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GI Flashcards

Exam 2

1
Q

Pediatric anatomy and physiology GI tract

What makes up the GI tract?

A

GI tract = MOUTH –> ANUS

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2
Q

Pediatric anatomy and physiology GI tract

Primary functions of GI tract:

A

Digestion and absorption of nutrients and water

Elimination of waste products

Secretion of various substances required for digestion

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3
Q

Pediatric anatomy and physiology GI tract

When does GI tract mature?

A

*Babies are born with immature GI tracts that are not fully mature until age 2.

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4
Q

Pediatric anatomy and physiology GI tract:

How is the mouth?

A

Mouth: highly vascular; entry point of infection.

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5
Q

Pediatric anatomy and physiology GI tract: Esophagus:

A

Esophagus: LES not fully developed until age 1, causing regurgitation/reflux.

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6
Q

Pediatric anatomy and physiology GI tract:

What is newborn stomach capacity?

A

Newborn stomach capacity only 10 to 20 mL.

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7
Q

Pediatric anatomy and physiology GI tract: intestines

A

Intestines: small intestine not mature at birth.

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8
Q

Pediatric anatomy and physiology GI tract

Biliary system:

A

liver relatively large at birth;

pancreatic enzymes develop postnatally, not reaching adult levels until 2 years old.

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9
Q

Pediatric anatomy and physiology GI tract

A

Fluid balance and losses: proportionately greater amount of body water compared to adults.

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10
Q

Fluid balance and losses:

How much water in infants compared to adults?

A

Infants and children have a greater amount of body water than adults.

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11
Q

Fluid balance and losses:

How do they excrete and require compared to adults?

A

They require a larger amount of fluid intake and excrete more fluid, putting them at risk for fluid loss with illness.

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12
Q

Fluid balance and losses

What increases fluid loss?

A

FEVER increases fluid loss @ rate of 7 mL/kg/24 hour period for every sustained 1○C rise in temperature

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13
Q

Fluid balance and losses

How much fluid loss occurs from skin?

A

Fluid loss from the skin accounts for 2/3 of insensible loss.

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14
Q

Fluid balance and losses:

How is basal metabolic rate?

A

The basal metabolic rate is higher in order to support growth.

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15
Q

Fluid balance and losses: How is concentration of urine? Why?

A

Renal immaturity does not allow the kidneys to concentrate urine as well.

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16
Q

Assessment: Health history:

A

Past Medical History: previous illness, surgeries, food allergies

Family History: Irritable bowel, Crohn’s

Present illness: when the symptoms began, how does this differ from normal for them, how have the symptoms been managed so far. Dietary information.
Chronic vs. acute?

Growth patterns – is there a point in the growth curve that you see when problems began?

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17
Q

Physical exam- how should you perform exams?

A

*Always perform exam from least invasive to most invasive.

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18
Q

Physical exam:
INSPECTION AND OBSERVATION:

A

Color (skin, eye, lip),

hydration (oral mucosa pink/moist, skin turgor elastic, tenting, tears?),

abdominal size and shape (protuberant could mean ascites (fluid or gaseous distention) or be normal variant; concave could mean blockage; look at umbilicus),

mental status (irritability and restlessness are early signs of mental change; lethargy).

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19
Q

Physical exam: AUSCULTATON:

Where are you listening? What are you listening for? What should you immediately report?

A

Listen for bowel sounds in all 4 quadrants.

Hyperactive sounds can be with diarrhea or gastroenteritis

Hypoactive or absent sounds (after 5 min of auscultating) may mean obstructive process

Immediately report

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20
Q

Physical exam: Percussion

Where is dullness?

A

Can have dullness 1-3 cm below right costal margin.

Are above symphysis pubis can be dull due to full bladder.

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21
Q

Physical exam: Percussion

Where would tympany occur?

A

Percussion every where should reveal tympany.

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22
Q

Physical exam:

PALPATION:

A

Leave this last.

First palpate lightly then deep.

Look for tenderness, lesions, tone.

The cecum may be felt as soft mass in LLQ.

RLQ tenderness, including rebound.

