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Gastrointestinal disorders 2 Flashcards

1
Q

▪ Return of gastric contents into the esophagus
▪ Backward movement of gastric content
▪ Neuromuscular disturbance in which the cardiac sphincter and lower portion of the esophagus are lax,
therefore allow easy regurgitation of gastric contents into esophagus

A

GastroEsophageal Reflux Disease (GERD)

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2
Q

s/s of peritonitis

A

relief of pain, increased PR and RR, fever, vomiting, absence of bowel sounds and
increased abdominal distention

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3
Q

INTUSSUSCEPTION is associated with

A

Cystic fibrosis & Celiac disease

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4
Q

NURSING CARE for gerd

A
  1. Identifying children with symptoms that suggest GER
  2. Preparing for surgery and post-op care
    ▪ Same as in any abdominal surgery
    ▪ Skin care on the gastrostomy site
  3. Maintain adequate nutrition
    ▪ Weigh daily
    ▪ Use of pacifier for non-nutritive needs
  4. Educating parents regarding home care
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5
Q

cause of hirschsprungs

A
  • Absence of ganglion cells in a segment of the
    colon
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6
Q

signs of Behavioral changes

A

irritability, fretfulness,
uncooperativeness, apathy

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7
Q

nutrition for hirschsprungs

A

low fiber, high calorie, high protein diet/TPN as ordered

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8
Q

INTUSSUSCEPTION

A
  1. Monitoring for s/s of complications = v/s and stools
    ▪ Passage of a normal brown stool indicates intussusception has reduced itself
  2. Maintain or establishing fluid and electrolyte balance
  3. Preparing for hydrostatic reduction and/or surgery=routine pre and postop care for abdominal surgery
    ▪ Pre-op = Preparation of parents, IVF, NGT for decompression, antibiotics
    ▪ Post-op = managing pain
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9
Q

MANAGEMENT of hirschsprungs: to keep stool small and soft so that they can be easily evacuated

A

Low residue diet

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10
Q

Reduce amount of acid in the gastric contents and prevent esophagitis

A

H2 antagonists

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11
Q

DIAGNOSTIC TEST of celiac
* Often follows screening test
* Demonstrates changes in mucusa and positive
clinical response to a gluten-free diet

A

jejunal biopsy

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12
Q

INTUSSUSCEPTION management: Done at the time of diagnostic testing
* The force exerted by the flowing
barium is usually sufficient to push the
invaginated portion (80-90% of cases)

A

HYDROSTATIC REDUCTION (by barium enema)

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13
Q

INTUSSUSCEPTION types: cecum invaginates into colon

A

Cecocolic

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14
Q

new approach of pyloromyotomy: use small incision for
the laparoscope = shorter surgical time,
more rapid post-op feeding and quicker
discharge

A

laparoscopy

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15
Q

Risk Factors of gerd

A
  1. Prematurity (hypotonia)
  2. Infants with bronchopulmonary dysplasia
  3. Asthma
  4. TEF/EA repair
  5. Gastrostomy placement
  6. Neurologic disorders (cerebral palsy)
  7. Cystic fybrosis
  8. Scoliosis – in relation to pressure in the stomach
  9. Hernia
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16
Q

clinical manifestation of GERD that means erosion of esophageal
tissue

A

hematemesis and melena

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17
Q

diagnosis for HPS

A
  1. History and physical exam
  2. Ultrasonography
  3. Upper GI series (barium swallow) – delay in gastric
    emptying
  4. Blood tests
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18
Q

Pharmacology Management of GERD

A

a. H2 antagonists
b. Proton pump inhibitor
c. Prokinetic agents

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19
Q

Majority
have mild GER that generally improves by ***** of age and requires only conservative lifestyle
changes and/or medical therapy.

A

12-18 months

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20
Q

colostomy care color

A

pink to reddish pink

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21
Q

HYPERTROPHIC PYLORIC STENOSIS manifestations

A
  1. Projectile vomiting
  2. No evidence of pain or discomfort except that of
    chronic hunger
  3. s/s of dehydration-decreased number of stools
  4. weight loss
  5. distended upper abdomen
  6. readily palpable olive shaped mass in the upper
    abdomen (epigastrium just to the right of the
    umbilicus)
  7. visible peristaltic waves that move L→R across
    epigastrium
  8. hyperactive bowel sounds
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22
Q

