Gastrointestinal Flashcards
what is the capacity of a neonate’s stomach?
10-20 mL
the neonate stomach can tolerate very small amounts of ___________
colostrum
what is the capacity of an infant’s stomach?
30-300 mL
why doesn’t reflux hurt infants?
low levels of HCl in gastric acid
food remains in an infant’s stomach for ______________. Therefore, they eat ____________.
short period
eat more frequently
breast milk is digested __________
quickly
iron is digested _____________
slowly
how are daily fluid requirements calculated?
first 10 kg = 100 mL/kg
second 10 kg = +50 mL/kg
> 20 kg = +20 mL/kg
how are hourly fluid requirements calculated?
first 10 kg x 4 mL/kg
second 10 kg x +2 mL/kg
> 20 kg x +1 mL/kg
infants are at very high risk for ___________
dehydration
what are some signs of dehydration?
decreased output
tachycardia
decreased BP
increased RR
headache
thirst
decreased LOC
concentrated urine
< 6 wet diapers/day
8+ hours between voids
dry mucous membranes
sunken eyes
sunken fontanelles
decreased skin turgor
loss of appetite
high pitched cry
what an early sign of dehydration?
tachycardia
what is a late sign of dehydration? why is it late?
hypotension
good at compensating
what is considered low urine output?
< 1 mL/kg/hr
what is the treatment for dehydration?
mild = oral fluids
severe = IV bolus of NS
how much IV fluid (NS) should be given for severe dehydration?
10-20 mL/kg
what are some clinical manifestations of GI dysfunction?
growth failure
regurgitation/spitting up
nausea/vomiting
constipation
diarrhea
abnormal bowel sounds
abdominal distension
abdominal pain
GI bleeding
jaundice
dysphagia
fever
weight loss
what are some signs of growth failure?
weight < 3rd percentile
BMI < 5th percentile
growth pattern decreased from baseline
what are some signs of constipation?
bloody stool
abdominal pain
what might cause abnormal bowel sounds?
inflammation
obstruction
what might cause abdominal distension?
delayed gastric emptying
accumulation of gas/stool
inflammation
obstruction
what are the 3 types of GI bleeds?
hematemesis
hematochezia
melena
what is hematemesis?
bright red
bleeding in upper GI
what is hematochezia?
bright red
bleeding in lower GI
what is melena?
dark tarry stool
bleeding in upper GI
jaundice is a sign of ____________
liver dysfunction
what are some characteristics of failure thrive?
weight < 2nd percentile
decreased velocity of weight gain
what is the Z score for failure to thrive?
-2 = weight < 2nd percentile
what are some causes of failure to thrive?
inadequate caloric intake
poor absorption
increased metabolism
decreased utilization
increased loss
what are some causes of inadequate caloric intake?
food insecurity
poor appetite
breast milk problems
restrictive eating disorders
neglect
incorrect formula preparation
what conditions might cause poor absorption leading to failure to thrive?
crohns
celiac
intestinal obstruction
what conditions might cause increased metabolism leading to failure to thrive?
cardiac defects
hypothyroid
how is failure to thrive diagnosed?
lab tests
- CBC
- ESR
- electrolytes
urinalysis + culture
why do we want CBC + ESR for failure to thrive?
possible immune disorder
inflammatory markers
why do we want a urinalysis + culture for failure to thrive?
protein in urine
UTI
how is failure to thrive managed?
feed them!
assess how they are feeding
if they don’t gain weight –> investigate other causes
acute diarrhea
sudden increase in frequency and change in consistency of stools
chronic diarrhea
increase in frequency and water content of stools for 14+ days
what is the leading cause of illness in children < 5 years? why?
acute diarrhea
put everything in their mouths
poor hand hygiene
what are the consequences of gastroenteritis?
dehydration which can lead to shock
acid base imbalance
what are the causes of acute diarrhea?
GI infection
URT infection
UTI
antibiotics
laxatives
what are the viral causes of GI infections?
norovirus
rotavirus
what are the bacterial causes of GI infections?
salmonella
C. diff
E. coli
staphylococcus
what is considered acute diarrhea?
