GI Flashcards
Exam 2
Pediatric anatomy and physiology GI tract
What makes up the GI tract?
GI tract = MOUTH –> ANUS
Pediatric anatomy and physiology GI tract
Primary functions of GI tract:
Digestion and absorption of nutrients and water
Elimination of waste products
Secretion of various substances required for digestion
Pediatric anatomy and physiology GI tract
When does GI tract mature?
*Babies are born with immature GI tracts that are not fully mature until age 2.
Pediatric anatomy and physiology GI tract:
How is the mouth?
Mouth: highly vascular; entry point of infection.
Pediatric anatomy and physiology GI tract: Esophagus:
Esophagus: LES not fully developed until age 1, causing regurgitation/reflux.
Pediatric anatomy and physiology GI tract:
What is newborn stomach capacity?
Newborn stomach capacity only 10 to 20 mL.
Pediatric anatomy and physiology GI tract: intestines
Intestines: small intestine not mature at birth.
Pediatric anatomy and physiology GI tract
Biliary system:
liver relatively large at birth;
pancreatic enzymes develop postnatally, not reaching adult levels until 2 years old.
Pediatric anatomy and physiology GI tract
Fluid balance and losses: proportionately greater amount of body water compared to adults.
Fluid balance and losses:
How much water in infants compared to adults?
Infants and children have a greater amount of body water than adults.
Fluid balance and losses:
How do they excrete and require compared to adults?
They require a larger amount of fluid intake and excrete more fluid, putting them at risk for fluid loss with illness.
Fluid balance and losses
What increases fluid loss?
FEVER increases fluid loss @ rate of 7 mL/kg/24 hour period for every sustained 1○C rise in temperature
Fluid balance and losses
How much fluid loss occurs from skin?
Fluid loss from the skin accounts for 2/3 of insensible loss.
Fluid balance and losses:
How is basal metabolic rate?
The basal metabolic rate is higher in order to support growth.
Fluid balance and losses: How is concentration of urine? Why?
Renal immaturity does not allow the kidneys to concentrate urine as well.
Assessment: Health history:
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?
Physical exam- how should you perform exams?
*Always perform exam from least invasive to most invasive.
Physical exam:
INSPECTION AND OBSERVATION:
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).
Physical exam: AUSCULTATON:
Where are you listening? What are you listening for? What should you immediately report?
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
Physical exam: Percussion
Where is dullness?
Can have dullness 1-3 cm below right costal margin.
Are above symphysis pubis can be dull due to full bladder.
Physical exam: Percussion
Where would tympany occur?
Percussion every where should reveal tympany.
Physical exam:
PALPATION:
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.
Common Medical Treatments:
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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Common Laboratory and Diagnostic Tests
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
Acute GI Disorders
Dehydration, vomiting, and diarrhea
Oral candidiasis and oral lesions
Hypertrophic pyloric stenosis
Necrotizing enterocolitis
Intussusception, malrotation, and volvulus
Appendicitis
Risk Factors for Gastrointestinal Disorders
Prematurity
Family history
Genetic syndromes
Chronic illness
Prenatal factors
Exposure to infectious agents
Foreign travel
Immune deficiency, chronic steroid use
Risk Factors for Dehydration
Diarrhea
Vomiting
Decreased oral intake
Sustained high fever
Diabetic ketoacidosis
Extensive burns
Dehydration: How is it rated?
By severity
Mild
Moderate
Severe
Dehydration:
Clinical Assessment
% of body weight loss
Level of consciousness
Blood pressure/Pulse
Skin turgor
Mucous membranes
Urine
Thirst
Fontanel/Respirations/
Eyes
What could depressed fontanel indicate?
Dehydration
20% of all deaths in developing countries are related to
diarrhea and dehydration
leading cause of illness in children <5 years
Acute diarrhea is leading cause of illness in children <5 years
Acute infectious diarrhea:
What is cause?
variety of causative organisms
Most pathogens are spread by fecal-oral route
Stool Collection Techniques
Diapers
Runny stool
Older ambulatory child
Stool Collection Techniques: Diapers
Use a tongue blade to scrape a specimen into the collection container.
