Gastrointestinal System - Pedi Flashcards

Question

Anorectal Malformations

Answer 1

**Imperforate Anus *** Rectum ends in a blind pouch * Level of defect influences outcome – fecal continence * Staged repair * Colostomy while waiting repair

Answer 2

* newborn assess for normal anal opening * passage of meconium stool within 24hours of birth * assess UO to identify accompanying GU abnormalities * assess for signs of intestinal obstruction – distension/vomiting

Answer 3

* Preop: NPO, gastric decompression, hydration status, education * Postop: pain, NPO maintained, gastric decompression, colostomy care, if needed. * After intestinal pull thru initially stool will be watery – skin breakdown

Answer 4

Congenital – 3-6 cm outpouching (bulge) of lower segment of small intestine *Most common birth defect of GI system – 2-3% population *Most children asymptomatic *If symptoms, usually age 1-2y *Painless rectal bleeding *“brick” or “currant jelly” – very red stool Can be associated with partial or complete bowel obstruction *Obstruction – younger children *Diverticulitis - older children (~ 8y) - looks like appendicitis

Answer 5

* Anemia * Bleeding * Ulcer * Obstruction (volvulus / intussusception) * Typically occur in first 2 years of life

Answer 6

* Rectal bleeding, painless * Abdominal pain * Bloody, mucusy stools

Answer 7

* Meckels Scan (radionuclide scan), CBC and metabolic panel

Answer 8

* possibly blood products * IV fluids * NPO * Surgery to repair

Answer 9

* Abdominal or pelvic viscera travel thru inguinal ring into inguinal canal *** Males**: bowel *** Females**: fallopian tubes/ovaries * **Nursing Assessment:** Bulging mass in lower abdomen/groin * ** Management: ** Surgical repair * Reduction until surgery/ teach family (NP/MD) * Education to family about incarcerated hernias and urgency

Answer 10

More common: Preterm infants / African Americans * Incomplete closure of umbilical ring * Most self resolve by 4yo * Surgery if large that fail to close by 4 yo

Answer 11

*Infants in young children more at risk *Increased extracellular fluid percentage, increase in body water compared to adults *Increased Basal Metabolic Rate *Immature renal function *Increased insensible fluid loss thru temp elevation

Answer 12

* Restore fluid volume * Prevent shock * Mild to moderate ORT * Severe IVF * Refer to Teaching Guidelines 20.1 ORT * Pedialyte, 50-100mL/kg over 4 hours, reeval * reg diet after rehydrated

Answer 13

*** forceful expulsion of gastric contents thru mouth * Many different causes – it is a symptom of some other condition * Infectious: gastroenteritis, OM, pharyngitis, sinusitis, pyelonephritis, meningitis * GI: intussusception, malrotation, appendicitis, cholecystitis, pancreatitis, GERD, pyloric stenosis * GU: ureteropelvic junction dysfunction * Endocrine: Diabetic ketoacidosis * Neuro: IICP * Other: food poisoning, toxic ingestion

Answer 14

* Hx * onset, progression, timing, characteristics * color – bilious never normal * bloody – GI bleed or esophageal bleed * hx of trauma? * feeding pattern * assoc symptoms ie fever, diarrhea, abdominal pain * PE * hydration/perfusion, mental status, abdomen

Answer 15

* Simple vomiting: ORT – 0.5 – 2oz ORS every 15 min age and size dependent * Antinausea meds * IVF

Answer 16

* increase in frequency or decrease in consistency of stool * Acute vs chronic (more than 2 weeks) ** Acute:** viral – watery, loose, fever, vomiting * bacterial – bloody stools or mucousy * Parasites – fever, watery ** Chronic:** infants: milk/soy intolerance, enteritis, hirschprungs, nutrient malabsorption * toddlers: nonspecific, enteritis, celiac, UC * school age: IBD, appendiceal abscess, lactase deficiency, constipation with encopresis

Answer 17

* Fungal infection of the oral mucosa * Most common infants/newborns * HR: immune d/o’s, corticosteroid MDIs, antibiotic use * May be transmitted bw BF mom and baby

Answer 18

* Meds and Education * Nystatin topically younger / swish and swallow older * Fluconazole – SE’s hepatotoxicity, N/V * BF mom’s much treat as well * Keep bottles and pacifiers clean * Wash toys

Answer 19

* The circular muscle of the pylorus becomes hypertrophied causing thickness in the luminal side of the pyloric canal * The thickness causes an gastric outlet obstruction * Nonbilious vomiting 3-6 weeks of life – becomes more frequent and forceful - - projectile * 2-3.5/1000 live births Males > Females

Answer 20

Pylorotomy

Answer 21

* Forceful, nonbilious vomiting * Hunger after vomiting * Wt loss * Dehydration * Hard moveable “olive” mass in RUQ

Answer 22

* Proximal segment of the bowel “telescopes” into a more distal segment * edema, vascular compromise and partial/total obstruction * Intermittent telescoping then reduces spontaneously

Answer 23

Barium/Air enema or Surgery

Answer 24

* Severe pain intermittent (drawing knees up) vomiting, diarrhea, currant-jelly stools, bloody, lethargy, may be able to palpate sausage shaped mass in upper mid abdomen

Answer 25

IVF, support for procedure

Answer 26

* occurs from a disruption in embryonic development * intestine is abnormally attached * mesentery narrows twisting on itself (volvulus) * Main symptom: bilious vomiting * abdominal pain, distension, bloody stools * Most cases first few weeks of life – but may occur when older

Answer 27

Surgery - Ladd procedure straighten out intestine and divide the bands that contribute to misalignment