3+ watery stools in 24 hours
if left untreated, acute diarrhea should resolve in ___________, unless its ________________
14 days
unless its bacterial
what are the 2 risks associated with diarrhea?
dehydration
electrolyte imbalance
what conditions are associated with chronic diarrhea?
malabsorption
IBD
immunodeficiency
lactose intolerance
how is diarrhea managed?
oral rehydration therapy
reintroduce adequate diet
- breast feeding/formula/easily digestible foods
how much fluid should be given oral rehydration when managing diarrhea?
5-10 mL q1-5 min
what are some easily digestible foods to be reintroduced when managing diarrhea?
cereal
cooked vegetables
meat
what are some causes of vomiting?
meningitis
head injuries
surgical procedures
improper feeding technique
stress
infection
what is a concerning amount of vomiting for a neonate?
12+ hours
what is a concerning amount of vomiting for a child < 2 years?
24+ hours
what is a concerning amount of vomiting for children?
48+ hours
what are 2 concerning signs with vomiting?
dehydration
green/yellow colour
what does green/yellow vomit indicate?
bile
empty stomach
what is the management for vomiting?
medications
restore fluids
proper positioning
what are the medications for vomiting?
antiemetics
metoclopramide
promethazine
what are the 2 antiemetics?
ondansetron
trimethobenzamide
what is the MOA of metoclopramide?
increases peristalsis
what should be used to restore fluids for vomiting?
glucose-electrolyte solution
what is the appropriate positioning for vomiting?
lateral recovery
vomiting without nausea is a sign of ______________
brain tumor
what system assessments should be done for vomiting?
neurological
GI
what are some causes of dehydration?
inadequate intake
vomiting
diarrhea
diabetic ketoacidosis
burns
renal disease
what are the 2 compensatory mechanisms for dehydration?
intestinal fluid enters vasculature
vasoconstriction
how often should vitals be assessed with dehydration?
q15-30 min
how often should newborns be voiding in their first 24 hours?
once
how often should newborns be voiding in their first 2 days?
twice
how often should newborns be voiding in their 3rd-4th days of life?
3-4 times
how often should infants be voiding in their 5th day of life?
6 times
how often should infants < 1 year be voiding?
q1-2 hours
how often should toddlers be voiding?
q3 hours
what are the 3 types of causes of constipation?
secondary to other disorders
idiopathic
chronic
what are some other disorders that cause constipation?
strictures
ectopic anus
Hirschsprung disease
hypothyroidism
hypercalcemia
lead poisoning
what medications can cause constipation?
antacids
diuretics
antiepileptics
antihistamines
opioids
iron supplements
what causes constipation in newborns?
imperforated anus
when should a newborn pass their first meconium stool?
within first 24-36 hours of birth
what should be assessed if a newborn does not pass meconium stool?
intestinal stenosis
Hirschsprung’s disease
hypothyroidism
meconium plugs
meconium ileus
what is a meconium plug?
meconium with low water content
what is meconium ileus?
obstruction of intestine due to abnormal meconium
meconium ileus is a manifestation of _____________
cystic fibrosis
what causes constipation in infants?
diet
constipation is more common in _____________ fed than _____________ fed. Why?
more common in bottle/formula fed than breast fed
breast fed have fewer and softer stools
constipation in formula fed infants is related to __________
iron
what are the causes of constipation in childhood?
environmental
(fear of using public washrooms)
normal development
(start holding it in)
painful
toilet training
what are the interventions for constipation?
fibre
fluids
stool softeners
prunes
what are some stool softeners?
docusate
lactulose
PEG 3350
what is encopresis?
involuntary passage of stool
stool sits in rectum and forms a hard rock
liquid stool leaks around causing incontinence
encopresis often occurs after ______________________
toilet training
encopresis is often seen in ______________
autism
with encopresis they don’t ______________
sense the need to defecate
what are the 2 types of encopresis?
