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exam 3 > GI > Flashcards

GI Flashcards

1
Q

GERD sx

A 
Vomiting and regurgitation - non-bilious
Crying
Irritable - esophagitis
Refusal to eat
Failure to thrive
Apnea, aspiration
URI
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2
Q

GERD diagnosis

A

Esophageal probe study with a pH probe (apple juice)

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3
Q

GERD tx

A 
Dietary modifications
Small frequent feedings
Thickening formula w/ cereal or oatmeal
Prone position
Elevate HOB
Meds: antacids, prokinetics and acid suppression
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4
Q

Opening through which food passes from the stomach to the intestines

A

Pylorus

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5
Q

Pyloric stenosis

A

Sphincter hypertrophies and leads to a narrowed opening and obstruction to the flow of food into the intestines

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6
Q

Pyloric stenosis sx

A 
Projectile vomiting
No bile
Hungry infant and wants to eat
Dehydration
Weight loss
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7
Q

Pyloric stenosis diagnosis

A

Palpate the hypertrophied pylorus (olive shaped mass)

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8
Q

Difference btwn GERD and pyloric stenosis

A

GERD:
oozing vomit, don’t want to eat, aspiration pneumonia, UGI, rice cereal/antacids
PYLORIC:
projectile vomit, want to eat, palpate mass/U.S.,

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9
Q

Pyloric stenosis tx

A

Pylormyotomy

Begin feeds slowly

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10
Q

Pyloric stenosis pre op mgmt

A 
Correct dehydration
Daily wt on same scale
NPO- pacifier
I & O - specific gravity
Weigh diapers
NG prep
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11
Q

When to begin feedings with Pyloric stenosis

A

As soon as bowel sounds present

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12
Q

Segment of bowel telescoped into an adjacent intestine

A

Intussusception

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13
Q

Intussusception occurrence

A

3-9 months

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14
Q

Intussusception sx

A 
Colic
Abd. pain
Vomiting
Currant jelly like stools
Big baby- obstructed stomach
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15
Q

Intussusception diagnosis

A

U.S.

Barium enema - perforation

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16
Q

Intussusception tx

A

Barium enema
Air enema
Surgery
NPO w/ NG tube

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17
Q

Absence of parasympathetic ganglion in the large intestine

A

Hirschsprung’s disease

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18
Q

What does Hirschsprung’s cause?

A

Prevents peristalsis and causes feces to accumulate proximal to the defect and leads to a bowel obstruction

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19
Q

Where is the section w/out ganglion located?

A

Recto sigmoid area

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20
Q

Hirschsprung’s sx

A 
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
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21
Q

Hirschsprung’s diagnosis

A

Commonly found around 1 year of age bc the signs and symptoms aren’t as bad; put off

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22
Q

Hirschsprung’s tx

A

Surgical, w/in 2 stages

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23
Q

Hirschsprung’s tx stage 1

A

Temporary colostomy of the normal bowel allows bowel to rest and child to gain wt

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24
Q

Hirschsprung’s tx stage 2

A

Affected area is resected/removed and the normal bowel is reanastomosed to the rectum. Colostomy is closed

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25
Q

What should be questioned with Hirschsprung’s?

A

Chronic constipation

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26
Q

Hirschsprung’s mgmt

A

Colostomy care

NPO w/ NG tube

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27
Q

Absence of anal opening

A

Imperforate anus

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28
Q

What is Imperforate anus associated with?

A

Defects of the urinary tract, esophagus and intestines

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29
Q

Imperforate anus sx

A

Obvious at birth
Stool coming from vagina due to a fistula
Unable to take rectal temp

30
Q

Imperforate anus diagnosis

A

Baby held upside down to allow air to ride into anal area

31
Q

Imperforate anus tx

A

Depends on extent..
Anal stenosis: dilation of anus anoplasty
High malformations: colostomy and reanastomsis

32
Q

Imperforate anus mgmt

A

Assess patency by taking rectal temp on newborn
Note failure to pass meconium first 24-48 hr
Observe rectal dimple
Record stools/meconium

33
Q

Who is at high risk post op due to urine and feces?

A

Imperforate anus pt

34
Q

Gluten sensitive enteropathy

A

Celiac disease

35
Q

BROW

A

Intolerance gluten and the protein to barley, rye, oats and wheat for celiac disease

36
Q

Celiac sx

A 
Anorexia
Abd. distention
Diarrhea
Irritability
Listlessness
Large amt of unabsorbed fat in stools
Stools are bulky, foul, smelling and float
Wt loss
37
Q

What does a celiac biopsy of the small bowel show?

