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PEDS > GI 2 > Flashcards

GI 2 Flashcards

1
Q

how do you calculate IV fluids for rehydration therapy

A

-usual wt (up to 10 kg)
-maintenance amount (100 mL/kg/24 hrs)
*then multiply % of body wt x10
this yields the mL/kg/24 hr required

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2
Q

what does the GI tract include

A

-esophagus, stomach, pancreas, SI, LI

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3
Q

children ingest and absorb nutrients through the ..

A

GI tract

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4
Q

GI peds differences

A
  • infants stomach empties in 2.5-3 hrs
  • increased rate of peristalsis d/t small stomach capacity
  • liver and pancreas do not mature until 6 mos
  • pancreatic lipase not secreted adequately
  • immature lower esophageal sphincter (prone to GE reflux)
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5
Q

what is important in the GI assessment

A

nutritional hx:

  • 24 hr recall
  • food frequency
  • food intolerance/allergy
  • food preferences
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6
Q

describe cleft lip & or palate

A
  • failure of soft tissue or bony structure to fuse
  • palate failure to close (isolated or associated with lip)
  • OR lip has failed to close (unilateral or bilateral)
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7
Q

diagnosis of cleft lip and or palate

A
  • physical exam using gloved finger in mouth

- first sign may be formula coming out of nose during feeding

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8
Q

incidence of cleft lip and or palate

A
  • cleft lip is more common (esp in males)
  • increased in asian pops and lower in african pops
  • *most common craniofacial malformation
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9
Q

normal fetal development of palate

A
  • 6th wk:maxillary processes fuse with nasal elevations on frontal prominence
  • 7th and 8th wk: upper lip merges at midline
  • 7th to 12th wk: fusion of palate
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10
Q

management of cleft lip and or palate

A
  • special feeding techniques:
  • devices (dropper, elongated nipple, brecht feeder, crosscut nipple)
  • elevate head after feeding
  • burp frequently
  • do not feed longer than 20-30 min (supplement with tube feed)
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11
Q

other issues with cleft lip and or palate

A

-dentilition, speech dysfunction, emotional issues, cosmetic concerns, chronic otitis, media cleft palate (CP)

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12
Q

describe surgery for cleft lip and or palate

A
  • cleft lip repair at 4 wks using staggered sutures

- cleft palate repair based on degree of deformity (usually by 1yr for speech development)

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13
Q

post op care of cleft lip and or palate

A
  • elbow restraints after surgery
  • keeps suture line clean
  • avoid prone position
  • prevent crying/sucking
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14
Q

describe esophageal atresia and tracheoesophageal fistula

A
  • malformation resulting from failure of esophagus to develop as a continuous tube during 4th and 5th wks gestation
  • esophagus may end in a blind pouch or develop a pouch connected to the trachea by a fistula
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15
Q

s/s of esophageal atresia

A
  • excessive salivation and drooling (difficluty to assess)
  • 3 signs: cyanosis, choking, coughing
  • **remember to assess for resp distress and assess lung sounds carefully
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16
Q

esophageal atresia is

A

a SURGICAL emergency

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17
Q

describe hypertrophic pyloric stenosis

A
  • **projectile vomiting

- hypertrophy of circular muscle of pylorus causing narrowing between stomach and duodenum

18
Q

clinical presentation of hypertrophic pyloric stenosis

A
  • dehydration
  • abdominal distention
  • palpable mass to right of umbilicus
  • visible peristalsis from L to R across epigastrum
19
Q

diagnosis of hypertrophic pyloric stenosis

A

ultrasound of upper GI

20
Q

treatment of hypertrophic pyloric stenosis

A
  • surgery (pyloramyotomy repair)

- WILL throw up initially after surgery but then will be fine

21
Q

describe GER

A

-gastric content reflux into lower esophagus results in tissue inflammation, scarring, and stricture

22
Q

clinical presentation of GER

A
  • chronic vomiting
  • hematemesis
  • FTT
  • abdominal pain
  • irritability
23
Q

diagnosis of GER

A
  • barium swallow

- endoscopy

24
Q

general treatment of GER

A
  • meds
  • thickened
  • prone with head elevated for 1-2 hrs after feeding
  • cardiac monitor
25
Q

surgery for GER

A

-NIssen fundoplication

creation of a valve mechanism with G tube for 6 wks post op

26
Q

GER meds

A
  • Antacids (neutralize activity)
  • Histamine Blockers: Zantac, Tagamet (decrease gastric acid production)
  • Metoclopramide: Reglan (increased esophageal motility and tone)
  • Cisapride: Propulsid (increased esophageal motility and tone)
27
Q

describe intussusception

A

-obstruction from teleocoping of one portion of the bowel into another portion

28
Q

s/s of intussusception

A
  • paroxysmal abd pain
  • distention
  • V
  • currant “jelly like” stools
  • palpable sausage mass in upper R quadrant
29
Q

diagnosis of intussusception

A
  • abd x ray

- barium enema

30
Q

treatment of intussusception

A
  • hydrostatic reduction using water soluble contrast and air pressure
  • surgery
31
Q

describe hirsuchsprug disease

A
  • congenital defect (familial)
  • aka congenital aganglionic megacolon
  • *absence of ganglion cells in one or more intestinal segments
  • *Results in: LACK OF PERISTALSIS, proximal bowel dilates, fecal matter accumulates
32
Q

s/s of hirsuchsprug disease

A
  • failure to pass meconium
  • bile stained (yellow and brown) vomit
  • constipation
  • frequent foul smelling, ribbon like or pellet stools
  • abd distention
  • palpable fecal mass
  • thin extremities
  • poor feeding
  • inadequate wt gain
33
Q

hirsuchsprug disease diagnostics

A
  • abd x ray
  • barium enema
  • rectal biopsy
34
Q

treatment of hirsuchsprug disease

A
  • removal or aganglionic portion of intestine
  • 2 step procedure
    1) temporary colonostomy
    2) bowel excision of agnaglionic portions and re-anastamos normal bowel to anal canal when 8-10 kg
35
Q

describe ostomies

A
  • intestinal ostomy (opening or stoma) into the small and large intestine that diverts fecal matter
  • may be elective or sugical emergency
  • outcome: evacuation of bowel and absence of infection
36
Q

describe appendicitis

A
  • inflammation of appendix(small sac structure at the end of cecum)
  • *most common childhood condition requiring surgery
37
Q

s/s of appendicitis and treatment

A
  • periumbilical pain (earliest sign)
  • THEN RLQ pain
  • test for rebound tenderness
  • treatment: surgery (appendectomy)
38
Q

describe Crohn’s disease

A

-periods of exacerbation and remission

s/s: abd pain, wt loss, cramps, anorexia, fever, rectal bleeding, peritoneal discomfort

39
Q

diagnostics of Crohn’s disease

A
  • CBC (anemia and increased WBC)
  • ESR increased
  • C reactive protein increased
  • stool sample
  • upper GI series
  • CT scan
  • barium enema
  • colonoscopy with biopsy
  • low iron, albumin, since, Mg, B12, protein
40
Q

describe IBS and s/s

A

*common cause of recurrent abd pain in children
s/s: abd pain, flatus, bloating, constipation, D, or combo
-AKA nervous stomach
-no specific test or procedure
-treatment is dietary

PEDS (24 decks)

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