- retentive*
- nonretentive
what is retentive encopresis?
incontinence with underlying constipation
what is non retentive encopresis?
incontinence without constipation
non-retentive encopresis is often associated with __________________
psychological triggers
how is encopresis treated?
enema
fleets (bottom) + laxatives (top)
what is gastroesophageal reflux?
transfer of gastric contents into esophagus
when does GER resolve?
spontaneously within first year
when does GER become GERD?
when complications develop
what are some complications of GER that might cause GERD?
growth failure
bleeding
dysphagia
GERD is less common in _______________ infants
breast fed infants
GERD is common in _____________ infants
preterm
what causes GERD?
lower sphincter doesn’t close
what are some clinical manifestations of GERD?
spitting up
vomiting
growth failure
coughing
wheezing
choking
heartburn
abdominal pain
dysphagia
how is GERD diagnosed?
anatomical abnormalities
- pyloric stenosis
- hernia
- esophageal stricture
24 hr esophageal pH monitoring
endoscopy
what are some anatomical abnormalities associated with GERD?
pyloric stenosis
hernia
esophageal strictures
what is the gold standard for GERD diagnosis?
24 hr intraesophageal pH monitoring
why is an endoscopy needed for GERD diagnosis?
strictures
esophagitis
rule out crohn’s
what are the interventions for GER?
nothing if thriving and no complications
thicken feeds
upright positioning
NG feeds (if growth failure)
avoid tobacco smoke
surgery
what is the surgery for GER? when is it indicated?
nissen fundoplication
only if severe
what are the treatments for GERD?
prokinetics
PPIs
nissen fundoplication
what is Hirschsprung’s disease?
mechanical obstruction caused by reduced intestinal motility
congenital aganglionic megacolon
Hirschsprung’s disease is more common in __________ with _____________
males with Down syndrome
what is the leading cause of death with Hirschsprung’s disease?
enterocolitis
Hirschsprung’s disease is _____________ in childhood
more chronic
what are some clinical manifestations of HD in newborns?
failure to pass meconium
bilious vomiting
refusal to feed
abdominal distension
what are some clinical manifestations of HD in infancy?
constipation
fever
vomiting
enterocolitis
growth failure
diarrhea
how is Hirschsprung’s disease diagnosed?
rectal biopsy to assess for lack of ganglion cells
____________ is required for most cases of Hirschsprung’s disease
surgery
what is the treatment for Hirschsprung’s disease?
surgery
(remove ganglionic portion)
relieve obstruction
restore motility
what is a complication associated with surgery for HD?
strictures
what are the 2 GI inflammatory disorders?
- acute appendicitis
- IBD
what is acute appendicitis?
inflammation of appendix
what is the most common cause of emergency abdominal surgery in childhood?
appendicitis
what is the common age range for appendicitis?
10-16 years
what causes acute appendicitis?
fecalith obstructs lumen of appendix causing inflammation
what are some clinical manifestations of acute appendicitis?
preumbiilical –> RLQ abdominal pain
fever
rigid abdomen
absent/hypoactive bowel sounds
vomiting
constipation
diarrhea
tachycardia
increased WBCs
what is the major complication of acute appendicitis?
rupture
patients are more __________ looking with ruptured appendix
septic
what happens to RLQ pain with a ruptured appendix?
disappears
how is acute appendicitis diagnosed?
CBC
urinalysis
serum hCG
CT scan
ultrasound
why is a CBC done for acute appendicitis?
increased WBC
increased CRP
why is a urinalysis done for acute appendicitis?
to rule out UTI
why is serum hCG needed for acute appendicitis?
to rule out ectopic pregnancy
how is acute appendicitis treated?
rehydration
antibiotics
surgical removal
what are the surgical procedure types for appendicitis?
laparoscopic (most cases)
open appendectomy (lots of pus)
what is a complication associated with appendix removal?
post-op ileus
what are the components of post-op care for ruptured appendix?
IV fluids
NPO + NG tube
suctioning
K+ supplements
sham clear fluids
perc drain
IV antibiotics
what is the discharge criteria post-appendix removal?
ambulating
no pain
no GI abnormalities
when can you shower after appendix removal?
24-48 hours post-op
when can you swim and bathe after appendix removal?