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23
Q

Common Medical Treatments:

A

Hydration (oral, enteral and IV)
Providing adequate nutrition (oral, enteral and IV)
Enemas and bowel preparations
Ostomies—surgical opening into a digestive organ
Probiotics—support/replace intestinal microbial flora
Medications

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24
Q

slide 11

A
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25
Q

Common Laboratory and Diagnostic Tests

A

Abdominal ultrasonography

Barium swallow, small bowel series

Blood work: amylase, electrolytes, lipase, LFTs

Esophageal manometry/ esophageal pH probe

Endoscopy (gastroscopy, colonoscopy)

Hemoccult, stool sample/culture, stool O&P

Hepatobiliary (HIDA) scan

Liver biopsy

Lactose tolerance test, urea breath test

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26
Q

Acute GI Disorders

A

Dehydration, vomiting, and diarrhea
Oral candidiasis and oral lesions
Hypertrophic pyloric stenosis
Necrotizing enterocolitis
Intussusception, malrotation, and volvulus
Appendicitis

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27
Q

Risk Factors for Gastrointestinal Disorders

A

Prematurity
Family history
Genetic syndromes
Chronic illness
Prenatal factors
Exposure to infectious agents
Foreign travel
Immune deficiency, chronic steroid use

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28
Q

Risk Factors for Dehydration

A

Diarrhea
Vomiting
Decreased oral intake
Sustained high fever
Diabetic ketoacidosis
Extensive burns

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29
Q

Dehydration: How is it rated?

A

By severity

Mild

Moderate

Severe

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30
Q

Dehydration:

Clinical Assessment

A

% of body weight loss

Level of consciousness

Blood pressure/Pulse

Skin turgor

Mucous membranes

Urine

Thirst

Fontanel/Respirations/

Eyes

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31
Q

What could depressed fontanel indicate?

A

Dehydration

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32
Q

20% of all deaths in developing countries are related to

A

diarrhea and dehydration

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33
Q

leading cause of illness in children <5 years

A

Acute diarrhea is leading cause of illness in children <5 years

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34
Q

Acute infectious diarrhea:

What is cause?

A

variety of causative organisms

Most pathogens are spread by fecal-oral route

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35
Q

Stool Collection Techniques

A

Diapers

Runny stool

Older ambulatory child

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36
Q

Stool Collection Techniques: Diapers

A

Use a tongue blade to scrape a specimen into the collection container.

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37
Q

Stool Collection Techniques: Runny stool

A

A piece of plastic wrap in the diaper may catch the specimen

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38
Q

Stool Collection Techniques: Runny stool

What may very runny stool require?

A

Very liquid stool may require application of a urine bag to the anal area

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39
Q

Stool Collection Techniques:
Older ambulatory child

A

First urinate in the toilet

Clean collection container fitting under the seat at the back of the toilet

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40
Q

Stool Collection Techniques:

When collecting, what should you not allow?

A

Do not allow urine to contaminate the stool specimen

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41
Q

Risk Factors for Intussusception

A

Male gender (higher incidence)
Meckel diverticulum
Duplication cysts
Polyps, hemangiomas, tumors
Appendix
Cystic fibrosis
Celiac disease
Crohn disease

42
Q

Intussusception

A

a serious condition in which part of the intestine slides into an adjacent part of the intestine.

43
Q

Structural Anomalies of the GI Tract

A

Cleft lip and palate
Omphalocele and gastroschisis
Hernias (inguinal and umbilical)
Anorectal malformations

44
Q

Cleft Lip/Cleft Palate

A

Facial malformations that occur during embryonic development-

45
Q

Cleft Lip/Cleft Palate- Why would Facial malformations that occur during embryonic development?

A

genetic link may be related to prenatal issue of smoking, use of steroids, alcohol, anticonvulsant meds (teratogentic)

46
Q

Cleft Lip/Cleft Palate:

How does the condition appear? isolated?

A

May appear as an isolated anomaly but may be associated with other syndromes ( Velo-cardial facial Syndrome (Shprintzen syndrome- cleft palate, cardiac anomaly, learning disability) Trisomy 3 and 18.

47
Q

Cleft Lip/Cleft Palate:

Diagnostic evaluation:

A

apparent at birth.

48
Q

Cleft Lip/Cleft Palate:

Diagnostic evaluation: Severity has impact on what?

A

Severity has impact on feeding- cleft of the hard and soft palate form a continuous opening between the mouth and nasal cavity but ability to swallow is normal

49
Q

Anomalies Associated With Cleft Lip and Palate

A

Heart defects
Ear malformations
Skeletal deformities
Genitourinary abnormality

50
Q

Complications Associated With Cleft Lip and Palate

A

Feeding difficulties
Altered dentition
Delayed or altered speech development
Otitis media

51
Q

Hypertrophic Pyloric Stenosis (HPS)

A

Constriction of pyloric sphincter with obstruction of gastric outlet

52
Q

Hypertrophic Pyloric Stenosis (HPS)- When does it develop?

