
- mech vent
- after surgery
- oliguric renal fail
- incr intracranial pressure
what will we see in GI dysfunction?
- growth fail
- spitting/regurgitation
- n/v, diarrhea, constipation
- jaundice
- dysphagia
- fever
what are the causes of dehydration? what will we see w dehydration?
- fluid loss
- incr renal excretion
- vomit & diarrhea
- ketoacidosis
- burns
- incr RR
what are types of dehydration?
- isotonic = lost in equal parts, primary form in children, risk for hypovolemia
- hypotonic = loss of electrolytes, physical signs more severe
- hypertonic = loss of water, specific fluid therapy
what should we measure to be accurate with intake & output?
- urine & stools
- vomit: # of episodes
- sweat
- V/S
- skin turgor & mucous membranes
- body weight
- fontanels in infants, dehydration = sunken
- sensory alterations
what are the manifestations of dehydration?
- weight loss
- VS changes
- behavioral changes
- thirst
- sunken fontanel
- tenting = not eating or drinking
- decr cap refill
- decr UOP
what is oral rehydration?
safer, less painful than IV
- promotes reabsorption of water
- reduced vomit, diarrhea & duration of illness
diarrhea – what do we need to know?
- leading cause < 5 yo
- 24% of deaths r/t diarrhea & dehydration of developing countries
- types: acute, infectious, chronic, nonspecific, intractable diarrhea or infancy
causes of diarrhea?
- gastroenteritis (stomach + intestines)
- enteritis (small intestine)
- colitis
- enterocolitis (colon + intestines)
- rota virus
- salmonella, shigella, campylobacter organism
- MOST COMMON: giardia organism
- C diff
- plesiomonas, yersinia organism
- antibx effects
- cryptosporidium organisms
- INTESTINAL PARASITES: giardia & pinworms
what is the management of diarrhea?
- assess fluid & electrolyte imbalance
- rehydration
- fluid therapy
- slow introduction to adequate diet
- support & education
how do we prevent diarrhea?
- 2 rotavirus vaccines
- personal hygiene
- clean water, protect from contamination
- careful food prep
what is the cycle of constipation?
big changes, fam problems, condition, psychosocial –> hold stool –> incre stool –> pain BM
- secondary to other disorders
- idiopathic constipation: no known cause
- chronic constipation: due to environment or psychosocial
what if meconium doesn’t pass in 24-36 hours after birth?
assess:
- intestinal atresia, stenosis
- hirschsprung disease, hypothyroidism
- meconium plug, meconium ileus
why would infants have constipation?
- diet
- breast milk has minimal residue
why would children have constipation? management?
- environment changes
- control over body
- stress
ENCOPRESIS: inappropriate passage of poop, with soiling (watery)
- common in males
- psychological distress
- secondary to constipation
- determine cause, diet, manage
- psychotherapeutic interventions
management
- hx of BM, meds, diet
- educate
- diet modifications
what is hirschsprung disease?
aka – CONGENITAL AGANGLIONIC MEGACOLON
- mechanical obstruction bc of inadequate motility of intestine
- more common in boys + down syndrome
- absence of ganglion cells in colon –> literally CANT PASS STOOL, no meconium at birth
how do we diagnose hirschsprung disease?
- diagnosed first few months of life
- complete hx
- x ray, barium enema studies
- anorectal manometric
- RECTAL BIOPSY
how do we treat hirschsprung disease?
SURGERY
- 1st stage: temporary ostomy
- 2nd stage: pull thru procedure
pre op, post op, discharge, educate
vomiting – what do we need to know?
forceful ejection of gastric content thru mouth
- with nausea
- nonbilious & bilious
- detect cause & prevent complications
- evaluate, look at hx
gastroesophageal reflux (GER) – what do we need to know?
gastric contents in esophagus
- occurs w everyone
- abnormal if high frequency & persistency
- may occur without regurgitation
- kids have this bc systems are immature –> heart burn
- losing weight & not eating –> get checked out, smaller bites, & sit up more
acute appendicitis – what do we need to know?
inflammation of the vermiform appendix
- diagnosis: Mcburney’s point
s/s
- more common in children
- low grade fever
- n/v
- stomach pain
- headache
- rebound tenderness
management:
- treat ruptured appendix
- monitor
- surgical removal to prevent rupture
inflammatory bowel disease (IBD) – what do we need to know?
includes ulcerative colitis & crohn’s disease
- nutrition: high protein high calorie, well balanced + MVI, iron, folic acid
- prognosis: follow up medication compliancy
what are the different types of hepatitis?
A B C D E
how do we do infection control for hepatitis?
handwash & avoid illicit drug use
biliary atresia – what do we need to know?
aka EXTRAHEPATIC BILIARY ATRESIA
- unknown cause
- if left untreated –> CIRRHOSIS
cleft lip & cleft palate – what do we need to know?
facial malformations during embryonic development
- show separately or together
- multifactorial inheritance
- surgical correction of CLEFT LIP @ 2-3 mo of age –> protect suture line
- surgical correction of CLEFT PALATE @ 6-12 mo of age –> asap so there is no effects on feeding + speech development
how do we help with feeding with kids with cleft lip & cleft palate? what are some problems?
- techniques & interventions
- special feeding equipment
problems:
- breast feeding issue
- growth failure
esophageal atresia & tracheoesophageal fistula (TEF) – what do we need to know?
- ESOPHAGEAL ATRESIA: failure of esophagus to develop has a continuous passage –> problems swallowing & feeding
- TEF: failure of trache to separate into a distinct structure
- can occur separate or together
- unknown cause
- risk for: aspiration & pneumonia
how do we manage TEF?
- maintain airway
- prevent pneumonia
- depress gastric or blind pouch
- support
- surgical repair
- prognosis: good in healthy children!
hernia – what do we need to know?
protrusion of portion of an organ thru abnormal opening –> danger of incarceration/strangulation
types
- diaphragmatic
- abdominal wall
- inguinal canal
hypertrophic pyloric stenosis – what do we need to know
constriction of pyloric sphincter WITH obstruction of gastric outlet
- need surgery to correct
- VOMITING across the room
- hungry but vomits after
intussusception – what do we need to know?
telescoping or invagination (folded back) of one portion of intestine INTO another
- 3mo - 3 yo
- sometimes due to intestinal lesions (10%)
- unknown cause
- RED JELLY POOP!!! EWWW
- we want to hear BM!!
malrotation & volvulus – what do we need to know?
MALROTATION: abnormal rotation of intestine around superior mesenteric artery DURING embryologic development
VOLVULUS: twisting of intestine around ITSELF –> compromising blood supply to intestines
–> necrosis, peritonitis, preformation & death
anorectal malformations – what do we need to know?
that these cause GI distress & issues passing stool
malabsorption syndromes – what do we need to know?
chronic diarrhea & malabsorption of nutrients –> fail to thrive, anatomic & biochemical defects
celiac disease – what do we need to know?
aka GLUTEN SENSITIVE ENTEROPATHY & CELIAC SPRUE
- steatorrhea
- first line management: diet changes
- low gluten diet
risk for –>
- general malnutrition
- abdominal distention
- secondary vit deficiencies
obesity – what do we need to know?
obesity is intertwined in EVERY DISEASE PROCESS & worsening outcomes
