CHAPTER 5:4 Flashcards
GASTROINTESTINAL DISORDERS
STRUCTURAL DISORDERS of GASTROINTESTINAL DISORDER
A. CLEFT LIP (HARELIP)/CLEFT PALATE
B. ESOPHAGEAL ATRESIA with TRACHEOESOPHAGEAL FISTULA
C. OMPHALOCELE/GASTROSCHISIS
Distinct facial defects that occurs singly or in combination
CLEFT LIP (HARELIP)/CLEFT PALATE
Malformation of the face that may occur individually or together
CLEFT LIP (HARELIP)/CLEFT PALATE
CLEFT LIP (HARELIP)/CLEFT PALATE:
→ Merging of the upper lip is completed between _____ wk AOG
→ Fusion of the palate is completed between _____ wk AOG
- 7-8th wk AOG
- 7-12th wk AOG
failure of the maxillary and median nasal processes to fuse
Cleft Lip
Incomplete fusion of the palate which results in communication between the mouth and the nose
Cleft Palate
Incidence of:
- Cleft Lip
- Cleft Palate
- 1:800 live births
- Males
——————— - 1:2000 live births
- Females
Associated with deformed
dental structures
Cleft Lip
Difficulty feeding =infant is unable to generate a negative pressure and create suction in the oral cavity
Cleft Palate
Types of Cleft Lip
- Complete
- Incomplete
- Unilateral
- Bilateral
Type of Cleft Lip that extends into the base of the nose and even the gums in which upper teeth are set may also be deformed
Complete
Prone to recurrent otitis media→fluid can get in the middle ear →tympanic membrane scarring →hearing loss
Cleft Palate
Type of Cleft Lip that is a small notch; maybe a little more than a notching of the vermillion border of the lip and may extend to the nostril
Incomplete
Type of Cleft Lip that is generally below the center of one nostril
Unilateral
Type of Cleft Lip that is beneath both nostril
Bilateral
Cause of CLEFT LIP (HARELIP)/CLEFT PALATE related to chromosomal abnormalities; associated with other defects (omphalocele; TEF); inherited – evidenced by increase incidence in relatives
Genetics
Cause of CLEFT LIP (HARELIP)/CLEFT PALATE related to teratogens (maternal smoking accounts for 11-12% of cases, viral infection, folic acid deficiency/avitaminosis)
Environmental
CL is apparent at birth – detected with what instrument while in Utero
Sonogram
surgical modification for Cleft Lip
CHEILOPLASTY
surgical modification for Cleft Palate
URANOPLASTY
Date of repair for CHEILOPLASTY
6-12 weeks (precedes CP)
Date of repair for URANOPLASTY
12-18 months
Surgical modification:
* early repair avoids oral deprivation, prevents trauma and difficulty for the parents
* its difficult to bond with an infant with deformed face
CHEILOPLASTY
surgical modification to take advantage of palatal changes that take place with normal growth and before child develops faulty speech
URANOPLASTY
surgical modification in anticipation of speech development, it is done before the child develops faulty speech habits
URANOPLASTY
what position is to facilitate swallowing and discourage aspiration to pediatrics with CLEFT LIP (HARELIP)/CLEFT PALATE
Upright position
What is done because more air is swallowed which can cause regurgitation/vomiting
Burp frequently
widely used as part of a cleft lip management to maintain postoperative apposition and to avoid excessive strain after cheiloplasty for a cleft lip
Logan’s bow/butterfly adhesive
At what condition are these done to Avoid trauma to the operative site:
▪ Elbow restraint
▪ Jacket restraint for older children to prevent rubbing of site
CL
In cleft palate, up to how many weeks are needed for the use of elbow restraint until palate is healed to avoid trauma to the operative site?
