GI Flashcards
What is the most common viral cause of belly aches in kids?
Gastroenteritis
What is the most common surgical cause for belly aches in children?
Appendicitis
What is colic pain characterized by? When does it peak? How long does it last? Is there long lasting effects?
Excessive crying for 3 or more hours a day most days of the week
Peaks at 4-8 weeks of age and can last as long as 12 weeks
No impact on development or cognitive abilities
When does function abdominal pain most common? Why? How can this be treated?
Peak in preschool (especially boys)
Potty training is developing and there can often be a dysfunction in the patten of holding the BM –> pain –> large hard stool –> more pain
Fiber, fruit, bowel retraining habits, water, miralax, veggies
What is chronic pain categorized by?
3 pain episodes that have been present over 3 months
Where is the most common area for pain? Why should you be concerned about that area?
Periumbilicus
Appendicitis begins in that area and localizes
What history should you be getting from parents and child about the pain?
- Pain assessment (PQRST - location, quality, triggers, relieving, onset and duration)
- Associated symptoms like change in appetite, vomit, diarrhea, fever, rash, joint aches/pains, weight loss
- Treatment tried
Should you give you child anti motility drugs for diarrhea?
NO it can mask s/s and prolong the illness
When should you worry about abdominal pain?
- Severe, localized pain
- Blood in emesis or stool
- Fever (infection/autoimmune)
- Appears ill/lethargic
- Losing weight
- Nocturnal pain
- Periumbilical pain
- If pain proceeds vomiting/diarrhea
What is a concern if the patient has pain and they are also lethargic?
Shock/sepsis concern
When visually inspecting the abdomen, what should you look for? What could these mean?
Distention: obstruction
Abdominal contours: abdominal mass
Discoloration like bruising: bowel incarcerations or perfusion is altered
Rebound and guarding
What does an increase/decrease in bowel sounds mean? What would they sound like for an obstruction
Increase: excessive peristalsis, gastroeneritis OR before level of obstruction
Decrease: decrease peristalsis, peritonitis/apendicitis OR after level of obstruction
What spot should you palpate/percuss last?
The spot that is painful
What are diagnostics tests that should be run for abdominal pain?
CBC, CMP, UA
Inflammatory markers: ESR, CRP
Pregnancy test
Stool cultures
Ultrasound/CT
Barium enema and x ray
Endoscopy
Colonoscpy
Would you use an ultrasound or CT in peds?
Ultrasound because their bellies are thin so you can see better
What are 6 important nursing diagnosis r/t GI?
- FTT or impaired weight gain
- Fluid volume deficit
- Pain
- Delayed G&D
- Risk for aspiration
- Risk for altered perfusion
What on the Bristol stool chart considered normal?
Type 3 and Type 4
How do you evaluate interventions?
Weight Gian
Pain relief
Appetite
BMs
UOP
What are nursing interventions that can be done for GI issues?
- IVF
- I&Os
- PEWS/VS
- Focused GI/respiratory
- Surgical care
- G-tube care
- Bowel regimen
- Pain management
Interventions to increase weight Gian/nutrition
Dietician, enteral feedings and supplemental nutrition
How do you decrease the risk of aspiration?
Clear airway
Positioning
Small feeds
What is gastroesophageal reflux? When does It peak? What is the treatment?
Normal baby spit up, happy spitters, asymptomatic
Peaks in 4-6 months
Resolves spontaneously, at 6 months normal foods so it will decrease and by 18 months will be completely gone
Why does gastroesophageal reflux peak at 4-6 months?
Generally happens with increase pressure on the abdomen
Sitting and rolling
When does GERD occur?
Preemies and complex diseases
How does GERD present in children?
Pain
FTT and poor weight gain
Cry during feeds
Arch away from feeding
Look like it is hurting to swallow
What does GERD increase the risk of in babies? Why?
Aspiration and apnea
Vomitting so frequently even in sleep
What is the medical management of GERD?
Position the baby upright for feeds and 20 minutes after feeds
Allow them to be prone while supervised b/c decreased pain
Feed small frequent meals and burp after every 1-2 ounces
Education parents on CPR d/t increased risk for aspiration and apnea
Medications: PPI and famotidine
Surgery required if extreme
What is the cause of gastroesophageal reflux and GERD?
Caused by a weakness in lower esophageal sphincter that allows for the contents of gastro to reflux up
Usually 1-2 ounces
What is considered delayed meconium? What are you worried about with delayed meconium?
24-36 hours of life w/o meconium
Concerned about CF, thrones, congenital hypothyroidism
When would you consider using cereal to thicken milk?
If child is not gaining weight
What are the obstructive disorders?
Pyloric stenosis
Intussiception
Hieschsprung disease
What are the interventions for obstructive disorders?
Prepare for surgery
IVF
NPO
Pain management
What are the s/s of pyloric stenosis?
Look ill and hangry - fussy
Vomiting will be impressive
Presents much sooner than GERD
Dehydrated
Weight loss
Palpate olives sized mass in epigastric region
What is the cause of pyloric stenosis? What is the treatment?
