Gastrointestinal Dysfunction

Question 1

Cleft lip and cleft palate - feeding

Answer 1

Encourage breastfeeding
Provide special nipples for infant unable to suck adequately on regular nipples - soft pliable bottle with soft elongated nipple with enlarged opening
May require oral device to enable suction during feeding
Point nipple away from cleft side and black of mouth to prevent aspiration
Feed slowly, burp frequently

Question 2

Cleft lip/cleft palate - post-op care

Answer 2

Assess airway patency
Mist tent/blow by to minimize edema, liquefy secretions, minimize distress
CL - position on back or in infant seat
CP - position on abdomen immediately post-op to facilitate drainage
Feed with rubber tipped medicine dropper, bulb syringe, breck feeder, or soft bottle nipple - no straws, metal utensils, sharp objects

Question 3

Gastroesophageal reflux treatment

Answer 3

Small, frequent feedings, burp frequently, position upright after feedings
Formula with rice cereal, use with larger nipple hole
Semi-elemental formula
Keep suction at bedside
Cardiac apnea monitor
Antiacid, proton pump inhibitor (PPI), histamine-2 blocker

Question 4

Infantile hypertrophic pyloric stenosis

Answer 4

Narrowing of the pyloric sphincter at the outlet of the stomach

Question 5

Pyloric stenosis signs

Answer 5

No abnormal signs in first week of birth - regurgitation, non-projectile vomiting, vomitus is non-bilious, only contains gastric content, may be blood-tinged
Vomiting increases in frequency and force over next 1-2 weeks - most of ingested food is expelled through projectile vomiting
Upper abdominal distention, palpable olive-shaped mass in epigastrium just right of umbilicus, visible peristaltic waves from left to right
Eventually signs of malnutrition occur

Question 6

Pyloric stenosis treatment

Answer 6

Position in high fowlers on right side after feedings
Atropine sulfate
Surgical intervention
Post-op care - start with small amounts of clear liquids then advance to full formula 24 hours after surgery

Question 7

Celiac disease

Answer 7

Chronic malabsorption syndrome - mucosa of proximal small intestine undergoes an immunologic response to gluten

Question 8

Celiac disease signs

Answer 8

Occur between 9-24 months - diarrhea that is often pale and watery with offensive odor, vomiting, constipation, anemia

Question 9

Hirschsprung’s disease

Answer 9

Congenital anomaly characterized by absence of nerves to a section of the intestines - results in mechanical intestinal obstruction due to inadequate mobility in an intestinal section
Can lead to intestinal dilation, distention, and ischemia secondary to bowel wall distention - leads to necrosis, perforation, and sepsis - enterocolitis can be fatal

Question 10

Hirschsprung’s disease signs

Answer 10

Neonates - failure to pass meconium, constipation, abdominal distention, bile-stained vomitus
Infants - FTT, abdominal distention, constipation with ribbon-like foul smelling stools

Question 11

Signs of enterocolitis (due to perforation in Hirschsprung’s disease)

Answer 11

Explosive bloody diarrhea, fever, severe prostration/weakness

Question 12

Hirschsprung’s disease care

Answer 12

Assess bowel functioning, provide smaller frequent meals, avoid rectal temperatures, assess for respiratory difficulty with distention
Pre-op - saline enemas, low fiber/high calorie diet

Question 13

Intussusception

Answer 13

Telescoping of one portion of intestine into an adjacent portion, causing obstruction
If not fixed within 24 hours, can lead to necrosis, hemorrhage, perforation, peritonitis, shock

Question 14

Intussusception signs

Answer 14

Abrupt severe paroxysmal abdominal pain - screaming, drawing knees into abdomen
Vomiting of gastric contents
Tender, distended abdomen possibly with palpable sausage-shaped mass
Currant jelly stools

Question 15

Hernia

Answer 15

Protrusion of bowel through an abnormal opening in the abdominal wall - most commonly at the umbilicus and through the inguinal canal

Question 16

Umbilical hernia treatment

Answer 16

Usually closes on its own by age 3-4 years

Question 17

Inguinal hernia treatment

Answer 17

Requires surgical repair

Question 18

Hydrocele

Answer 18

Presence of abdominal fluid in the scrotal sac

Noncommunicating hydrocele - residual peritoneal fluid is trapped within the lower segment of the processus vaginalis - no communication with peritoneal cavity - fluid is usually absorbed a couple months after birth

Question 19

Hydrocele post-op care

Answer 19

Use scrotal support, apply ice bags

Question 20

Communicating hydrocele is usually associated with ____

Answer 20

An inguinal hernia - processus vaginalis remains open from the scrotum to abdominal cavity

Question 21

Incarceration

Answer 21

Occurs when hernia becomes tightly caught in the hernia sac

Question 22

Encopresis

Answer 22

Soiling of underwear with stool in children past the age of toilet training (usually not diagnosed until child is at least 4 years old)
Commonly results from chronic constipation

Question 23

Encopresis signs

Answer 23

Hx of constipation or painful defecation, stooling every 3-7 hours and/or having small loose water stools, some may pass very large stools, soiling usually occurs in daytime, may have enuresis and frequent bladder infections
Child cannot differentiate urge to defecate from urge to pass gas, child may be “too busy” to defecate

Question 24

GER risk factors

Answer 24

Prematurity

Conditions that cause increased abdominal pressure - coughing (asthma, respiratory infection)