4-6 weeks
failure of the esophagus to develop a continuous passage, and esophagus ends in a blind pouch with no entry to the stomach
Esophageal atresia (EA)
abnormal connection between the esophagus and the trachea
Tracheoesophageal fistula (TEF)
3 C’s of TEF
choking, coughing, cyanosis
used to determine exact type of anomaly (radiopaque catheter then chest films are taken)
Radiography
Management for gastric decompression (placement of a feeding tube, left open to drain by gravity to keep stomach empty of secretion and prevent reflux into lung) and jejunosotomy feeding
Gastrostomy
an alternative to gastrostomy if the 2nd step surgery will be much later
Cervical esophagostomy
in post-op ESOPHAGEAL ATRESIA with TRACHEOESOPHAGEAL FISTULA, what is the best position to prevent gastric juice from flowing to the fistula
Semi-Fowler’s position or right side
Protrusion of intraabdominal contents into the base of umbilicus which is covered by a
translucent sac (peritoneum without skin)→rupture→evisceration
OMPHALOCELE
Protrusion of intraabdominal contents through defect in abdominal wall lateral to umbilical ring which is never with a peritoneal sac
GASTROSCHISIS
WHAT ARE THE DISORDERS OF MOTILITY IN GASTROINTESTINAL DISORDERS
A. GASTROESOPHAGEAL REFLUX
B. HIRSCHPRUNG’S DISEASE
C. COLIC
OBSTRUCTIVE DISORDERS IN GASTROINTESTINAL DISORDERS
A. INTUSSUSCEPTION
B. HYPERTROPHIC PYLORIC STENOSIS
MALABSORPTION SYNDROME IN GASTROINTESTINAL DISORDERS
CELIAC DISEASE
It is the Return of gastric contents into the esophagus / Backward movement of gastric content
GASTROESOPHAGEAL REFLUX
Neuromuscular disturbance in which the cardiac sphincter and lower portion of the esophagus are lax.
GASTROESOPHAGEAL REFLUX
What diagnosis for GASTROESOPHAGEAL REFLUX is used to establish presence of reflux
Barium swallow (esophagography)
What diagnosis for GASTROESOPHAGEAL REFLUX is used where pH determined at distal esophagus (insertion of small catheter into esophagus through nose)→ to determine the number of reflux episodes
24 hour pH probe study
sees number of reflex episodes
What diagnosis for GASTROESOPHAGEAL REFLUX is used with radionuclide scanning for evaluation of gastric emptying (after feeding a radioactive compound)
Scintigraphy
What management is For children with severe complications (recurrent aspiration pneumonia, apnea, severe esophagitis, failure to thrive, failure to respond to medical therapy)
surgery
What kind of surgery uses Valve mechanism by 360o wrap of the fundus (greater curvature of the
stomach) around the esophagus. A gastrostomy tube is usually inserted during the procedure
NISSEN FUNDOPLICATION
a management Alternative for children with neurologic impairment who are continuously tube fed
NON-SURGICAL PERCUTANEOUS GASTROJEJUNOSTOMY and placement of jejunostomy tube
what position is best for those with GASTROESOPHAGEAL REFLUX, after feeding and at night
PRONE (head elevated/flat)
NOT SUPINE/INFANT SEAT-worsens GER→↑intraabdominal pressure
30’ prone 60’ supine - both until 6 weeks
other name for HIRSCHPRUNG’S DISEASE:
Congenital Aganglionic Megacolon
_____=without nerve tissue in the colon/rectum
_____=dilated action of colon
- Aganglionic
- Megacolon
It is a Mechanical obstruction due to inadequate motility of the intestines
HIRSCHPRUNG’S DISEASE
Babies with this birth defect (HIRSCHPRUNG’S DISEASE) are born without intestinal nerve cells called __________
ganglion cells
leading cause of death in children with Hirschprung’s disease=inflammation of small bowel and colon; s/s=fever, explosive watery diarrhea, dehydration, severe prostrationseptic shock
Enterocolitis
what occurs when there is vomiting, refusal to suck
Dehydration
what diagnosis uses - biopsy samples of the inside of the large intestine, near the anus
Rectal biopsy
This procedure can be done without making an incision on the abdomen. Instead, small laparoscopic (telescopic) instruments are used and the operation is done through the anus.