Stool Collection Techniques: Runny stool
A piece of plastic wrap in the diaper may catch the specimen
Stool Collection Techniques: Runny stool
What may very runny stool require?
Very liquid stool may require application of a urine bag to the anal area
Stool Collection Techniques:
Older ambulatory child
First urinate in the toilet
Clean collection container fitting under the seat at the back of the toilet
Stool Collection Techniques:
When collecting, what should you not allow?
Do not allow urine to contaminate the stool specimen
Risk Factors for Intussusception
Male gender (higher incidence)
Meckel diverticulum
Duplication cysts
Polyps, hemangiomas, tumors
Appendix
Cystic fibrosis
Celiac disease
Crohn disease
Intussusception
a serious condition in which part of the intestine slides into an adjacent part of the intestine.
Structural Anomalies of the GI Tract
Cleft lip and palate
Omphalocele and gastroschisis
Hernias (inguinal and umbilical)
Anorectal malformations
Cleft Lip/Cleft Palate
Facial malformations that occur during embryonic development-
Cleft Lip/Cleft Palate- Why would Facial malformations that occur during embryonic development?
genetic link may be related to prenatal issue of smoking, use of steroids, alcohol, anticonvulsant meds (teratogentic)
Cleft Lip/Cleft Palate:
How does the condition appear? isolated?
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.
Cleft Lip/Cleft Palate:
Diagnostic evaluation:
apparent at birth.
Cleft Lip/Cleft Palate:
Diagnostic evaluation: Severity has impact on what?
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
Anomalies Associated With Cleft Lip and Palate
Heart defects
Ear malformations
Skeletal deformities
Genitourinary abnormality
Complications Associated With Cleft Lip and Palate
Feeding difficulties
Altered dentition
Delayed or altered speech development
Otitis media
Hypertrophic Pyloric Stenosis (HPS)
Constriction of pyloric sphincter with obstruction of gastric outlet
Hypertrophic Pyloric Stenosis (HPS)- When does it develop?
Usually develops in first 2 to 5 weeks of life
Hypertrophic Pyloric Stenosis (HPS)
Signs/Symptoms:
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)
Hypertrophic Pyloric Stenosis (HPS)
Incidence :
1-3 per 1000 live births
Hypertrophic Pyloric Stenosis (HPS):
Diagnostic evaluation:
history and physical (olive shaped mass) may perform ultrasound if unable to palpate
Hypertrophic Pyloric Stenosis (HPS)
Therapeutic management:
surgical laparoscopic procedure
Hypertrophic Pyloric Stenosis (HPS)
Prognosis:
most infants recover completely
Hypertrophic Pyloric Stenosis (HPS)
Nursing considerations:
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
Most common cause of acute intestinal obstruction in children < 5 years of age (typical 3mo-3yrs)
Intussusception
Intussusception. Pathophysiology:
Bowel telescopes into another segment of bowel-ischemia of bowel may result
Intussusception is a result of what?
Occasionally a result of intestinal lesions-polyp, lymphoma, meckel diverticulum ( congenital pouching on wall of intestine)
Intussusception- Cause?
Often cause is unknown: hypertrophy of intestinal lymphoid tissue secondary to viral infection
Intussusception: Clinical Manifestations
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
***BLACK OR RED JELLY LIKE STOOL
***BLACK OR RED JELLY LIKE STOOL is a sign of intussusception
Intussusception:
Diagnostic evaluation:
confirmed by ultrasound, spontaneous reduction can occur in 10% of cases
Intussusception
Therapeutic management:
air enema with/without water-soluble contrast
Intussusception
Prognosis:
80% non-operative reduction, surgery if indicated (surgeon will manually reduce the affected area if not possible with resect area and re-anastomose)
Intussusception:
Nursing considerations:
pre-op: NPO, CBC, electrolytes post-op/procedure: nurse must observe for passage of water soluble material
Chronic GI Disorders
Gastroesophageal reflux, peptic ulcer disease
Constipation/encopresis
Hirschsprung disease
Inflammatory bowel disease
Celiac disease
Recurrent abdominal pain
Failure to thrive and chronic feeding problems
Constipation
An alteration in frequency, consistency, or ease of passage of stool
Constipation- How is it caused?