Prokinetic agents

A

Metoclopramide HCl

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23
Q

Diagnosis for GERD: radionuclide scanning for evaluation of gastric emptying (after feeding a radioactive compound)

A

Scintigraphy

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24
Q

s/s of bleediing

A

hypovolemic shock

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25
Q

severe complications for GERD that requires surgery

A

recurrent aspiration pneumonia, apnea, severe esophagitis, failure to
thrive, failure to respond to medical therapy

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26
Q

MANAGEMENT of hirschsprungs
➢ Most require surgery rather than medical therapy

for mild cases (1-3)

A
  1. Low residue diet
  2. Stool softeners
  3. Isotonic irrigations
    o Not tap water-water intoxication
    o Not soap suds
  4. Surgery
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27
Q

feeding in colic

A
  1. Feed slowly
  2. Burp frequently
  3. Keep in upright position during feeding
  4. Do not overfeed
  5. If breastfeeding, avoid feeding foods that may contribute to gas formation such as onions, cabbage,
    collards, dry beans
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28
Q

other names for CELIAC DISEASE

A
  • Gluten – induced enteropathy
  • Gluten – sensitive enteropathy
  • Celiac sprue
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29
Q

surgical management of hirschsprungs

A

a) PERINEAL ONE STAGE OPERATION PULL THROUGH PROCEDURE (POOP procedure )

b) Staged repair
1. Palliative
2. Corrective

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30
Q

s/s of enterocolitis

A

fever, explosive watery diarrhea, dehydration, severe prostration- septic shock

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31
Q

MANAGEMENT of hirschsprungs:to prevent impaction until child is toilet trained; use volume appropriate to
weight of the child

A

Isotonic irrigations

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32
Q
  • An invagination or telescoping of one portion of
    intestines into another
  • Invagination of the cecum in colon producing obstruction
    of the intestines
  • Telescoping of bowel into itself
A

INTUSSUSCEPTION

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33
Q

Dance sign

A

empty RLQ

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34
Q

Diagnosis for GERD: pH determined at distal esophagus (insertion of small catheter into esophagus through
nose)→ to determine the number of reflux episodes

A

24 hour pH probe study

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35
Q

If frequent reflux disease, there is something wrong with ***

A

cardiac sphincter

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36
Q

complications of celiac

A
  • growth retardation
  • malignant lymphoma of small intestines
  • esophageal and GI cancers
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37
Q

nutritional supplements for celiac

A

vitamins, Fe and calories

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38
Q

= leading cause of death in children with Hirschprung’s disease = inflammation of small bowel
and colon;

A

enterocolitis

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39
Q

clinical manifestations of hirschsprungs in childhood

A

▪ Constipation (because of
absence of peristalsis)
o Chronic constipation –
▪ Ribbon like foul smelling stools
▪ Visible peristalsis
▪ Fecal masses easily palpable
▪ Poorly nourished and anemic

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40
Q

Cause of GERD

A

❖ Relaxed cardiac sphincter
1. related to dysfunction of lower esophageal
sphincter(LES)→transient relaxation of the LES
(TRLES)
2. delayed gastric emptying→ gastric distention
(overfeeding, gas)
3. increased abdominal pressure

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41
Q

cause of celiac disease

A
  • unknown; genetic predisposition + environmental
    factors
    a. Genetics
    b. Gluten exposure
    c. GUT Microbiome
    d. Medical Conditions
    e. Environmental Factors
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42
Q

management for HPS

A
  1. SURGERY
    * PYLOROMYOTOMY (FREDET-RAMSTEDT
    PROCEDURE)
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43
Q

triad symptoms oof intussusception

A
  1. Pain
  2. Vomiting –
  3. Passage of red currant jelly like stools
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44
Q

Increase resting LES pressure mildly and increase the rate of gastric emptying)
→ BUTS/e-restlessness, drowsiness, extrapyramidal reactions and in some,
increase number of reflux episodes

A

Prokinetic agents

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45
Q

clinical manifestations of GERD in respiratory problems

A

recurrent pneumonia,
chronic cough, wheezes, stridor, gagging, choking at end of feedings

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46
Q

Educating parents regarding home care in gerd

A

a. Feeding
▪ Thickened (1 tsp-1 tbsp of rice cereal/oz of formula)
▪ Small frequent feeding
▪ Frequent burping
❖ Above measures are to minimize reflux
b. Positioning
c. Medications and their side effects
d. How to suction mouth and nose if vomiting occurs
e. Gastrostomy feeding and gastrostomy site care

