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CPN Exam GI Conditions Flashcards

1
Q

Diarrhea/Gastroenteritis Etiology

A

Rotavirus = most common cause
C. difficile = most common antimicrobial associated
Bacteria, parasites, food intolerances

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2
Q

C.Diff

A

Bloody diarrhea
fever
abdominal pain

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3
Q

C.Diff complications

A

Metabolic acidosis
Dehydration

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4
Q

C.Diff Management

A

Prevention - Rotavirus Vaccine
Discontinue antimicrobial agent

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5
Q

Vomiting complications

A

Dehydration
Metabolic Alkalosis
Aspiration

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6
Q

Vomiting Management

A

May withhold feeding for 4-6 hours with IV fluid
Positioning
Rehydration Therapy

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7
Q

Pyloric Stenosis

A

Thickening of abdominal muscle around the circular pylorus muscle causing obstruction of the gastric outlet
More common in males

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8
Q

Pyloric Stenosis Assessment

A

1-3 months old
Projectile Vomiting - no bile
Dehydration

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9
Q

Pyloric Stenosis Diagnosis

A

Olive-like mass in abdomen
Abd US
Upper GI

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10
Q

Pyloric Stenosis surgical treatment

A

Involves splitting the overdeveloped muscle around the pyloric valve of the stomach, thereby spreading open the muscle and enlarging the pylorus to relieve the obstruction

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11
Q

Gastroesophageal Reflux

A

The passage of abdominal contents to the esophagus from an incompetent or poorly developed lower esophageal sphincter (LES)

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12
Q

Risk Factors for GER

A

Prematurity
Bronchopulmonary Dysplasia (BPD)
Cerebral Palsy (CP)

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13
Q

Complications of GER

A

Aspiration Pneumonia
Failure to Thrive

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14
Q

GER Diagnosis

A

Barium Swallow
Upper GI

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15
Q

GER Management

A

Small, more frequent feedings
Thickened formula
Positioning - upright 30 min post feeding
Avoid sitting positions
Back to sleep

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16
Q

GER Medications

A

Cimetidine
famotidine
Proton pump inhibitors

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17
Q

GER Surgical Repair

A

Nissen Fundoplication

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18
Q

Necrotizing Enterocolitis

A

Common in premature infants during neonatal period and in babies with cardiac defects
Blood flow to the GI tract is compromised
Bowel mucosa becomes necrotic
Bacteria invades necrotic tissue
Formula feeding provides nutrients for bacteria to grow

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19
Q

Necrotizing Enterocolitis Assessment

A

Abdominal distention
Increased gastric volumes
Vomiting
Bloody stool
Glucose + stool
Lethargy
Bradycardia
Hypotension
Temperature instability

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20
Q

Necrotizing Enterocolitis Management

A

Bowel Rest
Decompress abdomen - NG tube
Antibiotics
Decrease Stress

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21
Q

Necrotizing Enterocolitis Complications

A

Abdominal Perforation
Colostomy

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22
Q

Cleft Lip & Palate

A

Congenital defect with hereditary component
Incomplete midline fusion of the bones and tissues of the upper jaw and palate

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23
Q

Cleft Lip & Palate Management

A

Assess suck/swallow
Assess for abdominal distention
Feed slowly, upright
Burp Frequently
Specially designed nipple

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24
Q

Cleft Lip & Palate Repair

A

Cleft Lip: 1-4 months
Cleft Palate - 6-12 months (weaned from bottle)

