GI Flashcards
GERD sx
Vomiting and regurgitation - non-bilious Crying Irritable - esophagitis Refusal to eat Failure to thrive Apnea, aspiration URI
GERD diagnosis
Esophageal probe study with a pH probe (apple juice)
GERD tx
Dietary modifications Small frequent feedings Thickening formula w/ cereal or oatmeal Prone position Elevate HOB Meds: antacids, prokinetics and acid suppression
Opening through which food passes from the stomach to the intestines
Pylorus
Pyloric stenosis
Sphincter hypertrophies and leads to a narrowed opening and obstruction to the flow of food into the intestines
Pyloric stenosis sx
Projectile vomiting No bile Hungry infant and wants to eat Dehydration Weight loss
Pyloric stenosis diagnosis
Palpate the hypertrophied pylorus (olive shaped mass)
Difference btwn GERD and pyloric stenosis
GERD:
oozing vomit, don’t want to eat, aspiration pneumonia, UGI, rice cereal/antacids
PYLORIC:
projectile vomit, want to eat, palpate mass/U.S.,
Pyloric stenosis tx
Pylormyotomy
Begin feeds slowly
Pyloric stenosis pre op mgmt
Correct dehydration Daily wt on same scale NPO- pacifier I & O - specific gravity Weigh diapers NG prep
When to begin feedings with Pyloric stenosis
As soon as bowel sounds present
Segment of bowel telescoped into an adjacent intestine
Intussusception
Intussusception occurrence
3-9 months
Intussusception sx
Colic Abd. pain Vomiting Currant jelly like stools Big baby- obstructed stomach
Intussusception diagnosis
U.S.
Barium enema - perforation
Intussusception tx
Barium enema
Air enema
Surgery
NPO w/ NG tube
Absence of parasympathetic ganglion in the large intestine
Hirschsprung’s disease
What does Hirschsprung’s cause?
Prevents peristalsis and causes feces to accumulate proximal to the defect and leads to a bowel obstruction
Where is the section w/out ganglion located?
Recto sigmoid area
Hirschsprung’s sx
Failure to pass meconium w/in 24 - 48 hr p birth Abd. distention Bile stained vomit Refusal to sat Intestinal obstruction Enterocolitis Colon->rupture->sepsis->death
Hirschsprung’s diagnosis
Commonly found around 1 year of age bc the signs and symptoms aren’t as bad; put off
Hirschsprung’s tx
Surgical, w/in 2 stages
Hirschsprung’s tx stage 1
Temporary colostomy of the normal bowel allows bowel to rest and child to gain wt
Hirschsprung’s tx stage 2
Affected area is resected/removed and the normal bowel is reanastomosed to the rectum. Colostomy is closed
What should be questioned with Hirschsprung’s?
Chronic constipation
Hirschsprung’s mgmt
Colostomy care
NPO w/ NG tube
Absence of anal opening
Imperforate anus
What is Imperforate anus associated with?
Defects of the urinary tract, esophagus and intestines
Imperforate anus sx
Obvious at birth
Stool coming from vagina due to a fistula
Unable to take rectal temp
Imperforate anus diagnosis
Baby held upside down to allow air to ride into anal area
Imperforate anus tx
Depends on extent..
Anal stenosis: dilation of anus anoplasty
High malformations: colostomy and reanastomsis
Imperforate anus mgmt
Assess patency by taking rectal temp on newborn
Note failure to pass meconium first 24-48 hr
Observe rectal dimple
Record stools/meconium
Who is at high risk post op due to urine and feces?
Imperforate anus pt
Gluten sensitive enteropathy
Celiac disease
BROW
Intolerance gluten and the protein to barley, rye, oats and wheat for celiac disease
Celiac sx
Anorexia Abd. distention Diarrhea Irritability Listlessness Large amt of unabsorbed fat in stools Stools are bulky, foul, smelling and float Wt loss
What does a celiac biopsy of the small bowel show?
Atrophy of the villi
Cereal/ flours
Gluten free: Buckwheat, rice flour, corn, tapioca, soya
Gluten: wheat, bran, barely, rye, semolina, barley, pearl barley
Dairy products and eggs
Gluten free: Eggs, milk, cheese, butter, cream, curd cheese
Gluten: yogurts, cheese spreads
Beverages
Gluten free: coffee, tea, herb tea, cocoa, alc.
Gluten: malted drinks
Fruits and vegetables
Gluten free: All
Nuts and seeds, beans
Gluten free: All except certain baked beans
Preserves
Gluten free: Jams, syrup, marmalade
Miscellaneous
Gluten free: salt, pepper, vinegar, herbs, tamari, yeast
Gluten: soy
Extrusion of abd. contents, large and small intestine w/out umbilical cord
Gastroischesis
Gastroischesis appearance
To the right of the umbilical cord
No protective sac covering intestines
Extrusion of abd. contents and umbilical cord
Oomphalocele
Oomphalocele appearance
Centrally located with a sac
Gastroischesis / Oomphalocele sx
Obvious at birth
Detected during U.S. before birth - c/section
Gastroischesis / Oomphalocele tx
Depends on size
Silo to slowly force contents back in
Done over 7-10 days
Gastroischesis / Oomphalocele mgmt
Temperature
Prevent infection
Maintain tissue perfusion
Allow intestines to protrude through umbilical ring defect during crying/straining
Umbilical hernia
Umbilical hernia tx
May spontaneously close by 3-4 yrs
Surgery
When does a hernia need to be reported immediately?
With excessive crying and discoloration of the hernia
Herniation of the abd. contents through a defect in the diaphragm into the chest
Diaphragmatic hernia
Diaphragmatic hernia location
Left side
Diaphragmatic hernia incidence
8 weeks of gestation
Diaphragmatic hernia sx
Severe resp. distress Cyanosis Tachypnea Absent breath sounds of affected side Barrel chest Shifted heart sounds Bowel sounds in chest Flat abd.
Necrosis of the mucosa of the small and large intestine
Necrotizing enterocolitis
Necrotizing enterocolitis incidence
Affects both sexes and races equally
What causes Necrotizing enterocolitis?
Intestinal ischemia, bacterial coloniation or formula thas hypertonic
What does Necrotizing enterocolitis lead to?
Decreased bl. flow to the bowel-> ischemia of intestinal mucosa.
Distended/ swollen bowel-> sepsis-> perforation of bowel
Necrotizing enterocolitis sx
Abd. tenderness Distention Bloody stools Decreased bowel sounds Increased gastric residuals Shock-> apnea-> brady
Necrotizing enterocolitis tx
Stop oral feedings NG tube O2/vent. Surgery Resect necrotic bowel - colostomy ->short bowel syndrome w/malabsorption
Necrotizing enterocolitis mgmt
Check stools for blood
Abd. girths (mark w/ pen)
Check feeing residuals before feeds
Assess bowel sounds
Absence or obstruction of the bile ducts outside the liver preventing flow of the bile from the liver to the intestines
Biliary atresia
Most frequent reason for liver transplant in children
Biliary atresia
Biliary atresia sx
Newborn asymptomatic ^ becomes jaundiced w/in 2 weeks-2 mos. Urine is tea Stools are light in color Hepatomegaly Failure to thrive / malnutrition
Why is the urine tea colored with Biliary atresia?
Excretion of bilirubin
Why are the stools light in color with Biliary atresia?
Absence of bile pigments
Biliary atresia labs
^ bili ^ AST ^ ALP ^ ammonia Prolonged PT
Biliary atresia tx
Surgery for obstruction Kasai procedure (not a cure; die waiting)