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47
Q

clinical manifestations of GERD

A
  1. Passive regurgitation, spitting up/vomiting
    (effortless and non-projectile)
  2. Poor weight gain
  3. Hematemesis and melena
  4. Irritability or excessive crying
  5. Heartburn in older children
  6. Anemia secondary to blood loss due to irritation of the lining of the esophagus (HCl)
  7. Respiratory problems
  8. Dysphagia
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48
Q

Management of GERD:
→ Valve mechanism by 360o wrap of the fundus (greater curvature of the stomach) around the esophagus
→ A gastrostomy tube is usually inserted during the procedure

A

NISSEN FUNDOPLICATION

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49
Q

Celiac disease is secondary to what

A

CF

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50
Q

can be found in BROW food that can destroy walls of intestines

A

Gliadin

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51
Q

DIAGNOSTIC TEST of celiac
* screening test for presence of antigliadin; and
antireticulin and antiendomysial Ig A and Ig G
antibodies (antibodies to connective tissue)
* absence in gluten-free diet

A

blood test

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52
Q

a substance in wheat and other grains, may be found in a variety of foods
including breads, cakes, cereals, pasta, commercial dairy products and alcoholic
beverages.

A

gluten

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53
Q

results of ultasonography in HPS

A

elongated sausage-shaped mass
with an elongated pyloric channel

54
Q

DIAGNOSTIC TEST of celiac

A
  1. Blood test
  2. Jejunal biopsy
  3. HAL genetic test
55
Q

INTUSSUSCEPTION DIAGNOSIS

A
  1. History and physical exam
  2. Abdominal radiograph to detect intraperitoneal air
    from a bowel perforation
    ▪ If (+) barium enema is contraindicated
  3. Barium enema – obstruction of the flow of barium
  4. Ultrasound
  5. Rectal exam – mucus and blood
56
Q

ethnicity at risk of celiac disease

A

caucasians

57
Q

COMPLICATIONS OF SURGERY in gerd

A

small bowel obstruction, retching, gas-bloat syndrome,
Dumping syndrome

58
Q

INTUSSUSCEPTION incidence

A
  • onset: abrupt
  • one of the most frequent causes of intestinal obstruction between 3 months to 5 years of age; 50%
    below 1 year (3-12 months )of age
  • Males 2x>females
59
Q

results of blood tests in HPS

A

metabolic alterations from extensive
vomiting
▪ Hypochloremia , hyponatremia,hypokalemia
▪ Increased pH and HCO3
▪ increase BUN-dehydration

60
Q

dumping syndrome is a combination of

A

profuse sweating, nausea and dizziness)

61
Q

MANAGEMENT of celiac

A
  1. lifelong dietary modification
  2. specific nutritional supplements
62
Q

ER Becomes GERD when complications
such as

A

failure to thrive, bleeding or dysphagia

63
Q

INTUSSUSCEPTION types: most common; ileum invaginates into
cecum and ascending colon

A

Ileocolic

64
Q

Mechanical obstruction due to inadequate motility of the intestines

A

HIRSCHPRUNG’S DISEASE

65
Q

clinical manifestations of hirschsprungs in infancy

A

▪ Failure to thrive (failure to gain
weight and delayed growth)
▪ abdominal distention
▪ episodes of vomiting
▪ Constipation alternating with
diarrhea
▪ Ominous sign (enterocolitis)
o Explosive, watery
diarrhea, fever, severe
prostration

66
Q

GER and GERD may occur as separate disease entity

A
67
Q
  • recurrent episodes of unexplained crying inability to be consoled
  • occurs around 1-2 weeks of age; subsides spontaneously by 16 weeks
A

COLIC

68
Q

common cause of GERD
/ most common mechanism

A

Relaxed cardiac sphincter

69
Q

cause of HYPERTROPHIC PYLORIC STENOSIS

A

unknown, genetic predisposition children of parents
who had PS as infants

70
Q

Represents symptoms/tissue damage that result from GER

A

GERD

71
Q

INTUSSUSCEPTION types

A
  1. Ileocolic
  2. Cecocolic
  3. Ileoileal
72
Q

positioning in feeding for GERD

A

✓ PRONE (head elevated/flat) after feeding and at night
o NOT SUPINE/INFANT SEAT – worsens GER→↑intraabdominal pressure (could lead to aspiration)

