Gastrointestinal 1 Flashcards
Pediatric Differences
> small stomach capacity
incr peristalsis
small, freq feedings
freq + liquidy stools
30% of kids w cleft will have…
other congenital anomaly
___ intake may help prevention of cleft
folate
cleft lip + palate
etiology
45% cleft lip + palate
35% cleft palate
20% cleft lip
cleft occurs when…
maxillary process fails to fuse properly
cleft lip repair should occur…
2-3 months
cleft palate repair should occur… because…
6-12 months
>protects formation of tooth buds
>allows more norm speech pattern developt
Cleft Repair
post op
- soft elbow restraints to protect incision
- may affect feeding
- may need longer nipples w enlarged holes
Esophageal Atresia + Tracheoesophageal Fistula
foregut fails to lengthen, separate, + fuse into 2 parallel tubes
»4-5 wks gestation
Esophageal Atresia + Tracheoesophageal Fistula
manifestations
3 classic signs: >cyanosis >choking >coughing fluid returns thru nose + mouth during feeding
Pyloric Stenosis
hypertrophy of circular pylorus muscle
>stenosis is between stomach + duodenum
Pyloric Stenosis
manifestations
> projectile vomiting
hungry
peristaltic waves
olive-sized mass in RUQ
Pyloric Stenosis
diagnosis
> blood test to assess dehydration, alkalosis, hypo-Cl, hypo-K
U/S
Pyloric Stenosis
treatment + prognosis
laparoscopic pyloromyotomy
>good prognosis
>discharge win 24 hr after advancing diet
children are at risk for GERD…
- short narrow esophagus
- large vol feedings
- liquid diet
- frequent horizontal position
at risk population for GERD
hx of repaired esophageal atresia
symptoms of GER
- regurg, spit up, vomit
- freq hungry + irritable
symptoms of GERD
GER + >more severe irritability >refusal of feedings >poor wt gain >resp symptoms (cough, choke, wheeze, arching back during feedings) **in children, heartburn**
treatment for mild GER
> feed modificatn, smaller, + more frequent
thickened feeds
positioning
diet change
medication for GER
H2 antagonist: ranitidine + famotidine
if medication failed, treatment for ger
fundoplication
-may need G tube to vent or feed
Omphalocele
intestines fail to return to ab cavity
*membranes covering organs
Gastroschisis
bowel protrudes thru defect into side of umbilicus
**no membrane to cover organs ***
Omphalocele + Gastroschisis
nursing action
protect organs
prevent hypothermia or infection
*use bowel bag (covers body) or silo (covers just umbilicus + guts)
Intussusception
one part of intestines prolapses + invaginates (telescopes) into another
most common site of Intussusception
ileocecal valve
Intussusception can lead to.
> edema
necrosis
perforation
sepsis
Intussusception
manifestations
- abrupt onset
- bilious vomiting
- intermittent periods of comfort
- stools are red + resemble currant jelly bc mix of blood + mucus
Intussusception
diagnosis
- U/S
- contrast edema using air or barium (therapeutic + diagnostic)
which is the safer contrast enema? air or barium
air enema
Intussusception may require ___ for gastric decompression
NG tube
Volvulus
twisting of intestines
>can disrupt blood flow
Volvulus
manifestations
- bilious vomiting
- firm + distended abdomen
- bloody stools
- dehydration
Volvulus
treatment
emergency surgery required to prevent necrosis
