Exam 3 Gastroenterology Flashcards
Gastroenterology (3)
Diarrhea
Celiac Disease
Acute Appendicitis
Diarrhea
- Acute diarrhea -> ___ cause of ___ children < __ yo
- Acute infectious diarrhea -> ___ of ___ organisms
1) The most common viral cause =
2) Bacterial causes (4)
3) Bacterial diarrhea looks more =
- most, illness, < 5
- Variety of causative
1) Rotavirus (however new oral vaccine has reduced incidence)
2) E.coli, Salmonella, Shigella, Campylobacter
3) Bloody
Dehydration occurs when =
= total output of fluid exceeds intake
Why are infants at more risk for insensible water loss? (4)
1) > body surface area
2) Basal Metabolic rate
3) Immature kidney function, cannot concentrate urine
4) Greater need for fluids to excrete solutes
Isotonic Dehydration =
Hypotonic Dehydration =
Hypertonic Dehydration =
= water and salt lost in equal amounts
= More electrolyte loss than water loss
= more water loss then electrolyte loss
Fluid Distribution
1) Intracellular Fluids (4)
2) Extracellular Fluids (3)
3) Interstitial fluid =
4) Intravascular fluid =
1) K+, Phosphate, Sulfate, Protein
2) Na, Cl, Bicarb (saline)
3) fluid between cells, outside of blood vessels
4) Plasma within vessels
During Illness
- First loss of fluid in ____ compartment
- Greater risk for dehydration and alterations in fluid and electrolytes bc?
- Extracellular
- infants/young children have greater proportion of extracellular fluid (40%) compared to our (20-30%)
Clinical manifestations of dehydration
1) Weight _____
2) _____ pulse
3) _____ BP
4) _____ peripheral circulation
5) _____ urinary output
6) ____ specific gravity
7) _____ skin turgor
8) ____ mucous membranes
9) _____ of tears
10) ____ fontanels
1) loss
2) rapid
3) decreased
4) decreased
5) decreased
6) increased
7) decreased/dry
8) absence
9) sunken
Severe Dehydration
1) Weight loss >/- ___% most accurate way to assess acute dehydration
2) Very increased Vitals (2)
3) _____ hypotension > ___ mmhg change can lead to ___
4) Behavior can range from ____ to _____
5) ____ to ____ thirst, ___ to ___ mucous membranes
6) __ tears, ___ eyes, ___ fontanels
7) m___, __ skin, Cap refill =
1) 10%
2) increased HR, Hyperpnea (deep, rapid)
3) Orthostatic, > 20 mmhg change can lead to shock
4) hyperirritable to lethargic
5) Moderate to intense, dry to parched
6) absent, sunken, sunken
7) cool, mottled, very delayed > 4 secs
First Choice Management for Dehydration is?*
Oral Rehydration Therapy - PEDIALYTE*
Why is ORT first choice?
- s____, ___ painful, less ____ than IV rehydration
- enhances and promotes reabsorption of (2)
- reduces v___, d___, ___ of illness
- safer, less, costly
- H20, Na
- vomiting, diarrhea, duration
ORT contains (4) electrolytes
- ____ mEq of sodium/L
- Given in ___ volumes: __-__ ml/kg q __-___ hrs
- Can give even if _____
Glucose, Na, Cl, K
- 75
- 50-100 ml, 3-4 hr
- vomiting (small amounts)
Dehydration magement
1) Observe for =
2) NO (2) why?
3) Reintroduction of foods should be? What type of foods to avoid? (3)
1) Urine output
2) Antimotility bc can cause ileus, Antibiotics bc is a virus
3) Slow, Gradual reintroduction of bland foods, Avoid sugary, spicy, fried foods
Hospital Management for Dehydration
- If ORT doesn’t work?
- Assessment of skin ___, m__ m___, f_____
- hospitalization for IV rehydration
- turgor, mucous membranes, fontanels
I/O's - 1 g wet diaper = \_\_ mL (subtract weight of diaper) - weigh all diapers, even with \_\_\_\_ Daily \_\_\_\_, \_\_\_ signs Lab Values = \_\_\_\_ bicarb, \_\_\_ h/h ->
- 1 ml
- stool
- weights, VS
- low bicarb, high H/H -> makes blood thick (hypercoaguable)
Daily Maintenance Fluid Requirements 1) \_\_\_\_\_\_ ml/kg/day for 1st 10 kg 2) \_\_\_\_\_ ml/kg/day for 2nd Kg 3) \_\_\_\_ ml/kg/day for remaining divide by \_\_\_ to get hourly rate
1) 100
2) 50
2) 20
24
Patient Education: Diarrhea
1) Most diarrhea are spread = ___-___ route
2) Hand ____ before eating, after using bathroom
3) ______ water supply, protect from _____
4) _____ food _____
5) Notify _____/_____
1) Fecal-oral
2) washing
3) Clean, contamination
4) Careful food prep
5) Daycare/School
Celiac Disease =
= An autoimmune disease caused by sensitivity to protein gluten
Gluten is found in (3)
Wheat, Barley, Rye
With Celiac Disease, if gluten is consumed, what happens?
