Chapter 22: GI Dysfunction Flashcards
Explain generally how daily maintenance fluid requirements are calculated.
5 steps
- determine child’s weight in kg
- calculate 100 mL/kg for the first 10 kg of weight
- calculate 50 mL/kg for the second 10 kg of weight
- calculate 20 mL/kg for the remaining kg of weight
- add values together
What is Hirschsprung disease?
- AKA congenital aganglionic megacolon
- mechanical obstruction from inadequate motility of the intestine d/t absence of ganglion cells in the colon
What population of children experiences Hirschsprung disease more commonly?
- more common in males
- more common in children with Down syndrome
What are signs and symptoms of Hirschsprung disease?
4 signs and symptoms
- accumulation of stool with distention of abdomen
- failure of internal anal sphincter to relax
- enterocolitis (inflammation of small and large intestines)
- neonates – delayed passage of first mec
How is Hirschsprung disease diagnosed?
3 diagnostic evaluations
- X-ray with barium enema
- anorectal manometric exam – catheter with balloon inserted into rectum to determine internal pressure
- rectal biopsy – confirms diagnosis
How is Hirschsprung disease treated?
4 treatments
- enema
- surgery to remove aganglionic portion – most common
- low fiber diet
- measure abdominal girth and circumference (measure at umbilicus)
What is gastroesophageal reflux (GER)? What predisposes children to GER?
5 predisposing factors
- GER: transfer of gastric contents into the esophagus, but with no damage to tissues
- predisposing factors:
1. prematurity
2. borderline personality disorder (BPD)
3. cystic fibrosis
4. asthma
5. cerebral palsy
What are some signs and symptoms of GER? How is GER diagnosed?
3 s/s; 2 diagnosis methods
- signs and symptoms:
1. frequent spitting up
2. lack of weight gain
3. ALTE (apparent life-threatening event) or BRUE (brief resolved unexplained event) - diagnosed by:
1. H&P
2. pH study of intraesophagus – gold standard
How is GER managed?
5 management techniques
- dietary changes
- meds – H2 antagonists (-tidine meds)
- surgery if severe
- positioning
- special caution when feeding
What is acute appendicitis, and what causes it?
- acute appendicitis: inflammation of appendix
- caused by obstruction or infection
How is acute appendicitis diagnosed?
3 diagnostic tests
- H&P
- ultrasound
- CT scan
How is appendicitis managed?
5 management methods
- appendectomy
- IVF
- antibiotics for perforation up to 82% if less than 5 years old
- suction if ruptured
- pain medication if ruptured
What is biliary atresia? What is the major sign/symptom?
- AKA extrahepatic biliary atresia
- biliary atresia: failure of extrahepatic bile ducts to develop/are closed
- major s/s: jaundice
How is biliary atresia diagnosed?
2 diagnostic tests
- H&P
- HIDA scan – checks functioning of gallbladder
How is biliary atresia managed?
2 treatments
- Kasai procedure – removal of blocked bile ducts and gallbladder and replacing with a segment of the child’s own small intestine to form a new extrahepatic bile duct
- liver transplant
What is the best age for the Kasai procedure for biliary atresia?
less than 2 months old
* 75 - 90% survival rate
What are cleft lip and cleft palate?
- cleft lip: hole in upper lip d/t incomplete formation
- cleft palate: hole in roof of mouth d/t incomplete formation
How are cleft lip and cleft palate diagnosed?
- visual exam of oral cavity
- fetal ultrasound
How are cleft lip and cleft palate managed?
5 management methods
- CL repair – surgery by 2 - 3 months so infant can feed properly
- CP repair – surgery by 12 months to not interfere with growth, but want to fix in time for speech development
- feed using wide-based nipple
- provide cheek support while feeding
- burp frequently during feeds
What is an esophageal atresia/tracheoesophageal fistula?
- failure of the esophagus to develop as a continuous passage separate from the trachea
- esophagus instead ends in a blind pouch or a pouch connected to the trachea by a fistula
What are some signs and symptoms of esophageal atresia/tracheoesophageal fistula? (3 C’s)
- coughing
- choking
- cyanosis
How is esophageal atresia/tracheoesophageal fistula managed?
5 management methods
- NPO
- IVF
- upright position
- suction
- surgery
What is gastroschisis?
protrusion of bowel through a defect in the abdominal wall to the side of the umbilicus
What is omphalocele?
when intra-abdominal contents herniate through the umbilical cord
What is hypertrophic pyloric stenosis?
- constriction of the pyloric sphincter with obstruction of gastric outlet
- lumen becomes inflammed and edematous –> obstruction
What are the major signs and symptoms of hypertrophic pyloric stenosis?
3 signs/symptoms
- projectile vomiting
- dehydration
- electrolyte imbalance/depletion
What is intussusception?
- telescoping of a portion of the intestine into another
- obstructs passage of stool –> inflammation, edema, decreased bloodflow
At what age of children is intussusception most common?
3 months to 3 years
What are some signs and symptoms of intussusception?
2 signs/symptoms
- sudden onset of crampy abdominal pain
- currant jelly stool (bright red stools) from strangulation of intestines
How is intussusception diagnosed?
2 diagnostic tests
- ultrasound
- rectal exam demonstrating blood and mucus
How is intussusception treated? What could occur if not treated promptly?
2 treatments; 4 possible outcomes
- treatments:
1. enema
2. surgery - if not treated promptly, could result in:
1. bowel ischemia
2. perforation
3. peritonitis
4. death
What is short bowel syndrome (SBS)?
- malabsorptive disorder d/t decreased mucosal surface area
- usually the result of small bowel resection
What is necrotizing enterocolitis?
- an acute inflammatory disease of the bowel
- mostly affects infants with vascularly compromised GI tracts
How is necrotizing enterocolitis treated?
2 treatments
- NPO for 24 - 48 hrs if suspect birth asphyxia
- minimal enteral feedings of breastmilk –> promotes intestinal maturation
What are some nursing interventions for necrotizing enterocolitis?
3 interventions
- check for abdominal distention
- antibiotics
- monitor nutritional needs