May be secondary to other disorders : strictures/ectopic anus, hypothyroidism, Vit D excess, chronic lead poisoning-meds: iron supp, diuretics)
Constipation:
Idiopathic
Idiopathic (functional) constipation—no known cause
Constipation
Chronic constipation
Chronic constipation—may be due to environmental or psychosocial factors
Constipation in Infancy
\What is it related to?
What kind of baby fed infants usually get constipation? What are interventions?
Often related to diet
Constipation in exclusively breast-fed infant almost unknown
Formula-fed infants may develop constipation
Interventions : increase fruits, vegetables, cereals
Constipation in Childhood:
WHat is it often a result of?
Often a result of environmental changes or control over body functions
Constipation in Childhood:
Encopresis:
Encopresis: constipation with fecal soiling (holding)
Constipation in Childhood:
What may is result from?
May result from stress
Constipation in Childhood- What is management?
Management- increase fiber, vegetables, medication: ie Miralax
Gastroesophageal Reflux (GER):
What is it defined as?
Defined as transfer of gastric contents into the esophagus
Gastroesophageal Reflux (GER)- Who does it occur in?
Occurs in everyone
Gastroesophageal Reflux (GER)
What makes this abnormal even though it occurs in everyone?
Frequency and persistency may make it abnormal
Gastroesophageal Reflux (GER)- What can it occur without?
May occur without GERD
Gastroesophageal Reflux (GER)
How can GERD appear?
GERD may occur without regurgitation
GER Symptoms in infants?
Spitting up, regurgitation, vomiting, excessive crying, irritability, arching of back, stiffening
Weight loss, FTT
Respiratory problems
Hematemesis
Apnea
GER Symptoms: Children
Heart burn
Abdominal pain
Non-cardiac chest pain
Chronic cough
Dysphagia
Nocturnal asthma
Recurrent pneumonia
GERD: When does GER become a disease?
GER becomes a disease when complications develop
GERD: WHat is it associated with? What are examples?
Associated with respiratory symptoms : wheezing, chronic cough (at night-nocturnal asthma), infants arching of back
GERD: What can predispose children to high prevalence?
Certain conditions predispose children to high prevalence: premie with neurological impairment, hiatal hernia, morbid obesity
Signs and Symptoms of Crohn Disease and Ulcerative Colitis
Abdominal cramping
Nighttime symptoms, including waking due to abdominal pain or urge to defecate
Fever
Weight loss
Poor growth
Delayed sexual development
Rome Committee 12-Week Criteria for Irritable Bowel Syndrome
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.
Hepatobiliary Disorders
Pancreatitis
Gallbladder disease
Jaundice
Biliary atresia
Hepatitis (multiple types)
Cirrhosis and portal hypertension
Liver transplantation
Colostomy and Ileostomy
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Nursing Management of the Newborn With Omphalocele or Gastroschisis
What are goals?
Preventing hypothermia, maintaining perfusion to the eviscerated abdominal contents by minimizing fluid loss, and protecting the exposed abdominal contents from trauma and infection.
Nursing Management of the Newborn With Omphalocele or Gastroschisis
What are interventions?
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.
Nursing Management of a Newborn With Meckel Diverticulum:
Signs and symptoms?
Bleeding, anemia, severe colicky abdominal pain.
Abdominal distention, hypoactive bowel sounds, guarding, abdominal mass, rebound tenderness.
Nursing Management of a Newborn With Meckel Diverticulum:
Management
Administer ordered blood products and IV fluids.
Maintain NPO status.
Perform postoperative care and family education.
Oral Rehydration Therapy: What should it contain?
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).
Oral Rehydration Therapy: What is not appropriate for oral rehydration?
Tap water, milk, undiluted fruit juice, soup, and broth are NOT appropriate for oral rehydration.
Oral Rehydration Therapy: What do children with mild to moderate dehydration require?
Children with mild to moderate dehydration require 50 to 100 mL/kg of ORS over 4 hours.
Oral Rehydration Therapy:
After reeval, what may need to occur if child is still dehydrated?
After reevaluation, oral rehydration may need to be continued if the child is still dehydrated.
Oral Rehydration Therapy:
What can occur after rehydration in child?
When rehydrated, the child can resume a regular diet.