PERINEAL ONE STAGE OPERATION PULL THROUGH PROCEDURE (POOP procedure )
What procedure is the Removal of aganglionic segment and temporary colostomy made with the part of the bowel with normal nerve transmission to allow this part to rest and let child gain weight
Staged repair
closure of the colostomy and reanastomosis of working part of colon to point near anus
Corrective
recurrent episodes of unexplained crying inability to be consoled
COLIC
Colic occurs around what weeks of age; subsides spontaneously by how many weeks
- 1-2 weeks of age
- 16 weeks
sharp, visceral pain resulting from torsion, obstruction, or smooth muscle spasm of a hallow or tubular organ, such as a ureter or the intestines
COLIC
An invagination or telescoping of one portion of intestines into another
INTUSSUSCEPTION
Invagination of the cecum in colon producing obstruction of the intestines
INTUSSUSCEPTION
one of the most frequent causes of intestinal obstruction between 3 months to 5 years of age;
50% below 1 year (3-12 months )of age
INTUSSUSCEPTION
TYPES of INTUSSUSCEPTION (according to location)
- Ileocolic
- Cecocolic
- Ileoileal
TYPE of INTUSSUSCEPTION which is the most common; ileum invaginates into cecum and ascending colon
Ileocolic
types of Non-surgical management for INTUSSUSCEPTION
a. HYDROSTATIC REDUCTION (by barium enema)
b. PNEUMATIC INSUFFLATION (AIR ENEMA)
TYPE of INTUSSUSCEPTION which ileum invaginates into another portion of the ileum
Ileoileal
complications of INTUSSUSCEPTION include:
- Perforation
- Peritonitis
- Sepsis
Non-surgical management for INTUSSUSCEPTION Done at the time of diagnostic testing
HYDROSTATIC REDUCTION (by barium enema)
TYPE of INTUSSUSCEPTION which cecum invaginates into colon
Cecocolic
What is used to detect intraperitoneal air from a bowel perforation
Abdominal radiograph
what is used for the obstruction of the flow of barium
Barium enema
Non-surgical management for INTUSSUSCEPTION where The force exerted by the flowing barium is usually sufficient to push the invaginated portion (80-90% of cases)
HYDROSTATIC REDUCTION (by barium enema)
Non-surgical management for INTUSSUSCEPTION with No risk of peritonitis and is More rapid
PNEUMATIC INSUFFLATION (AIR ENEMA)
management for INTUSSUSCEPTION which is a manual reduction of invagination and resection of nonviable intestine when necessary
Surgical
other name for HYPERTROPHIC PYLORIC STENOSIS
INFANTILE HYPERTROPHIC PYLORIC STENOSIS
A hypertrophic obstruction of the circular muscle of the pyloric canal
HYPERTROPHIC PYLORIC STENOSIS
one of the most common conditions requiring surgery in infants, and is seen at the First few weeks of life (1-10 weeks)
HYPERTROPHIC PYLORIC STENOSIS
standard treatment, which Longitudinal incision through the circular muscle fibers of the pylorus down to, but not including the submucosa
PYLOROMYTOMY (FREDET-RAMSTEDT PROCEDURE)
other names for CELIAC DISEASE
- Gluten –induced enteropathy
- Gluten-sensitive enteropathy
- Celiac sprue
Inherited Autoimmune disease of the proximal intestine characterized by abnormal mucosa and permanent intolerance to gluten
CELIAC DISEASE
causes: genetics, gluten exposure, GUT microbiome, medical conditions, environmental factors
Secondary to CF as a cause of malabsorption in children
CELIAC DISEASE
- Chronic, insidious, noted after introduction of gluten-containing grains in the diet, typically
between 1-5 y/o - 1st signs=failure to thrive, diarrhea
CELIAC DISEASE
what is an excessively large, pale, oily, frothy stools called
Steatorrhea
screening test for presence of antigliadin; and antireticulin and antiendomysial Ig A and Ig G antibodies (antibodies to connective tissue)
Blood test
Often follows screening test Demonstrates changes in mucusa and positive clinical response to a gluten-free diet
Jejunal biopsy
in CLEFT LIP (HARELIP)/CLEFT PALATE, Merging of the upper lip is completed at what week AOG
between 7-8th wk AOG
in CLEFT LIP (HARELIP)/CLEFT PALATE, Fusion of the palate is completed at what week AOG
between 7-12th wk AOG
Stomach capacity in mL for:
* NB
* 1 week
* 2-3 weeks
* 1 month
* 3 months
* 1 year
* 2 years
- NB - 10-20mL
- 1 week - 30-90mL
- 2-3 weeks - 75-100mL
- 1 month - 90-150mL
- 3 months -150-200mL
- 1 year - 210-360mL
- 2 years - 500mL
6 Postoperative care nursing care for those with CLEFT LIP (HARELIP)/CLEFT PALATE
- Maintain airway patency
- Observe for bleeding
- Avoid trauma to the operative site
- Minimize pain
- Optimum nutrition
Causes of CLEFT LIP (HARELIP)/CLEFT PALATE:
- Genetics
- Environmental
- Exposure to certain drugs during pregnancy
- Nutritiona deficiencies
- Certain medical conditions
what are the ESSR according to Richard 1991
▪ Enlarge the nipple (long, soft)
▪ Stimulate the suck reflex
▪ Swallow fluid appropriately
▪ Rest
what position is best for those with CLEFT LIP (HARELIP) to maintain airway patency
upright/infant seat position
what position is best for those with CLEFT PALATE to maintain airway patency
lie on abdomen
At what condition is “Rubber tipped syringe on the side of the mouth” used to provide optimum nutrition?
