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Pediatrics > Gastrointestinal Disorder > Flashcards

Gastrointestinal Disorder Flashcards

1
Q

Define

Hirshprung’s Disease

congenital aganglionic megacolon

A

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).

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2
Q

Which people have increased risk for Hirshprung’s Disease?

congenital aganglionic megacolon

A
  1. People w/ Down Syndrome
  2. Male (4x more common)
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3
Q

What is the etiology of Hirshprung’s disease?

congenital aganglionic megacolon

A

Unknown, but suspected to have a genetic component

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4
Q

What is the leading cause of death in children w/ Hirshprung’s disease?

congenital aganglionic megacolon

A

enterocolitis

an inflammation that occurs in a person’s digestive tract

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5
Q

Define

Enterocolitis

A

Inflammation of the lining in the small intestine and/or colon (large intestine)

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6
Q

When is Hirshprung’s disease diagnosed?

A

usually in the newborn period

in rare instance not till infancy or childhood.

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7
Q

What are four signs of Hirshprung’s disease in a newborn?

A
  1. Reluctance to ingest fluids
  2. Bild-stained vomitus
  3. Abdominal distention
  4. Failure to pass meconium within 24 to 48 hrs. after birth
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8
Q

What are the following a sign and symptoms of?

  • Constipation
  • Failure to thrive
  • Diarrhea around area of colon and vomiting
  • Fever
  • Severe exhuastion
A

Infant’s
Hirshprung’s Disease (congenital aganglionic megacolon)

Additional symptoms: abdominal distention

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9
Q

What are the following signs and symptoms of?

  • Constipation
  • Malnourishment
  • Anemia
  • Ribbon-like and foul smelling stool
  • Visible peristalsis
  • Palpable fecal masses
A

Childhood Hirshprung’s Disease

Additional symptom: abdominal distention

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10
Q

How is Hirshprung’s disease definitively diagnosed?

A

Rectal biopsy

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11
Q

What finding is expected for Hirshprung’s Disease when performing a rectal biopsy?

A

Absence of ganglionic cells

Ganglionic (nerve) cells cause peristalsis to occur.

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12
Q

What are the 3 non-definitive ways to diagnosis Hirshprung’s disease?

A
  1. Barium enema
  2. Rectal exam
  3. Anorectal manometry
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13
Q

When is a barium enema contraindicated?

X-ray exam that can detect abnormalities in the large intestine (colon)

A

patient has enterocolitis

risk for bowel rupture

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14
Q

What would occur if Hirschsprung disease is present during an anorectal manometry?

A

No relaxation of internal (anal) sphincter upon balloon inflation.

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15
Q

What two things are noted during a rectal exam w/ Hirschsprung’s disease?

A
  1. Tight internal (anal) sphincter
  2. Absence of stool
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16
Q

What are the treatment options for Hirschsprung’s disease?

congenital aganglionic megacolon

A
  1. Temporary ostomy
  2. Pull-through surgery
17
Q

What is a pull-through surgery?

A

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

18
Q

What is contraindicated during enterocolitis?

A

Rectal temperature
Barium enema

19
Q

What are the following signs and symptoms of?

  • Shock
  • Absent bowel sounds
  • Abdominal distention and tenderness
  • Vomiting
  • Irritability
  • Dyspnea
  • Cyanosis
  • Fever
A

Perforated bowel

R/T enterocolitis

20
Q

Why is skin integrity a concern after treatment for Hirshprung’s Disease?

A

Initial Incontinence is common as the anal sphincter needs time to heal

21
Q

When does NPO end for children that have been treated for Hirshprung’s Disease?

A

When bowel sounds return or flatus has passed.

Until than they are on IV fluids

22
Q

What is Gastroesophageal Reflux

A

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.

23
Q

Sandifer’s syndrome is a sign and symptom of what disease?

A

Gastroesophageal Reflux

24
Q

What can Sandifer’s syndrome be misinterpreted as?

A

Seizures

25
Q

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
A

Gastroesophageal Reflux

Additional symptom: Sandifer’s syndrome

26
Q

What are the three diagnostic tests for Gastroesophageal Reflux

A
  1. 24 hour esophageal pH. monitoring
  2. Radionuclide tests.
  3. Endoscopy & esophageal biopsy
27
Q

Which is the recommended test to diagnosis gastroesophageal reflux?

A

24 hour esophageal pH. Monitoring

28
Q

What three things are being assesed w/ 24 hour esophageal pH. monitoring?

A
  1. Total time pH is < 4
  2. Number of episodes pH < 4
  3. Duration of the longest episode of pH < 4
29
Q

What does management of gastroesophageal reflux depend on?

A

Severity of gastroesophageal reflux

30
Q

What are the three recommended intervention for a thriving infant w/o respiratory complications diagnosed w/ gastroesophageal reflux?

A
  1. Positioning (HOB elevated)
  2. Small frequent feedings
  3. Thicken formula w/ rice cereal*

*not done w/ if infant is breastfeeding

31
Q

What are the three recommended intervention for a child that fails to thrive w/ severe reflux.

A
  1. NG feedings
  2. Medication
  3. Surgery (Nissen Fundoplication)*

*if medications do not work

32
Q

When should medications for gastroesophageal reflux medication be administered?

A

30 mins before meal

33
Q

What age are H2 blockers (Histamine antagonist) recommended for use for gastroesophagel reflux?

cimetidine (Tagamet), famotidine (Pepcid)

A

If child is < 1 year

cimetidine (Tagamet) drug of choice

34
Q

What age are Protein Pump Inhibitors (PPI) recommended for use for gastroesophagel reflux?

*lansoprazole (Prevacid), omeprazole (Prilosec) *

A

If child is > 1 year

lansoprazole (Prevacid) drug of choice

35
Q

What is a Nissene Fundoplication?

A

When the fundus of the stomach is wrapped around the lower portion of the esophagus.

Pediatrics (10 decks)

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