Gastrointestinal Disorder Flashcards
Define
Hirshprung’s Disease
congenital aganglionic megacolon
Disease in which a portion of the large intestine is aganglionic causing Ø peristalsis. Which leads to an accumulation of stool resulting in distended sigmoid colon (megacolon).
Which people have increased risk for Hirshprung’s Disease?
congenital aganglionic megacolon
- People w/ Down Syndrome
- Male (4x more common)
What is the etiology of Hirshprung’s disease?
congenital aganglionic megacolon
Unknown, but suspected to have a genetic component
What is the leading cause of death in children w/ Hirshprung’s disease?
congenital aganglionic megacolon
enterocolitis
an inflammation that occurs in a person’s digestive tract
Define
Enterocolitis
Inflammation of the lining in the small intestine and/or colon (large intestine)
When is Hirshprung’s disease diagnosed?
usually in the newborn period
in rare instance not till infancy or childhood.
What are four signs of Hirshprung’s disease in a newborn?
- Reluctance to ingest fluids
- Bild-stained vomitus
- Abdominal distention
- Failure to pass meconium within 24 to 48 hrs. after birth
What are the following a sign and symptoms of?
- Constipation
- Failure to thrive
- Diarrhea around area of colon and vomiting
- Fever
- Severe exhuastion
Infant’s
Hirshprung’s Disease (congenital aganglionic megacolon)
Additional symptoms: abdominal distention
What are the following signs and symptoms of?
- Constipation
- Malnourishment
- Anemia
- Ribbon-like and foul smelling stool
- Visible peristalsis
- Palpable fecal masses
Childhood Hirshprung’s Disease
Additional symptom: abdominal distention
How is Hirshprung’s disease definitively diagnosed?
Rectal biopsy
What finding is expected for Hirshprung’s Disease when performing a rectal biopsy?
Absence of ganglionic cells
Ganglionic (nerve) cells cause peristalsis to occur.
What are the 3 non-definitive ways to diagnosis Hirshprung’s disease?
- Barium enema
- Rectal exam
- Anorectal manometry
When is a barium enema contraindicated?
X-ray exam that can detect abnormalities in the large intestine (colon)
patient has enterocolitis
risk for bowel rupture
What would occur if Hirschsprung disease is present during an anorectal manometry?
No relaxation of internal (anal) sphincter upon balloon inflation.
What two things are noted during a rectal exam w/ Hirschsprung’s disease?
- Tight internal (anal) sphincter
- Absence of stool
What are the treatment options for Hirschsprung’s disease?
congenital aganglionic megacolon
- Temporary ostomy
- Pull-through surgery
What is a pull-through surgery?
Diseased portion of intestine is removed and then functioning intestine is immediately connected to anus w/o temporary stoma phase.
Tx for Hirshprung’s Disease
What is contraindicated during enterocolitis?
Rectal temperature
Barium enema
What are the following signs and symptoms of?
- Shock
- Absent bowel sounds
- Abdominal distention and tenderness
- Vomiting
- Irritability
- Dyspnea
- Cyanosis
- Fever
Perforated bowel
R/T enterocolitis
Why is skin integrity a concern after treatment for Hirshprung’s Disease?
Initial Incontinence is common as the anal sphincter needs time to heal
When does NPO end for children that have been treated for Hirshprung’s Disease?
When bowel sounds return or flatus has passed.
Until than they are on IV fluids
What is Gastroesophageal Reflux
When stomach acid repeatedly flows back into the tube (esophagus) connecting your mouth and stomach.
This backwash (acid reflux) can irritate the lining of your esophagus.
Sandifer’s syndrome is a sign and symptom of what disease?
Gastroesophageal Reflux
What can Sandifer’s syndrome be misinterpreted as?
Seizures
What are the following signs and symptoms of?
- Bloody stool
- Vomiting
- Failure to thrive and reoccuring weight loss
- Respiratory illness
- Irritability
- Coughing, choking, apnea, bradycardia, and Hiccups
Gastroesophageal Reflux
Additional symptom: Sandifer’s syndrome
What are the three diagnostic tests for Gastroesophageal Reflux
- 24 hour esophageal pH. monitoring
- Radionuclide tests.
- Endoscopy & esophageal biopsy
Which is the recommended test to diagnosis gastroesophageal reflux?
24 hour esophageal pH. Monitoring
What three things are being assesed w/ 24 hour esophageal pH. monitoring?
- Total time pH is < 4
- Number of episodes pH < 4
- Duration of the longest episode of pH < 4
What does management of gastroesophageal reflux depend on?
Severity of gastroesophageal reflux
What are the three recommended intervention for a thriving infant w/o respiratory complications diagnosed w/ gastroesophageal reflux?
- Positioning (HOB elevated)
- Small frequent feedings
- Thicken formula w/ rice cereal*
*not done w/ if infant is breastfeeding
What are the three recommended intervention for a child that fails to thrive w/ severe reflux.
- NG feedings
- Medication
- Surgery (Nissen Fundoplication)*
*if medications do not work
When should medications for gastroesophageal reflux medication be administered?
30 mins before meal
What age are H2 blockers (Histamine antagonist) recommended for use for gastroesophagel reflux?
cimetidine (Tagamet), famotidine (Pepcid)
If child is < 1 year
cimetidine (Tagamet) drug of choice
What age are Protein Pump Inhibitors (PPI) recommended for use for gastroesophagel reflux?
*lansoprazole (Prevacid), omeprazole (Prilosec) *
If child is > 1 year
lansoprazole (Prevacid) drug of choice
What is a Nissene Fundoplication?
When the fundus of the stomach is wrapped around the lower portion of the esophagus.