A

Usually develops in first 2 to 5 weeks of life

53
Q

Hypertrophic Pyloric Stenosis (HPS)

Signs/Symptoms:

A

projectile vomiting after feeding (3-4 feet when side lying) ,

non-bilious, may be blood tinged,

infant hungry,

possible dehydration,

palpable OLIVE-SHAPED tumor in epigastrium (just right of umbilicus- hypertrophied pylorus)

54
Q

Hypertrophic Pyloric Stenosis (HPS)
Incidence :

A

1-3 per 1000 live births

55
Q

Hypertrophic Pyloric Stenosis (HPS):

Diagnostic evaluation:

A

history and physical (olive shaped mass) may perform ultrasound if unable to palpate

56
Q

Hypertrophic Pyloric Stenosis (HPS)

Therapeutic management:

A

surgical laparoscopic procedure

57
Q

Hypertrophic Pyloric Stenosis (HPS)

Prognosis:

A

most infants recover completely

58
Q

Hypertrophic Pyloric Stenosis (HPS)

Nursing considerations:

A

Pre-op- restore hydration and electrolyte status. Post-op- IV fluids until infant feeds, vomiting may occur for 24-48 hours until they can tolerate po feeds, monitor vital signs, I&O’s, pain management

59
Q

Most common cause of acute intestinal obstruction in children < 5 years of age (typical 3mo-3yrs)

A

Intussusception

60
Q

Intussusception. Pathophysiology:

A

Bowel telescopes into another segment of bowel-ischemia of bowel may result

61
Q

Intussusception is a result of what?

A

Occasionally a result of intestinal lesions-polyp, lymphoma, meckel diverticulum ( congenital pouching on wall of intestine)

62
Q

Intussusception- Cause?

A

Often cause is unknown: hypertrophy of intestinal lymphoid tissue secondary to viral infection

63
Q

Intussusception: Clinical Manifestations

A

Sudden acute abdominal pain

Child screaming & drawing knees to chest

Child appear normal & comfortable
between episodes of pain

Vomiting; Lethargy

Passage of red currant jelly-like stool
(mixed with blood & mucous)

Tender, distended abdomen

Palpable sausage-shaped mass in URQ

Fever

64
Q

***BLACK OR RED JELLY LIKE STOOL

A

***BLACK OR RED JELLY LIKE STOOL is a sign of intussusception

65
Q

Intussusception:

Diagnostic evaluation:

A

confirmed by ultrasound, spontaneous reduction can occur in 10% of cases

66
Q

Intussusception

Therapeutic management:

A

air enema with/without water-soluble contrast

67
Q

Intussusception

Prognosis:

A

80% non-operative reduction, surgery if indicated (surgeon will manually reduce the affected area if not possible with resect area and re-anastomose)

68
Q

Intussusception:

Nursing considerations:

A

pre-op: NPO, CBC, electrolytes post-op/procedure: nurse must observe for passage of water soluble material

69
Q

Chronic GI Disorders

A

Gastroesophageal reflux, peptic ulcer disease

Constipation/encopresis

Hirschsprung disease

Inflammatory bowel disease

Celiac disease

Recurrent abdominal pain

Failure to thrive and chronic feeding problems

70
Q

Constipation

A

An alteration in frequency, consistency, or ease of passage of stool

71
Q

Constipation- How is it caused?

A

May be secondary to other disorders : strictures/ectopic anus, hypothyroidism, Vit D excess, chronic lead poisoning-meds: iron supp, diuretics)

72
Q

Constipation:

Idiopathic

A

Idiopathic (functional) constipation—no known cause

73
Q

Constipation

Chronic constipation

A

Chronic constipation—may be due to environmental or psychosocial factors

74
Q

Constipation in Infancy
\What is it related to?

What kind of baby fed infants usually get constipation? What are interventions?

A

Often related to diet

Constipation in exclusively breast-fed infant almost unknown

Formula-fed infants may develop constipation

Interventions : increase fruits, vegetables, cereals

75
Q

Constipation in Childhood:

WHat is it often a result of?

A

Often a result of environmental changes or control over body functions

76
Q

Constipation in Childhood:

Encopresis:

A

Encopresis: constipation with fecal soiling (holding)

77
Q

Constipation in Childhood:

What may is result from?

A

May result from stress

78
Q

Constipation in Childhood- What is management?

