CPN Exam GI Conditions Flashcards
Diarrhea/Gastroenteritis Etiology
Rotavirus = most common cause
C. difficile = most common antimicrobial associated
Bacteria, parasites, food intolerances
C.Diff
Bloody diarrhea
fever
abdominal pain
C.Diff complications
Metabolic acidosis
Dehydration
C.Diff Management
Prevention - Rotavirus Vaccine
Discontinue antimicrobial agent
Vomiting complications
Dehydration
Metabolic Alkalosis
Aspiration
Vomiting Management
May withhold feeding for 4-6 hours with IV fluid
Positioning
Rehydration Therapy
Pyloric Stenosis
Thickening of abdominal muscle around the circular pylorus muscle causing obstruction of the gastric outlet
More common in males
Pyloric Stenosis Assessment
1-3 months old
Projectile Vomiting - no bile
Dehydration
Pyloric Stenosis Diagnosis
Olive-like mass in abdomen
Abd US
Upper GI
Pyloric Stenosis surgical treatment
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
Gastroesophageal Reflux
The passage of abdominal contents to the esophagus from an incompetent or poorly developed lower esophageal sphincter (LES)
Risk Factors for GER
Prematurity
Bronchopulmonary Dysplasia (BPD)
Cerebral Palsy (CP)
Complications of GER
Aspiration Pneumonia
Failure to Thrive
GER Diagnosis
Barium Swallow
Upper GI
GER Management
Small, more frequent feedings
Thickened formula
Positioning - upright 30 min post feeding
Avoid sitting positions
Back to sleep
GER Medications
Cimetidine
famotidine
Proton pump inhibitors
GER Surgical Repair
Nissen Fundoplication
Necrotizing Enterocolitis
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
Necrotizing Enterocolitis Assessment
Abdominal distention
Increased gastric volumes
Vomiting
Bloody stool
Glucose + stool
Lethargy
Bradycardia
Hypotension
Temperature instability
Necrotizing Enterocolitis Management
Bowel Rest
Decompress abdomen - NG tube
Antibiotics
Decrease Stress
Necrotizing Enterocolitis Complications
Abdominal Perforation
Colostomy
Cleft Lip & Palate
Congenital defect with hereditary component
Incomplete midline fusion of the bones and tissues of the upper jaw and palate
Cleft Lip & Palate Management
Assess suck/swallow
Assess for abdominal distention
Feed slowly, upright
Burp Frequently
Specially designed nipple
Cleft Lip & Palate Repair
Cleft Lip: 1-4 months
Cleft Palate - 6-12 months (weaned from bottle)
Esophageal Atresia
Occurs when the proximal end of the esophagus ends in a blind pouch; food cannot enter the stomach
Tracheoesophageal Fistula
Occurs when there isa connection between the esophagus and the trachea
EA/TEF Assessment
History of polyhydramnios
Excessive oral secretions
Abdominal Distention
EA/TEF Management
Do not feed orally
Maintain patent airway
Surgical repair - in stages
Appendicitis
Acute inflammation and infection of the appendix
Appendicitis Pain Signs
Begins as diffuse pain; then localizes in the right lower quadrant at McBurney’s point– Rebound tenderness
Appendicitis Assessment
Fever, Increased WBC
Decreased bowel sounds, Nausea/vomiting, rigidity, guarding
Appendicitis Rupture
Sudden relief of pain followed by diffuse pain
Appendicitis Treatment
IV Antibiotics/PO antibiotics
Appendectomy
Celiac Disease
An enteropathy caused by an insensitivity to the gluten found in wheat
Celiac Disease Assessment
Steatorrhea
Abdominal Distension
Failure to thrive
Muscle Wasting
Celiac Disease Management
Gluten-free diet
Vitamin Supplementation (MTV, Folic Acid, Iron)
Hirschsprung Disease (Megacolon)
A congenital anomaly of decreased intestinal motility resulting in mechanical obstruction of the intestine
Hirschsprung Disease Assessment
Abdominal Distention
Constipation
Ribbon-like, liquid stools
Hirschsprung Disease Management
Diagnosis: Rectal Biopsy
Surgical correction with or without an ostomy
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
Intussusception Prevalence
3 months - 2 years
Males > Females
90% idiopathic
Intussusception Assessment
Sudden onset abdominal pain
Knees to chest
Inconsolable crying
Bilious vomiting
Currant-Jelly stools
Intussusception Management
Abdominal Xray
Abd US
Barium Enema - Gold Standard
Intussusception Treatment
Hydrostatic Reduction with Barium Enema
Water Soluble Contrast with Air Pressure
80% successful
Intussusception Surgical Repair
Manual reduction, possible resection of gangrenous bowel
Encopresis
Fecal soiling of underwear in a child older than 4 years
Most commonly caused by constipation
Inflammatory Bowel Disease
Chronic intestinal inflammation
-Ulcerative Colitis
-Crohn’s Disease
Ulcerative Colitis
Inflammation involves the colon and rectum only
Affects 2-layers (mucosa and submucosa) of the bowel
Crohn’s Disease
Inflammation can involve any part of the GI tract
Affects all layers of the bowel wall
IBD Symptoms
Bloody diarrhea
Abdominal pain/cramps
Weight loss
Growth retardation (common presenting symptom)
IBD Medications
Analgesic and antispasmodics (pain relief)
Corticosteroids (inflammation)
Immunomodulators (methotrexate and cyclosporine)
Biologics (Remicade = infliximab)
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
IBD Surgical Treatment
Total Colectomy (often cures UC)
Hyperbilirubinemia
Unconjugated/Indirect
Congugated/Direct
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
Conjugated/Direct Bili
Formed when unconjugated/indirect bilirubin travels to the liver and is conjugated with glucuronic acid
Elevated in biliary atresia
Treated surgically
Biliary Atresia
A congenital anomaly involving the obstruction, obliteration or absence of extrahepatic biliary structures
Unknown etiology
Can cause liver failure/death
Biliary Atresia Assessment
Jaundice
Pruritis - causing irritability
Pale Stool
Hepatomegaly, ascites, splenomegaly
Failure to thrive
Increased LFT’s - direct bilirubin, Alk Phos, PT
Biliary Atresia Management
Administer Fat-Soluble Vitamins (A,D,E,K)
Kasai procedure
Liver transplant
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
NG Tube Patency
Check tube placement with each medication/feeding
Flush and clamp tube after each medication administered
Acetaminophen Dosing
10-15 mg/kg per dose every 4 hours
Non-Therapeutic - <10mg/kg dose
Overdose = Liver Failure - treated with Acetadote, Mucomyst
Tylenol with Codeine
NOT recommended in Children - metabolized in liver and converted to morphine - genetic predisposition can cause morphine overdose