CL
At what condition is “Paper cup/large hole nipple” used to provide optimum nutrition?
CP
at what week is the development of larynx, trachea, beginning lung tissue, and esophageal lumen
4-6th week
What are the 5 types of ESOPHAGEAL ATRESIA with TRACHEOESOPHAGEAL FISTULA
- Simple esophageal atresia with no fistula (Isolated EA) - A 2
- EA with proximal TEF - B4
- EA with distal TEF - C1
- EA with double TEF - D4
- Isolated TEF - E3
Type of ESOPHAGEAL ATRESIA with TRACHEOESOPHAGEAL FISTULA: where Upper and lower ends of esophagus are blind, no
connection to the trachea
Simple esophageal atresia
with no fistula (Isolated EA) - A2
Type of ESOPHAGEAL ATRESIA with TRACHEOESOPHAGEAL FISTULA: where Upper end of the esophagus ends into the
trachea
EA with proximal TEF - B4
Type of ESOPHAGEAL ATRESIA with TRACHEOESOPHAGEAL FISTULA: where Upper end of esophagus is blind, lower end
connects into the trachea=most common
EA with distal TEF - C1
Type of ESOPHAGEAL ATRESIA with TRACHEOESOPHAGEAL FISTULA: where Both upper and lower ends of esophagus open
into the trachea by a fistula
EA with double TEF - D4
Type of ESOPHAGEAL ATRESIA with TRACHEOESOPHAGEAL FISTULA: where No Esophageal atresia but with fistula between
normal esophagus and trachea
Isolated TEF - E3
At what days is Gastrostomy tube feedings applicable to Provide optimum nutrition for those with ESOPHAGEAL ATRESIA with TRACHEOESOPHAGEAL FISTULA
5th-7th day-post-op feedings
At what days is Oral feeding when anastomosis site healed applicable to Provide optimum nutrition for those with ESOPHAGEAL ATRESIA with TRACHEOESOPHAGEAL FISTULA
10th day-2nd week
How do you Protect sac from trauma and infection as a NURSING CARE for those with OMPHALOCELE/GASTROSCHISIS
- Monitor sac and make sure that it is covered with sterile gauze soaked in NSS
- Place dried sterile gauze over sterile moist gauze and cover with plastic wrap
what is a neuromuscular disturbance in which the gastroesophageal (cardiac) sphincter and lower portion of esophagus are lax and therefore allow easy regurgitation of gastric contents into esophagus
GASTROESOPHAGEAL REFLUX DISEASE (GERD)
Causes: Relaxed cardiac sphincter, delayed gastric emptying, increased abdominal pressure
Pharmacologic management for those with GASTROESOPHAGEAL REFLUX
a. H2 antagonists
b. Proton pump inhibitor
c. Prokinetc agents
What pharmacologic management for those with GASTROESOPHAGEAL REFLUX: Reduce amount of acid in the gastric contents and prevent esophagitis
H2 antagonists
Cimetidine (tagamet), famotidine (Pepcid), Ranitidine (Zantac)
What pharmacologic management for those with GASTROESOPHAGEAL REFLUX: Block acid production
Proton pump inhibitor
Omeprazole (Prilosec), lansoprazole (prevacid)
What pharmacologic management for those with GASTROESOPHAGEAL REFLUX: Increase resting LES pressure mildly and increase the rate of gastric emptying)
→ BUT S/e-restlessness, drowsiness, extrapyramidal reactions and in some,
increase number of reflux episodes
Prokinetc agents
Metochlopromide HCl
small bowel obstruction, retching, gas-bloat syndrome, Dumping syndrome
what are considered in Feeding for those with GASTROESOPHAGEAL REFLUX
▪ Thickened (1 tsp-1 tbsp of rice cereal/oz of formula)
▪ Small frequent feeding
▪ Frequent burping
What is done to keep stool small and soft so that they can be easily evacuated
Low residue diet
What is done to prevent impaction until child is toilet trained; use volume appropriate to weight of the child
Isotonic irrigations
Not tap water-water intoxication | Not soap suds
What is the significance of Keeping in upright position during feeding for those with colic
to prevent aspiration
What is done to decrease self stimulation by jerky or sudden movements for those with colic
Swaddle
what is the telescoping of bowel into itself called
INTUSSUSCEPTION