73
Q

diagnosis of hirschsprungs: biopsy samples of the inside of the large intestine, near the anus
* If no ganglion cells are seen on the biopsy samples, Hirschsprung’s Disease is diagnosed →(failure of the
ganglion cells to migrate at the GI tract during gestation (rectum & proximal large intestine) → internal
anal sphincter fails to relax → absence of peristalsis → accumulation of intestinal contents → distention
of bowels → megacolon

A

rectal biopsy

74
Q

NURSING CARE in hirschsprungs

A
  1. Monitoring v/s including abdominal circumference and ominous signs (enterocolitis)
  2. Maintain fluid and electrolyte balance-IVF, I&O
  3. Maintain adequate nutrition-low fiber, high calorie, high protein diet/TPN as ordered
  4. Help parents adjust to the congenital defect in the child
  5. Prepare client for surgery
    ▪ Psychologic and physical preparation similar to those scheduled for abdominal surgery
    ▪ Repeated saline enemas to empty the bowel and or colonic irrigation using antibiotic solution to
    decrease bacterial flora (or by systemic antibiotics)
  6. Postoperative care
    ▪ Colostomy care – normal pink to reddish pink
  7. Discharge = assist parents in colostomy care
75
Q

diagnosis of hirschsprungs

A
  1. HISTORY (passage & characteristic of stool) AND CLINICAL manifestations
  2. Barium enema
  3. Rectal biopsy
  4. Abdominal X-ray
  5. Rectal Examination
76
Q

dilated action of colon (due to fecal materials left because of no motility)

A

megacolon

77
Q

how is Projectile vomiting in HPS

A

-3 ft from infant which usually
occurs 30-60 minutes after feeding

78
Q

NURSING DIAGNOSES

A

➢ Fluid volume deficit r/t frequent vomiting
➢ Altered nutrition: less than body requirements r/t vomiting and lack of absorption of nutrients
➢ High risk for infection r/t surgical incision

79
Q

incidence of hirschsprungs

A
  • Accounts for 1⁄4 of all cases of neonatal obstruction although diagnosed in later infancy/childhood
  • Males 4x>females
  • Familiar pattern in small cases
  • More common in children with Down’s syndrome
  • Can present as an acute (life threatening) / chronic disorder
80
Q

diagnosis of hirschsprungs: The pictures of the intestine will show a wide or dilated area next to a narrow area of intestine. The
narrow area is the part of the bowel without ganglion cells. The wide area of the intestine is healthy
bowel filled with stool that can’t be passed.

A

Barium enema

81
Q

nursing care for celiac

A
  1. Health education in maintaining a gluten-free diet
    for the child
    * Thorough explanation of the disease process
    * Gluten free diet should not be discontinued
    when the child is symptom free
82
Q

INTUSSUSCEPTION CLINICAL MANIFESTATIONS

A
  1. Pain – acute, severe, colicky abdominal pain
    ▪ Child screams and draws knees onto the chest
    ▪ Appears normal and comfortable during intervals
    between episodes of pain
  2. Vomiting – bile-stained (obstruction is below Ampulla
    of Vater)
  3. Passage of red currant jelly like stools (because fecal
    material is unable to move beyond the obstruction,
    the stool contains blood and mucus)
  4. Palpable sausage shaped mass in RUQ
  5. Empty RLQ (Dance sign)
  6. Tender, distended abdomen
  7. Lethargy
83
Q

signs of impaired absorption of nutrients

A
  • Malnutrition
  • Muscle wasting (prominent in legs and
    buttocks)
  • Anemia
  • Anorexia
  • Abdominal distention
84
Q

H2 antagonists

A

Cimetidine (tagamet), famotidine (Pepcid), Ranitidine (Zantac)

85
Q

diet for celiac

A

high protein, high calorie, no gluten

86
Q

CAREGIVER TEACHING INFORMATION in Colic

A

A. Feeding
B. Swaddle to decrease self stimulation by jerky or sudden movements
C. Take the infant for a car ride
D. Use a swing for at least 20 minutes
E. Walk or rock the infant while applying gentle pressure to his abdomen
F. gently massage the infant’s back while he is lying down
G. Supply background or “white” noise ( hair dryer, Vacuum cleaner, fan) or play a womb sound
tape(known as “souffle” toy) or some sound music
H. Place the infant in a quiet darkened room to reduce environment stimulus