A

Management- increase fiber, vegetables, medication: ie Miralax

79
Q

Gastroesophageal Reflux (GER):

What is it defined as?

A

Defined as transfer of gastric contents into the esophagus

80
Q

Gastroesophageal Reflux (GER)- Who does it occur in?

A

Occurs in everyone

81
Q

Gastroesophageal Reflux (GER)

What makes this abnormal even though it occurs in everyone?

A

Frequency and persistency may make it abnormal

82
Q

Gastroesophageal Reflux (GER)- What can it occur without?

A

May occur without GERD

83
Q

Gastroesophageal Reflux (GER)

How can GERD appear?

A

GERD may occur without regurgitation

84
Q

GER Symptoms in infants?

A

Spitting up, regurgitation, vomiting, excessive crying, irritability, arching of back, stiffening

Weight loss, FTT

Respiratory problems

Hematemesis

Apnea

85
Q

GER Symptoms: Children

A

Heart burn
Abdominal pain
Non-cardiac chest pain
Chronic cough
Dysphagia
Nocturnal asthma
Recurrent pneumonia

86
Q

GERD: When does GER become a disease?

A

GER becomes a disease when complications develop

87
Q

GERD: WHat is it associated with? What are examples?

A

Associated with respiratory symptoms : wheezing, chronic cough (at night-nocturnal asthma), infants arching of back

88
Q

GERD: What can predispose children to high prevalence?

A

Certain conditions predispose children to high prevalence: premie with neurological impairment, hiatal hernia, morbid obesity

88
Q

Signs and Symptoms of Crohn Disease and Ulcerative Colitis

A

Abdominal cramping
Nighttime symptoms, including waking due to abdominal pain or urge to defecate
Fever
Weight loss
Poor growth
Delayed sexual development

89
Q

Rome Committee 12-Week Criteria for Irritable Bowel Syndrome

A

Abdominal pain relieved by defecation.

Onset of pain or discomfort associated
with a change in frequency of stool.

Onset of pain or discomfort associated with a change in form of stool.

No structural or metabolic explanation for this abdominal pain.

Types can be designated as constipation, diarrheal, or mixed.

90
Q

Hepatobiliary Disorders

A

Pancreatitis
Gallbladder disease
Jaundice
Biliary atresia
Hepatitis (multiple types)
Cirrhosis and portal hypertension
Liver transplantation

91
Q

Colostomy and Ileostomy

A

slide 40

92
Q

Nursing Management of the Newborn With Omphalocele or Gastroschisis

What are goals?

A

Preventing hypothermia, maintaining perfusion to the eviscerated abdominal contents by minimizing fluid loss, and protecting the exposed abdominal contents from trauma and infection.

93
Q

Nursing Management of the Newborn With Omphalocele or Gastroschisis

What are interventions?

A

Cover the abdominal contents with a non-adherent sterile dressing avoiding trauma to the intestine, cover with plastic wrap to minimize heat and fluid loss; prevent abdominal distention with low suction to orogastric tube, monitor fluid status.

94
Q

Nursing Management of a Newborn With Meckel Diverticulum:

Signs and symptoms?

A

Bleeding, anemia, severe colicky abdominal pain.

Abdominal distention, hypoactive bowel sounds, guarding, abdominal mass, rebound tenderness.

95
Q

Nursing Management of a Newborn With Meckel Diverticulum:

Management

A

Administer ordered blood products and IV fluids.

Maintain NPO status.

Perform postoperative care and family education.

96
Q

Oral Rehydration Therapy: What should it contain?

A

Oral rehydration solution (ORS) should contain 75 mmol/L sodium chloride and 13.5 g/L glucose (standard ORS solutions include Pedialyte, Infalyte, and Ricelyte).

97
Q

Oral Rehydration Therapy: What is not appropriate for oral rehydration?

A

Tap water, milk, undiluted fruit juice, soup, and broth are NOT appropriate for oral rehydration.

98
Q

Oral Rehydration Therapy: What do children with mild to moderate dehydration require?

A

Children with mild to moderate dehydration require 50 to 100 mL/kg of ORS over 4 hours.

99
Q

Oral Rehydration Therapy:

After reeval, what may need to occur if child is still dehydrated?

A

After reevaluation, oral rehydration may need to be continued if the child is still dehydrated.

100
Q

Oral Rehydration Therapy:

What can occur after rehydration in child?

A

When rehydrated, the child can resume a regular diet.

Peds (15 decks)

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