GI Flashcards
Before birth, what provides nutrients?
Placenta
Describe structure and maturity of GI tract at birth, and what does this cause
Structurally complete, immature
Increased incidence of vomiting
Sucking is a reflex until
6 weeks
Why should any baby born before 34 weeks not be fed orally?
No sucking reflex
Stomach capacity at birth
1 tablespoon, 15ml
In newborns, stomach distention can lead to
Respiratory depression
When can solids begin to be digested
4 months, when pancreatic enzymes begin to be produced
Intestinal motility/peristalsis is ___________ in newborns
increased
When are pancreatic enzymes produced
4 months
When does liver maturation occur?
first year of life
By what age should a child be having 3 meals a day?
2
When should a child gain excretory control?
2-3
Why do children have more urine/kg?
inability to concentrate urine
What is the most common and serious acquired GI disorder in hospitalized preterm neonates?
Necrotizing Enterocolitis
When does NEC appear
First 2 weeks of life after milk feeding begun
What are factors thought to cause NEC?
intestinal ischemia, bacterial/viral infection, lack of breast feedings, immaturity of intestine, low birth weight
Characteristic symptoms of NEC
distention, irritability, quick deterioration
Describe the treatment following the physical assessment (positive x-ray) of a baby with NEC
Quick deterioration!!!
Treatment is prompt
> NPO
> IV fluids
> ABX
> Sx
5 Long Term Complications of NEC
Malabsorption
Short bowel
Scarring causing obstruction following surgery
Scarring within abdomen causing pain and female infertility
Venous problems r/t long term TPN
5 Complications of Prematurity
- Intraventricular Hemorrhage
- Retinopathy of Prematurity
- Feeding/nutrition
- Anemia
- Respiratory Distress Syndrome
5 Causes of Acute GI disorders (dehydration/vomiting)
- Infection
- Structural Anomalies
- Neurologic
- Endocrine
- Food poisoning
Viral Causes of Diarrhea
- Rotovirus
- Adenovirus
- Norwalk
- Cytomegalovirus
Bacterial Causes of Diarrhea
- Salmonella
- E. Coli
- Shigella
- C. Diff
Assessment of Patient with mild dehydration:
alert, soft/flat fontanelles, normal eyes, pink moist oral mucosa, elastic turgor, normal HR/BP, warm pink extremities, brisk cap refill, maybe slightly decreased urine output
8 Things to Assess for Hydration Status
- Mental Status
- Fontanels
- Eyes
- Oral Mucosa
- Skin turgor
- HR/BP
- Extremities
- Urine Output
Assessment of Patient with moderate dehydration:
alert/irritable, sunken fontanelles, mildly sunken orbits, pale/slightly dry oral mucosa, decreased turgor, increased HR, normal BP, delayed cap refill, UO < 1ml/kg/hr
Assessment of Patient with Severe Dehydration:
alert to irritable/comatose, sunken fontanels, deeply sunken orbits with no tears, dry mucosa, tenting turgor, increased HR progressing to brady, normal BP progressing to hype, cool dusky skin delayed cap refill, < 1ml/kg/hr
Treatment of mild/moderate dehydration
Oral rehydration containing sodium and glucose
Treatment of severe dehydration
bolus of NS, IV fluids D5NS
Why must dextrose/glucose be present in IV fluids for treatment of dehydration?
metabolism increases when sick
Formula for fluid maintenance
- 100ml/kg for the first 10kg
- 50ml/kg for the next 10kg
- 20ml/kg for the remainder
When does the lip develop in utero?
5-6weeks
When does the palate develop in utero?
7-9 weeks
How is cleft lip diagnosed
Finger in mouth at birth to assess palate
Lip detectable on 18 week ultrasound
When is a cleft lip repaired?
2-3 months
When is a cleft palate repaired?
6-16 months
Which position should a child be in following repair of cleft lip/palate?
upright/semi fowler, restraints, never on tummy
Complications of Cleft Lip/Palate
- susceptibility to colds
- hearing loss/otitis media
- speech/feeding difficultues
- higher incidence of dental issues
Post Op Cleft Lip Repair Nursing Diagnosis and Interventions
- inadequate nutrition
- frequent burping r/t high air intake
- Pain
- Infection (clean suture line without injury)
- Airway (try to avoid suction)
- logan bar
- SLP
What is Hirschsprung Disease
the absence of autonomic parasympathetic ganglion cells of the colon that prevents peristalsis at that portion of the intestine.
What does Hirschsprung Disease cause?
Obstruction of the intestine
Characteristic symptoms of Hirschsprung (and others)
CONSTIPATION
> failure to pass meconium
gradual onset of vomiting (bilious)
distention
When are most children with Hirschsprung symptomatic?
6 weeks to 2 months of life
What is the treatment for Hirschsprung?
Bowel Resection with Reanastomosis
What is the most common TEF?
Esophageal Atresia with Distal Transesophageal Fistula
How does a child with TEF present when born?
access amniotic fluid/saliva
What occurs after feeding a child with TEF?
Will immediately vomit/nowhere for formula to go
How is TEF diagnosed?
- A catheter is gently passed into the esophagus to check for resistance.
- A Barium Swallow test is used to diagnose the extent of the problems.
What occurs before all GI surgical procedures as treatment
All oral feedings are stopped (NPO) and intravenous fluids are started.
What can occur as a result/complication of TEF correction and what is the result?
Scar tissue at surgical site can cause stricture - frequent vomiting resulting in need for dilation under general anesthetic
What is an imperforated anus?
The passage of fecal material is obstructed by a structural anomaly of the anus and rectum.
How is imperforated anus diagnosed?
- inspection of perineum for fistula and rectal atresia
- US and GI to confirm
How does rectal atresia present?
- abdominal distention 2. vomiting
- failure to pass meconium
What occurs post-op following surgical repair of imperforated anus
- assure cleanliness; very high infx risk
- may need manual dilations in case of anal stenosis r/t scar tissue
What is intussusception?
when one portion of the bowel slides/invaginates into the next; invagination of bowel. Will slide in and out which can cause injury to bowel.
Characteristic presentation of intussusception
GELATINOUS RED STOOLS
EXTREME PAIN
SAUSAGE SHAPED MASS
Vomiting
How is intussusception treated?
Barium enema treatment resolves most issues; occasionally need surgery
What is pyloric stenosis?
Hypertrophy of the circular pylorus muscle results in stenosis of the passage between the stomach and duodenum, partially obstructing the lumen of the stomach.
How is pyloric stenosis diagnosed?
Ultrasound
Characteristic presentation (and other symptoms) of pyloric stenosis
PROJECTILE VOMITING
> failure to gain weight
> signs of dehydration
> hungry
> irritable
When are symptoms of pyloric stenosis evident
2-8 weeks
What is a nissen fundoplication?
Procedure in which stomach is wrapped and tightened for kids with extreme reflux
Why are you monitoring electrolytes for children presenting with vomiting or diarrhea?
Rx for dehydration/alteration to electrolytes
4 grades of intraventricular hemorrhage
- confined bleed
- moves into ventricles
- bleed causes increase in ventricular size
- ventricles full
Describe the oral rehydration used for a dehydrated patient
Should contain sodium and glucose
Which IV fluids are used for rehydration of patients?
NS or LR