= immune response is triggered and damage is caused to lining of small intestine -> nutrients cannot be absorbed -> nutrient deficiencies
Clinical Manifestations of Celiac Disease
1) D____, Abdominal ____, _____, weight ___, f_____
2) ___-smelling, ____ stool
3) Growth ____ if not caught early
Diagnosis = ___/____ levels, ____ of small intestines
1) Diarrhea, pain, distention, loss, fatigue
2) Foul-smelling, frothy
3) Delay
IgA, IgG, Biopsy
Tx for Celiac Disease =
- after a few days starting gluten free diet, child will start ____ weight and symptoms will _____
= No tx, just lifelong gluten free diet
- gaining, resolve
Foods that are naturally Gluten Free =
Grains/Starches that are Gluten Free =
= fruits, vegetables, beef, poultry, fish, nuts, eggs, dairy
= corn, quinoa, millet, rice, buckwheat, flax, lentils, wild rice, potato, soy, yucca, tapioca
Foods to avoid with celiac disease =
READ LABELS!
Wheat, barley, rye, pasta, breads, pizza, cake, cookies, processed foods
Long term diet = high in ___ and ____, low in ___
Easier for child if ___ has same meals to
Considerations
1) ____ can be challenging
2) Hard to eat ____
3) Difficulties with what age group?
Resources
1) referall to _____
2) Academy of nutrition and dietetics
- calories, protein, low in fat
- family
1) Compliance
2) out
3) teenagers
1) dietician
Acute Appendicitis =
= Inflammation/obstruction of vermiform appendix
Clinical Manifestations of Acute Appendicitis
- Where is the pain?*
- _____ pain
- F___, V____, A_____
- I_____, Un_____, App_____
- RLQ - Mcburney’s point (between umbilicus and anterior iliac spine)
- Preumbilical
- Fever, Vomiting, Anorexia
- Irritable, Uncomfortable, Apprehensive
If there is a sudden relief of appendicitis pain could indicate what?*
Perforation which could lead to peritonitis, very dangerous!
Management of Acute Appendicitis
1) Surgical Removal (2)
2) Pre and post op surgical care (2)
3) ____ management
1) Laparoscopy, Laparotomy
2) Antibiotic therapy, Possible NG tube
3) Pain
Cleft Lip and/or Cleft Palate =
= Facial malformations that occur during early (5-9 wks) of embryonic development, the lip and/or palate do not fuse
- may appear separately or together
Causes of Cleft Lip/Palate (5)
1) _____ abnormalities (1)
2) ____ defects
3) ____ malformations
4) ______ deformities
5) _______ abnormality
1) Associated with chromosomal abnormalities (Pierre Robin Syndrome)
2) Heart Defects
3) Ear malformations
4) Skeletal deformities
5) Genitourinary abnormality
Cleft Lip/Palate also associated with what maternal issues (4)
1) Maternal ____
2) Prenatal _______
3) ______ maternal ____
4) _____ during early pregnancy (2)
1) Maternal smoking
2) Prenatal infection
3) Advanced maternal age
4) Medications during early pregnancy (anticonvulsants, steroids)
Management of Cleft/Lip Palate
- Surgical Closure of ___ precedes correction of _____ (__-__months)
- Ongoing management with (7)
- Close monitoring of surgical ____, including _____ and preventing baby from?
- Solution for feeding issues =
- lip, palate (12-18 mo)
- Plastic surgery, craniofacial specialists, oral surgery, dental and orthodontist, audiology, ST, psychology
- site, cleaning, from touching face
- = use bottles with specialized nipples
Post Surgical Care for Cleft Lip/Palate
- Prevent _____ to ____ line
- Place infant in what positions (2)
- May require _____ hands
- Avoid putting what items in the mouth? (5)
- Prevent child from ______ by (3)
- injury, suture
- supine, side lying
- restraining
- suction catheters, spoon, straws, pacifiers, plastic syringe
- crying by cuddling, rocking, pain meds
