Gastrointestinal Ch 22 Flashcards
enteritis
infection of small intestine
gastroenteritis
infection of stomach and intestines
colitis
infection of colon
enterocolitis
infection of colon and intestines
signs of dehydration in infants
oliguria
increased specific gravity
hypotension
tachycardia
increased capillary refill
cool extremities
decrease of plateau in weight
sunken fontanels
mottled/pale skin
dx enteritis
stool sample
managing enteritis
contact isolation
BRAT diet
rehydration (oral, NG, IV)
avoid juice and soda (sugar increases GI motility, caffeine is a diuretic)
monitor electrolytes
antibiotics
antifungals
BRAT diet
bananas
rice
applesauce
toast
causes of constipation
- may be secondary to other medical disorders (myelomeningocele)
- environmental factors (diet)
- psychosocial factors (stress)
- idiopathic (functional)
meconium
should be passed within 24-36 hours of life
Hirschsprung disease
congenital disorder in which part of the colon/rectum lacks ganglionic cells/nerves that normally control defecation (aganglionic portion of colon)
babies dont pass meconium within 24-36 hrs
dx: xray, barium enema, rectal exam
confirm dx by rectal biopsy (there will be lack of nerves)!
hallmark symptom: ribbon like feces!
accumulation of stool with abd distention
treat: conservation (daily rectal dilations, enemas, laxatives), surgical (resection of disease part of colon)
hypothyroidism
a reason why meconium may not pass
everything slows
decreased GI motility
cystic fibrosis
can cause meconium plug or ileus
Appendicitis
obstruction of appendix lumen
symptoms: periumbilical pain and RLQ pain (mcburney point), N/V, lethargy, fever
dx: US or CT shows enlarged appendix, elevated WBC
ruptured= clean out area and abx
nonruptured= appendectomy or abx for a week
monitor for bleeding, infection. avoid abd exercises
meckel diverticulum
a pouch on the wall of the lower part of the smaller intestine
congenital disorder
caused by residual of umbilical chord
dx: radionucleotide scan
symptoms: asymptomatic unless becomes inflamed, painless rectal bleeding, currant jelly-like stools, abd pain
treat: surgical resection of diverticulum, postop NG tube suction
complications: hemorrhage, bowel obstruction
inflammatory bowel disease (IBD)
includes chrons disease and ulcerative colitis
autoimune disorder (body attacks GI lining)
goal: induce and maintain remission
for extreme circumstances, can create an ostomy for bowel rest
can also do bowel resections r/t scarring
Chron’s disease
can affect any part of the GI tract
affects all layers of the bowel
symptoms: abd pain, fever, bloody loose stool
dx: colonoscopy
treat: low fiber diet, steroids, abx
Ulcerative colitis
affects only colon
continuous inflammation of the inner most lining of the colon
symptoms: abd pain, fever, loose bloody stools
dx: colonoscopy
treat: low fiber diet, abx, steroids
biliary atresia
blockage in the bile ducts
causes liver inflammation that can lead to fibrosis
symptoms: jaundice, dark urine, light stools, poor weight gain, failure to thrive
dx: elevated bilirubin, elevated AST and ALT, low albumin
treat: need liver transplant to live
esophageal atresia
failure of esophagus to develop separate of the trachea
dx: xray, noticed immediately bc cant breathe or swallow
CM: choking on secretions, apnea, respiratory distress, excessive saliva
manage: NPO, suction to prevent aspiration
hernia
protrusion of a portion of intestine through abd wall
complication: strangulation or incarceration of exposed bowel
treat: surgery
pyloric stenosis
genetic
constriction of pyloric sphincter that creates an obstruction
hallmark symptom: projectile vomiting
symptoms: palpable olive-like mass, poor weight gain
dx: ultrasound of pylorus
treat: IVF and electrolyte stabilization, maintain NPO, then surgery
intussusception
telescoping of one portion of the intestine into another
often caused by virus
dx: confirm by xray
triad of symptoms: shooting abd pain, abd mass, jelly-like stools containing blood and mucus
treat: air enema, barium enema, surgery
cleft lip
incomplete fusion of the lip in utero
causes: family history, maternal exposure to alcohol smoking or anticonvulsants, lack of folic acid
treat: surgery btw 2-3 months (infants need to be 10 weeks old, weigh 10 lbs, and have a Hgb above 10)
post op care: clean incision with saline or hydrogen peroxide, arm restraints, use one way or wide nipple bottles
cleft palate
incomplete fusion of roof of mouth
occurs in utero
treat: surgery at 6-12 mo
post op care: IVF before transitioning to oral liquids, remove packing after 2-3 days, avoid pacifier and hard nipples, elbow restraints, use one way or wide nipple bottles
daily maintainence fluid formula
first 10kg of body weight= 100mL/kg
second 10kg (10-20kg)=
50mL/kg
rest of the weight (20kg+)=
20mL/kg