87
Q

INTUSSUSCEPTION complications

A
  • Perforation
  • Peritonitis
  • Sepsis
88
Q

DIAGNOSTIC TEST of celiac
test for the presence of HAL DO2
HAL DQ8

A

HAL genetic test

89
Q

management of gerd: Alternative for children with neurologic impairment who are continuously tube fed

A

PERCUTANEOUS GASTROJEJUNOSTOMY and placement of jejunostomy tube

90
Q

(attempt to vomit but nothing goes out/up),

A

retching

91
Q

signs of celiac crisis

A
  • acute sever episodes of profuse, watery
    diarrhea and vomiting
  • Precipitated by : infections (respiratory,
    GIT), prolonged fluid and electrolyte
    depletion, emotional disturbance
92
Q

Associated with respiratory symptom of GERD

A

apnea, bronchospasm,
pneumonia

93
Q

Block acid production

A

Proton pump inhibitor

94
Q

complications of hirschsprungs

A

*Obstruction→↑abdominal circumference, absence of stool, vomiting, pain and decreased or absent bowel
sounds
* Bowel perforation
a) peritonitis
b) bleeding
* Enterocolitis
* Dehydration

95
Q

signs of Projectile vomiting in HPS

A

▪ Child is “good eater” /”avid nurser” who vomits
occasionally or shortly after feeding and eagerly
accepts a second feeding after vomiting (Chronic
hunger)
▪ Nonbilous-stale milk (undigested)
▪ Blood tinged – repeated irritation to the
esophagus
❖ Electrolyte depletion – METABOLIC
ALKALOSIS

96
Q

Management of GERD

A
  1. Diet-thickened feedings
  2. Pharmacology
  3. Surgery
  4. NON-SURGICAL PERCUTANEOUS GASTROJEJUNOSTOMY and placement of jejunostomy tube
97
Q

CLINICAL MANIFESTATIONS celiac disease

A
  • Chronic, insidious, noted after introduction of glutencontaining grains in the diet, typically between 1-5 y/o
    1. Impaired fat absorption
    2. Impaired absorption of nutrients
    3. Behavioral changes
    4. Celiac crisis
98
Q

most common mechanism of GERD

A

Relaxed cardiac sphincter

transient relaxation of the LES
(TRLES

99
Q

post op NURSING CARE for HPS

A

a. Maintain fluid and electrolyte balance
b. Minimize weight loss
* Small frequent feedings
* Clear liquid-formula
c. Promote rest and comfort
* Swaddle infant to maintain warmth and comfort
* Encourage parents to hold and cuddle the infant
* Provide pacifier to meet the infant’s need to suck
* Avoid pressure on incision-diaper-slide gently under the butt rather than
* Administer acetaminophen as ordered
d. Prevent infection
* Keep surgical wound clean and dry
* Check for s/s of infection
e. Discharge planning and patient’s family home care teaching
* s/s of infection and notify physician
* fold diaper so that it doesn’t touch incision

100
Q

INTUSSUSCEPTION types: ileum invaginates into another portion of
the ileum

A

Ileoileal

101
Q

Identifying children with symptoms that suggest GER

A

▪ History of feeding problems
▪ Observe for episodes of vomiting, note color, consistency and amount
▪ Observe for respiratory distress at end of feeding

102
Q
  • sharp, visceral pain resulting from torsion, obstruction, or smooth muscle spasm of a hallow or tubular organ,
    such as a ureter or the intestines
A

COLIC

103
Q
  • Disease of the proximal intestine characterized by abnormal mucosa and permanent intolerance to gluten
  • Inherited Autoimmune disease
A

celiac disease

104
Q

signs of . Impaired fat absorption (assos. with cystic fibrosis)

A
  • Steatorrhea (excessively large, pale, oily,
    frothy stools)
  • Exceedingly foul smelling stools
105
Q

hallmark of megacolon

A

Chronic constipation

106
Q

INTUSSUSCEPTION management

A
  1. Non-surgical
    a. HYDROSTATIC REDUCTION (by barium enema)
    b.PNEUMATIC INSUFFLATION (AIR ENEMA)
  2. Surgical (Open) – manual reduction of invagination
    and resection of nonviable intestine when necessary
107
Q

clinical manifestations of hirschsprungs in NB

A

▪ failure to pass meconium within
24-48 hours after birth
▪ abdominal distention (can be
associated with gas)
▪ bile stained emesis
▪ refusal to suck = weight loss and
dehydration
▪ irritability

