Gastrointestinal - CCRN

Question 1

What is intrinsic factor?

Where is it produced?

Answer 1

Required for absorption of B12

Secreted by parietal cells of the stomach

Question 2

What type of food slows gastric emptying?

Answer 2

High fat

Question 3

What gets absorbed in the small intestine?

Answer 3

Fats
Amino acids
Vitamins
Proteins
Sugars
Carbs

Question 4

What gets absorbed in the duodenum?

Answer 4

Iron
Trace elements
Water soluble vitamins

Question 5

What is absorbed in the Jejunum?

Answer 5

Protein

Sugar carbs

Question 6

What is absorbed in the ileum?

Answer 6

Bile salts

Vitamin B12

Question 7

What is absorbed in the descending colon?

Answer 7

Water

Electrolytes

Question 8

What prevents air from entering the esophagus during respiration?

Answer 8

Upper esophageal sphincter

Question 9

List the functions of the liver:

Answer 9

Forms clotting factors
Synthesizes plasma protein and bile
Stores glycogen, fat and fat soluble vitamins
Breaks down fat, carbs, protein, bilirubin, toxins

Question 10

When does the liver mature?

Answer 10

During the first year of life

Question 11

What is GERD?

Answer 11

Gastroesophageal Reflux Disease
Reflux of gastric contents into esophagus
Relaxation of lower esophageal sphincter
More common in preemies

Question 12

List s/sx of GERD:

Answer 12

Failure to Thrive
Aspiration
Apnea

Question 13

How is GERD dx?

Answer 13

Hx, presenting sx
pH probe placed for 24 hours (+ for GERD if pH s <4 for >15 seconds)
Record feedings

Question 14

List tx for GERD. (Meds and Surgery)

Answer 14

Nissan Fundoplication= severe cases = fundus of stomach is wrapped around esophagus

MEDS:
Tagamet, Zantac, Pepcid = decrease acid secretion, lead to H/A, bradycardia or tachycardia

Proton Pump Inhibitors:
Omeprazole (Prilosec), Pantoprazole (Protonix), Lansoprazole
More for short term use
Cause diarrhea, increased liver enzymes

Prokinetics
Metaclopromide (Reglan), erythromycin
Slow gastric emptying

Question 15

What are common causes of acute GI hemorrhages in kids?

Answer 15

Bacterial enteritis
Milk/soy allergy
Mucosal erosion from gastric acid
Intussesseption
Meds: NSAIDs, Indomethacin

Rare in kids, usually self-limiting
Can be life threatening

Question 16

What physiologic “landmark” is used to define upper vs lower GI bleeds?

Answer 16

Ligament of Treitz

Question 17

Give examples of causes of upper GI bleeds:

Answer 17

Gastritis
Irritating ingestion
Varies

Question 18

Give examples of causes of lower GI Bleeds:

Answer 18

NEC
Volvulus
Milk allergy

Question 19

What is bright or Dark blood from the rectum called?

Answer 19

Hematochezia

Question 20

List s/sx of GI bleed:

Answer 20

Vomiting blood
Bloody/tarry stools
S/sx of hypovolemic shock

Question 21

List management techniques for GI bleeds.

Answer 21

Fluid replacement
Transfusion
Tx underlying cause
Saline lavage until bleeding stops
Monitor s/sx of abd perforation (fever, abd rigidity, severe pain)
Monitor gastric pH

Question 22

What are esophageal varices?

Answer 22

Dilated veins in the lower esophagus d/t portal hypertension

Question 23

What are possible tx for esophageal varices?

Answer 23

Vasopressin (short acting, vasoconstricts = decreased blood flow to spleen = decreased portal HTN)
Octreotide (decreases blood flow to spleen, inhibits synthesis of gastric, gastric acid)
Endoscopic variceal sclerosis - shrinks varices