2 weeks post-op
what is IBD?
chronic intestinal inflammation
what is ulcerative colitis?
inflammation of rectum and colon
what is Crohn’s disease?
inflammation of any part of GI
ulcerative colitis affects ___________ layers
mucosal and submucosal
Crohn’s disease affects __________ layers
all
(transmural)
what are some characteristics and manifestations of ulcerative colitis?
rectal bleeding
diarrhea
less frequent pain
some weight loss
some joint pain
what are some characteristics of Crohn’s disease?
diarrhea
abdominal pain
weight loss
anorexia
anal and perianal lesions
fistulas
strictures
how is IBD diagnosed?
lab tests
examine stools
upper GI series
what lab tests should be done for IBD?
CBC (anemia)
ESR ad CRP (inflammation)
what should we look for when examining stools for IBD diagnosis?
blood
leukocytes
infectious organisms
what is involved in an upper GI series for IBD?
endoscopy and colonoscopy with biopsies
CT and ultrasound
what should be assessed with CT and ultrasound for IBD diagnosis?
abscesses
inflammation
fistulas
what are fistulas?
lesions that pierce intestinal walls
form tracts between adjacent structures
how is IBD treated?
drug therapy
nutrition
surgery
what medications are involved in IBD treatment?
5-ASAs
corticosteroids
immunomodulators
antibiotics
biological therapies (TNF-alpha agents)
how does 5-ASA treat IBD?
induces and maintains remission
what corticosteroids are used for IBD?
prednisone
budesonide (IV)
what are some adverse effects of long-term corticosteroid use?
growth suppression
weight gain
decreased bone density
what is the benefit of budesonide for IBD treatment?
less adverse effects than prednisone
when are immunomodulators used for IBD treatment?
if steroid resistant or dependent
what are some adverse effects of immunomodulators?
infection
bone marrow toxicity
what diet is recommended for IBD?
high protein
high calorie
a colectomy is curative for ___________ but not _____________
cures UC, but not crohn’s
what is the surgical procedure for ulcerative colitis?
colectomy
what is a cleft lip or palate?
facial malformation that occurs during embryonic development
when can a cleft lip or palate be first seen?
week 6-8 of pregnancy
cleft lips and palates are more common in __________
boys
what are the cases of a cleft lip or palate?
teratogens
how is a cleft lip diagnosed?
ultrasound
how is a cleft palate diagnosed?
gloved finger
what is the major complication with cleft lips and palates?
feeding difficulties
what are some feeding interventions for babies with a cleft lip or palate?
upright
Haberman special nipple
when can a cleft lip be repaired?
4 months
when can a cleft palate be repaired?
9-12 months
what are some considerations for cleft lip or palate?
pain management
speech therapy
avoid suctioning
what is a hernia?
protrusion of organ through abdominal wall
what is the mot common type of hernia?
inguinal
what are the 4 types of hernias?
umbilical
inguinal
ompahlocele
gastroschisis
what is an ompahlocele?
protrusion of organs at base of umbilical cord
covered by protective sac
what is gastrochisis?
protrusion of organs to right of umbilical cord
not covered by protective sac
what are the 2 obstructive disorders?
pyloric stenosis
intussusception
what is pyloric stenosis?
hypertrophic obstruction of pyloric sphincter
food doesn’t empty from stomach into duodenum
what are some clinical manifestations of pyloric stenosis?
non-bilious vomiting
dehydration
irritable
abdominal pain
describe the vomiting that occurs with pyloric stenosis?
projectile
non-bilious
occurs immediately after feeding
(remain hungry)
how is pyloric stenosis diagnosed?
ultrasound
what is the treatment for pyloric stenosis?
pylomyrotomy
what is intussusception?
proximal bowel segment telescopes into distal
increased pressure top blood flow causing ischemia and leakage of blood and mucous into intestine
what is the mot common site for intussusception?
ileocecal valve
ileum invaginates into cecum and colon
what are some clinical manifestations of intussusception?
colicky abdominal pain
vomiting
red currant jelly-like stool
sausage shaped mass in RUQ
empty LRQ
how is intussusception diagnosed?
ultrasound
rectal exam
what is the treatment for intussusception?
push bowel out
pneumoenema reduction
hydrostatic reduction
surgery to manually reduce invagination
what is pneumoenema reduction?
air enema
what is hydrostatic reduction?
saline enema
what is the benefit of hydrostatic reduction vs pneumoenema reduction?
no radiation involved
how do you know when the intussusception is resolved?
pass normal brown stool