108
Q
  • A hypertrophic obstruction of the circular muscle of the pyloric canal
  • Gastric outlet obstruction – Hypertrophy of the pyloric sphincter causing stenosis and obstruction
A

HYPERTROPHIC PYLORIC STENOSIS

109
Q

management for HPS:
▪ standard treatment
▪ Longitudinal incision through the circular
muscle fibers of the pylorus down to, but
not including the submucosa
▪ Approaches:
→ Before: RUQ incision that left a scar in the
abdomen
→ Now: Laparoscopy

A

PYLOROMYOTOMY (FREDET-RAMSTEDT
PROCEDURE)

110
Q

surgical management of hirschsprungs:Removal of aganglionic segment and temporary colostomy made with the
part of the bowel with normal nerve transmission to allow this part to rest and let child
gain weight

A

palliative staged repair

111
Q

1st signs of celiac

A

failure to thrive, diarrhea

112
Q

other name for HYPERTROPHIC PYLORIC STENOSIS

A

INFANTILE HYPERTROPHIC PYLORIC STENOSIS

113
Q

NTUSSUSCEPTION management:
* No risk of peritonitis
* More rapid

A

PNEUMATIC INSUFFLATION (AIR ENEMA)

114
Q

allow the intestine to
relax so stool can pass through the intestine and
out of the body. Without these special nerve
cells, the intestine can’t relax and it becomes
very narrow

A

ganglion cells

115
Q

Complication of GER:

A

persistent esophagitis with scarring, recurrent
aspiration pneumonia

barrett’s esophagus

116
Q

when they eat with food gluten, it damages/destructs the villi found in small intestine
will result to malnourishment and decrease bone density)

A

. CELIAC DISEASE

117
Q

meaning of electrolyte depletion

A

metabolic alkalosis

118
Q

HYPERTROPHIC PYLORIC STENOSIS incidence

A
  • one of the most common conditions requiring surgery in infants
  • First few weeks of life (1-10 weeks)
  • First born male infants (5x)>females
  • Full term>premature infants
  • Caucasians, less frequently in Asians and blacks
119
Q

celiac disease:
substitute BROW with corn and rice
Foods to avoid: bread, cake, doughnuts, cookies,
crackers, preserved foods with gluten as filler,
commercially prepared ice cream, malted milk,
prepared puddings, grains, BROW, crackers, cereals,
spaghetti, macaroni noodles

A
120
Q

NURSING CARE for HPS

A
  1. Maintain fluid and electrolyte balance and Minimize weight loss
    * Monitor I & O, weight, urine sp. gr., character of stools,
    * IVF
  2. Provide supportive care to parents
    * Encourage participation in care, verbalization of fears and concerns, provide simple and clear explanation
    regarding condition and care
    * Inform that occasional vomiting after surgery may occur
  3. Prepare infant for surgery
121
Q

surgical management of hirschsprungs: done without making an incision on the abdomen. Instead,
small laparoscopic (telescopic) instruments are used and the operation is done through
the anus.

A

PERINEAL ONE STAGE OPERATION PULL THROUGH PROCEDURE (POOP procedure )

122
Q

Proton pump inhibitor

A

Omeprazole (Prilosec), lansoprazole (prevacid)

123
Q

INTUSSUSCEPTION cause

A

Unknown
* May be the result of hypertrophy of Peyer’s patches,
bowel rumors, or polyps
* Idiopathic (90% of cases) likely a result of
hypertrophy of intestinal lymphoid tissue (Peyer’s
patches) secondary to viral infection (recurrent bout
of gastroenteritis)

124
Q

complication of HPS

A

persistent pyloric obstruction,
wound dehiscence and GER

125
Q

Other name of hirschsprung’s disease

A

congenital aganglionic megacolon

126
Q

complication of surgery in hirschsprungs

A

anal stricture → further therapy=dilation or bowel retraining therapy

127
Q

Diagnosis for GERD

A
  1. History and child’s feeding pattern and clinical manifestations
  2. Barium swallow (esophagography)
  3. 24 hour pH probe study
  4. Scintigraphy
128
Q

Diagnosis for GERD: to establish presence of reflux

A

Barium swallow (esophagography)

129
Q

closure of the colostomy and reanastomosis of working part of colon to
point near anus
o Several months later when child weighs approximately 20 lbs (9kg)
o After closure of the colostomy = fecal incontinence and constipation may persist

A

corrective staged repair

130
Q

without nerve tissue in the colon/rectum

A

aganglionic

MCN (6 decks)

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