Muscle in the pyloric opening is hypertrophied and closes/obstructs the passage of good
Treatment is surgery
When does pyloric stenosis peak?
2-4 weeks of age
What is intussusception? What could it cause?
Telescoping of the intestine which leads to an obstruction
Decrease perfusion, inflammation, septic shock/death, gangrene, infection
When does intussusception peak? What is the diagnostic?
Peaks in toddlers (6 months - 3 years)
Barium enema
How do you treat intussusception?
Barium enema - force area of intestine to be straightened out but tends to return within 24 hours so need to stay overnight and be rechecked
Surgery (this is a surgical emergency if barium enema doesn’t work)
What are the s/s of intussusception?
Healthy
No appetite
Start by squatting in pain and then perk up, overtime pain is more persistent and severe
Child crying all the time doesn’t want to eat, sleep, play
Fever
Gaurding abdomen
Currant jelly like stools
Possible mass palpated
What is Hirschensprung disease?
total absence of autonomic nerve cells in a portion of the colon therefore peristalsis cannot happen in that area which created a congenital aganglionic megacolon and can lead to enterocolitis and evolve into peritonitis
What does the assessment of a child with Hirschensprung disease look like?
FTT
Fever
Distended abdomen
BS are hyperactive before obstruction and hypoactive after obstruction
Guarding abdomen
LLQ palate mass
Percuss sounds dull over the solid BM
When does Hirschensprung disease turn into a surgical emergency?
Fever and explosive/forceful diarrhea
What is the difference between Hirschensprung disease in a newborns and older infant/preschool/toddler
Newborn: full - delayed meconium
Older infant/preschool/toddler: partial - FTT, ribbon like stools, constipation, fecal masses
What do you diagnose Hirschensprung disease?
Rectal biopsy
How do you manage Hirschensprung disease?
Rectal irrigations
Surgery: remove section of bowel and pull through to the rectum OR temporary stony and pull through
Lifelong bowel stimulation and regulation (miralax, enema, digital manipulation)
What are the types of structural disorders?
Midline
Cleft lip and palate
Tracheoesophageal fistula or atresia
Abdominal wall defects
What are the risks associated with structural disorders?
Infection
Necrotizing enterocolitis
Sepsis
Chronic abdominal indues (feeding tubes)
FTT
Aspiration
What occurs in Tracheoesophageal fistula or atresia?
Trachea and esophagus are undifferentiated, become tangled or malformed
What are the s/s of Tracheoesophageal fistula or atresia? When are these seen? What type of emergency is this?
Threee C’s
Coughing, choking, cyanosis
Seen with feeds - need to stop and treat
RESPIRATORY emergency
How do you diagnose Tracheoesophageal fistula or atresia? Treatment?
Contrast abdominal x ray
Prenatal diagnosis
Treat surgically - no feeds until then
What us the first thing to do with a cleft lip/palate?
Establish a normal feeding and strong suck - may need to modify feeding techniques to allow for adequate growth
Establish a bond with parents - bond at risk
When are cleft lip/palates fixed?
6-24 months
What are the s/s of appendicitis?
Pain starts in the periumbilical/vague region –> localizes to RLQ (mcburnies point)
Pain proceeds diarrhea
Guarding
Fever
Acute pain starts within 24 hours
What are some lab values that may be different with appendicitis?
High WBC count
Increase inflammation markers
What is the peak age for appendicitis?
school age to adolescent
What is a complication of appendicitis? What are the s/s of this?
Perforation of the appendix if diagnosis is missed –> sepsis
S/s: severe pain that significantly improves and then clinical deterioration occurs
What is the difference between inflammatory bowel disease and appendicitis?
Ultrasound will show an inflamed appendix
What are the s/s of inflammatory bowel disease?
Chronic pain (3 or more months)
Pain is episodic
Joint pain
Rash
Delayed puberty
Poor growth
Bloody diarrhea
Feeling of BM but nothing comes
What is the treatment of inflammatory bowel disease?
Immune modulators
Immune suppression
Surgical management for pain
Nutritional support
How do malabsorption disorder present?
Chronic FTT
Chronic abdominal pain
Foul, greasy stools with undigested food particles
What is the patho behind celiac disease?
Immune dysregulation to the digestion of gluten
Protein touches the vili in small intestine –> inflammation and destroys vili and loose surface area in the gut that absorbs nutrients
What type of stool is associated with celiac disease?
Loose/explosive stools
How do you diagnose celiac? How do you treat it?
Biopsy to confirm diagnosis - FTT prior to
Treat by avoiding gluten which is found in wheat, rye, barely, and oats
What is occurs in cystic fibrosis?
Pancreatic insufficiency –> malabsorption because body isn’t excreting the enzymes needed to digest food
Bowel obstructions
DM
What should diet and hydration look like for a patient with CF?
high fat, high protein, high calorie diet (might not be able to consume all calories needed orally so supplement with G-tube may be needed)
2-3 L of hydration/day
What type of supplement do patients with CF need to take?
Vitamin A, D, E, and K
Pancreatic enzyme supplement every time eat
What type of stool does a patient with CF have?
Steatoea - fatty stools