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25
Esophageal Atresia
Occurs when the proximal end of the esophagus ends in a blind pouch; food cannot enter the stomach
26
Tracheoesophageal Fistula
Occurs when there isa connection between the esophagus and the trachea
27
EA/TEF Assessment
History of polyhydramnios Excessive oral secretions Abdominal Distention
28
EA/TEF Management
Do not feed orally Maintain patent airway Surgical repair - in stages
29
Appendicitis
Acute inflammation and infection of the appendix
30
Appendicitis Pain Signs
Begins as diffuse pain; then localizes in the right lower quadrant at McBurney’s point– Rebound tenderness
31
Appendicitis Assessment
Fever, Increased WBC Decreased bowel sounds, Nausea/vomiting, rigidity, guarding
32
Appendicitis Rupture
Sudden relief of pain followed by diffuse pain
33
Appendicitis Treatment
IV Antibiotics/PO antibiotics Appendectomy
34
Celiac Disease
An enteropathy caused by an insensitivity to the gluten found in wheat
35
Celiac Disease Assessment
Steatorrhea Abdominal Distension Failure to thrive Muscle Wasting
36
Celiac Disease Management
Gluten-free diet Vitamin Supplementation (MTV, Folic Acid, Iron)
37
Hirschsprung Disease (Megacolon)
A congenital anomaly of decreased intestinal motility resulting in mechanical obstruction of the intestine
38
Hirschsprung Disease Assessment
Abdominal Distention Constipation Ribbon-like, liquid stools
39
Hirschsprung Disease Management
Diagnosis: Rectal Biopsy Surgical correction with or without an ostomy
40
Intussusception
One portion of the intestine telescopes into another leading to: Lymphatic and venous obstruction resulting in Ischemia Mucous backflow into the intestine Leaking of blood into the intestine
41
Intussusception Prevalence
3 months - 2 years Males > Females 90% idiopathic
42
Intussusception Assessment
Sudden onset abdominal pain Knees to chest Inconsolable crying Bilious vomiting Currant-Jelly stools
43
Intussusception Management
Abdominal Xray Abd US Barium Enema - Gold Standard
44
Intussusception Treatment
Hydrostatic Reduction with Barium Enema Water Soluble Contrast with Air Pressure 80% successful
45
Intussusception Surgical Repair
Manual reduction, possible resection of gangrenous bowel
46
Encopresis
Fecal soiling of underwear in a child older than 4 years Most commonly caused by constipation
47
Inflammatory Bowel Disease
Chronic intestinal inflammation -Ulcerative Colitis -Crohn's Disease
48
Ulcerative Colitis
Inflammation involves the colon and rectum only Affects 2-layers (mucosa and submucosa) of the bowel
49
Crohn's Disease
Inflammation can involve any part of the GI tract Affects all layers of the bowel wall
50
IBD Symptoms
Bloody diarrhea Abdominal pain/cramps Weight loss Growth retardation (common presenting symptom)
51
IBD Medications
Analgesic and antispasmodics (pain relief) Corticosteroids (inflammation) Immunomodulators (methotrexate and cyclosporine) Biologics (Remicade = infliximab)
52
IBD Nutrition
Enteral and parenteral nutrition High-protein, High-calorie diet Low residue (low fiber) diet during periods of bowel inflammation Vitamin supplementation: multi-vitamin, folic acid, iron
53
IBD Surgical Treatment
Total Colectomy (often cures UC)
54
Hyperbilirubinemia
Unconjugated/Indirect Congugated/Direct
55
Unconjugated/Indirect Bili
Biproduct of red blood cell breakdown Passes blood-brain barrier in neonates (when levels are high) Elevated in physiologic/neonatal jaundice - Treated with phototherapy
56
Conjugated/Direct Bili
Formed when unconjugated/indirect bilirubin travels to the liver and is conjugated with glucuronic acid Elevated in biliary atresia Treated surgically
57
Biliary Atresia
A congenital anomaly involving the obstruction, obliteration or absence of extrahepatic biliary structures Unknown etiology Can cause liver failure/death
58
Biliary Atresia Assessment
Jaundice Pruritis - causing irritability Pale Stool Hepatomegaly, ascites, splenomegaly Failure to thrive Increased LFT's - direct bilirubin, Alk Phos, PT
59
Biliary Atresia Management
Administer Fat-Soluble Vitamins (A,D,E,K) Kasai procedure Liver transplant
60
NG Tube Placement
pH ≤ 5 = gastric placement of NG tube tip pH > 5 requires other methods to confirm placement Check tube length Obtain x-ray
61
NG Tube Patency
Check tube placement with each medication/feeding Flush and clamp tube after each medication administered
62
Acetaminophen Dosing
10-15 mg/kg per dose every 4 hours Non-Therapeutic - <10mg/kg dose Overdose = Liver Failure - treated with Acetadote, Mucomyst
63
Tylenol with Codeine
NOT recommended in Children - metabolized in liver and converted to morphine - genetic predisposition can cause morphine overdose

CPN Exam (10 decks)

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