Answer 28

* Acute inflammation of appendix * Peaks second decade of life * Obstruction of the appendix: possibly from fecal matter * IF it perforates inflammatory fluid and bacteria leak into abdominal cavity = Peritonitis (more common younger children) * Older children more mature omentum – making an abscess

Answer 29

* Hx: may be gradual onset * typically sxs progress but are not intermittent * vague abdominal pain that localizes to RLQ over hours * N/V after onset of pain * Small volume, frequent stools * Fever (low grade) unless perforation (high grade)

Answer 30

* ill appearance/uncomfortable guarded movements Pain > at McBurneys point RLQ Distenstion and diffuse pain - peritonitis

Answer 31

* CBC * CRP * US vs CT scan

Answer 32

* nonruptured, nongangrenous appendix preop antibiotics – no post op antibiotics * suppurative or gangrenous appendix antibiotics post op 48-72hours perforated – antibiotics possible for 7-14 days (may wait on surgery) * IF abscess develops post op - drains

Answer 33

* reflux of gastric contents into esophagus * occurs during relaxation of LES during swallowing, crying, valsava * Normal first year of life – outgrow 12-18 mos of age * Sxs: vomiting, irritability with feeding or posturing after feeds, bradycardia

Answer 34

* HOB elevated * upright 30” after feeds * small, frequent feeds * Medications: ie prilosec

Answer 35

* Typically presents during TT years * Painful experience during defecation turns to fear of defecation * and withholding behaviors * Organic causes are rare: sign of disease ie spina bifida or sacral agenesis * affects 30% of pedi population * Failure to achieve complete evacuation of the lower colon * BF: stool with each feed, sometimes skip 2-3 days * Bottle fed: 1-2 per day, may skip 2-3 days

Answer 36

* less than 3 BM / week * at least one episode fecal incontinence/week (post Toilet trained) * excessive stool retention hx * hard/painful BM * large fecal rectal mass * stool passage volume clogs toilet * stool withholding behavior (retentive posturing)

Answer 37

soiling of fecal matter into underwear beyond age of expected TT (4-5 yo)

Answer 38

* Toileting Behaviors: regular toileting times, positive reinforcement for toileting * Dietary changes * Medications: suppositories/enema, miralax, colace, senna

Answer 39

* disorder of motility of the intestinal track resulting in obstruction * most commonly characterized: Failure to pass a meconium within first 24 hours of life * Lack of ganglion cells in the intestine - inadequate motility * Can occur anywhere from rectosigmoid colon all the way to small intestine

Answer 40

Hx: Passage of meconium * did require rectal stimulation * Down syndrome or family hx higher incidence Exam: Abdominal distension * may stool with rectal stimulation / typically stool not in rectum until after stimulation Dx: rectal suction bx – aganglionic cells

Answer 41

* initially may do rectal dilations * Surgery: resection / ostomy while healing

Answer 42

* Ostomy care, I+O’s, skin care * Observe for signs and symptoms of enterocolitis: fever, distension, rectal bleeding

Answer 43

* Nutrient malabsorption – excessive intestinal fluid and electrolyte loss * Occurs after massive small intestinal resection * Most common causes are NEC, small intestinal atresia, gastroschisis, malrotation or trauma to small intestine * Goals: minimize bacterial overgrowth and maximize nutrition * Management: possible antibiotics prophylactically, vitamin and mineral supplementation, antidiarrheals, TPN

Answer 44

* Crohns and UC * Cause: UK * 15-20% diagnosed in childhood/adolescence * Exacerbations & remissions; chronic, sometimes debilitating

Answer 45

affects large and small intestines (can affect entire alimentary canal, mouth – anus) * Lesions full thickness, acute and chronic inflammation, noncaseating granulomas, extraintestinal fistulas, abscesses, strictures, and fibrosis * Abdominal pain, diarrhea with blood if colon involved, perianal disease, fistula, abscess, anorexia

Answer 46

* affects only large intestine and rectal mucosa (proctitis) * guishing features Crohns and UC * Superficial, acute inflammation of mucosa * Abdominal pain, bloody diarrhea, urgency, tenesmus

Answer 47

* Immunologic Disorder * Gluten causes damage to the small intestine * Villi in small intestine damaged d/t immunologic response to digestion of gluten * Most common chronic GI d/o Europe and US * Prevalence > 3% - increased if family hx, autoimmune or genetic d/o’s

Answer 48

Treatment – Gluten free diet (strict) Initial presentation: often by age 2 diarrhea, steatorrhea, constipation, FTT/wt loss, Abdominal distention, poor muscle tone, irritability, fatigue, dental d/o’s, anemia, amenorrhea, delayed puberty, nutritional deficiencies

Answer 49

* Gluten free- Diet – Strict * Dietitian * Support groups * Resources Teaching Guidelines for Dietary Considerations table 20.2

Answer 50

* Approx 2-4 % all pedi outpt visits are r/t recurrent abdominal pain * Etiology: UK * May occur as a result of: rectal distension, impaired gastric relaxation in response to pain, or heightened sensitivity to visceral pain * Psychological responses may occur if pain persistent or recurrent

Answer 51

* Typically a battery of tests are completed blood, Xrays, other diagnostics r/t complaints to r/o other organic causes * Identifying triggers and increasing coping skills * Return to activities/school – keep routines

Answer 52

* Cause: UK * Absence of all or some of the major biliary ducts * resulting in obstruction of bile flow * Cholestasis occurs

Answer 53

* Light beige stools (Normal stool color for infants is yellow, green or brown.) * Dark brown urine * Distended abdomen * Hepatosplenomegaly * Difficulty gaining weight * Ascites * Cirrhosis in several mos if untreated

Answer 54

* Surgery (Kasai procedure) most successful before 45 days old * if not successful, or later in age, may need liver transplant * Other D/o’s Hepatitis, Pancreatitis, Gallbladder Disease