A

Atrophy of the villi

38
Q

Cereal/ flours

A

Gluten free: Buckwheat, rice flour, corn, tapioca, soya

Gluten: wheat, bran, barely, rye, semolina, barley, pearl barley

39
Q

Dairy products and eggs

A

Gluten free: Eggs, milk, cheese, butter, cream, curd cheese

Gluten: yogurts, cheese spreads

40
Q

Beverages

A

Gluten free: coffee, tea, herb tea, cocoa, alc.

Gluten: malted drinks

41
Q

Fruits and vegetables

A

Gluten free: All

42
Q

Nuts and seeds, beans

A

Gluten free: All except certain baked beans

43
Q

Preserves

A

Gluten free: Jams, syrup, marmalade

44
Q

Miscellaneous

A

Gluten free: salt, pepper, vinegar, herbs, tamari, yeast

Gluten: soy

45
Q

Extrusion of abd. contents, large and small intestine w/out umbilical cord

A

Gastroischesis

46
Q

Gastroischesis appearance

A

To the right of the umbilical cord

No protective sac covering intestines

47
Q

Extrusion of abd. contents and umbilical cord

A

Oomphalocele

48
Q

Oomphalocele appearance

A

Centrally located with a sac

49
Q

Gastroischesis / Oomphalocele sx

A

Obvious at birth

Detected during U.S. before birth - c/section

50
Q

Gastroischesis / Oomphalocele tx

A

Depends on size
Silo to slowly force contents back in
Done over 7-10 days

51
Q

Gastroischesis / Oomphalocele mgmt

A

Temperature
Prevent infection
Maintain tissue perfusion

52
Q

Allow intestines to protrude through umbilical ring defect during crying/straining

A

Umbilical hernia

53
Q

Umbilical hernia tx

A

May spontaneously close by 3-4 yrs

Surgery

54
Q

When does a hernia need to be reported immediately?

A

With excessive crying and discoloration of the hernia

55
Q

Herniation of the abd. contents through a defect in the diaphragm into the chest

A

Diaphragmatic hernia

56
Q

Diaphragmatic hernia location

A

Left side

57
Q

Diaphragmatic hernia incidence

A

8 weeks of gestation

58
Q

Diaphragmatic hernia sx

A 
Severe resp. distress
Cyanosis
Tachypnea
Absent breath sounds of affected side
Barrel chest
Shifted heart sounds
Bowel sounds in chest
Flat abd.
59
Q

Necrosis of the mucosa of the small and large intestine

A

Necrotizing enterocolitis

60
Q

Necrotizing enterocolitis incidence

A

Affects both sexes and races equally

61
Q

What causes Necrotizing enterocolitis?

A

Intestinal ischemia, bacterial coloniation or formula thas hypertonic

62
Q

What does Necrotizing enterocolitis lead to?

A

Decreased bl. flow to the bowel-> ischemia of intestinal mucosa.
Distended/ swollen bowel-> sepsis-> perforation of bowel

63
Q

Necrotizing enterocolitis sx

A 
Abd. tenderness
Distention
Bloody stools
Decreased bowel sounds
Increased gastric residuals
Shock-> apnea-> brady
64
Q

Necrotizing enterocolitis tx

A 
Stop oral feedings
NG tube
O2/vent.
Surgery
Resect necrotic bowel - colostomy
->short bowel syndrome w/malabsorption
65
Q

Necrotizing enterocolitis mgmt

A

Check stools for blood
Abd. girths (mark w/ pen)
Check feeing residuals before feeds
Assess bowel sounds

66
Q

Absence or obstruction of the bile ducts outside the liver preventing flow of the bile from the liver to the intestines

A

Biliary atresia

67
Q

Most frequent reason for liver transplant in children

A

Biliary atresia

68
Q

Biliary atresia sx

A 
Newborn asymptomatic
^ becomes jaundiced w/in 2 weeks-2 mos.
Urine is tea
Stools are light in color
Hepatomegaly
Failure to thrive / malnutrition
69
Q

Why is the urine tea colored with Biliary atresia?

A

Excretion of bilirubin

70
Q

Why are the stools light in color with Biliary atresia?

A

Absence of bile pigments

71
Q

Biliary atresia labs

A 
^ bili
^ AST
^ ALP
^ ammonia
Prolonged PT
72
Q

Biliary atresia tx

A 
Surgery for obstruction
Kasai procedure (not a cure; die waiting)

exam 3 (6 decks)

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