GI alterations Flashcards
Causes of Failure to Thrive ?
- Not getting enough food or milk
- Not being able to absorb
- Disease that affects metabolic needs
- Defective utilization from genes, infection, or metabolic disease
What is failure to thrive?
A persistent deviation from established growth patterns
deficit of growth and height
Why might child not be able to get enough food?
Poverty
Parents not feeding them
Do infants over eat or under eat?
No they don’t. They will stop eating when they are full. So if they stop eating before getting full, that means there may be a reflex such as pain causing them to stop.
How are social activity and eating related?
Well if something is stopping the infant from enjoying the social bonding of feedings, then they won’t wanna eat. Disturbed parent- child interaction.
Multidisciplinary approaches to Failure to Thrive?
Medical, social, physio-speech therapy
How do they dx failure to thrive?
Will be evidence from failure of growth based on weight.
If long term tho, weight and height
How to help family with failure to thrive treatment for infant?
Educate them, write things down for them,
Goals with Failure to thrive?
Correct nutritional deficit
Manage physiologic conditions
Intervene to improve environment or behaviors
Above all, educate and evaluate family.
Why is documentation so important with failure to thrive?
Documentation is important incase of leg
Why is it important to spend time caretaker?
Evaluate them and educate them
What type of defect is a cleft lip and cleft palate?
Congenital defect
Cleft lip is more prevalent in which gender?
Males
Cleft palate is more prevalent in which gender?
Females
What can cause a cleft appearance?
Genetics but also other things like not getting enough Folic Acid as a PG mom for fetus and thus causing spinal abnormalities that effect the lips or palate.
Why is a cleft lip or palate a concern for nutrition?
Bc a cleft lip or palate can effect whether an infant or young child can eat.
What sides can a cleft lip be on?
It can be unilateral or bilateral.
Can an infant with a cleft lip breast feed?
They can do it well enough since the breast can fill the cleft and create suction. Now, if they are doing bottle feeding, they need a specific nipple.
Will they fix a palate or lip first they are clefted?
And how old?
What should we educate parents about lip clefts?
What type of suture lines?
Fix the lip first
Between 2-3 months but timing of surgery rt the extent of the cleft . An older child is preferred bc they do better afterwards.
Educate parents that infant/child may need multiple surgeries for the lip.
Z- plasty staggered suture lines to minimize scar retraction in lip
After lip surgery, what position can we put the infant in?
What are elbow restraints?
How to clean the suture lines for cleft lip?
No laying on abdomen. Put them in supine back positioning to avoid damage to sutures.
We can put infant in plastic restrains to keep their arms straight. This keeps them from touching anywhere near the lip. But it can be taken off when you are supervising them.
W water. Need to make sure food doesn’t stick to lilp
What is pain management after lip surgery?
Will the natural indention be there after first surgery?
Opioids for first 24-48 hrs.
Can also alternate Ibuprofen and Tylenol
No - may have to rebuild that.
Which palate is involved with cleft palate?
What can the cleft palate leave an opening into?
Hard or soft palates or both
Cleft palate can leave an opening into the nasal cavity.
How many surgeries will a cleft palate take?
What other procedure may be involved?
What age do you get a cleft repair?
Usually more than 1.
Bone grafting
6 & 12 months bc they want to establish nutrition before too long and before it affects infant speech
Velopharyngeal dysfunction descriptions?
What percent?
will cause nasally air sound when talking. The soft palate to the back of the throat will be open & it will need to be fixed
20-30% of cases
Which has more difficulty with recovering from surgery: cleft lip or cleft palate?
Cleft palate due to nasal cavity being open
What types of feeding methods are there for cleft palate after surgery?
- Syringe bottle methods. There are two. Can pump and do bottle feeding from there. Will take practice
- Push mother’s nipple further back into infant mouth for suction (milk in nasal cavity is ok - just a loud sound and may come out nose)
Can a baby use a sippy cup after cleft palate surgery?
What silverware can be used?
How can they keep the nasal cavity clean for a cleft palate?
No. - can try to get baby to use a cup but not a sippy cup bc of pressure. The cup ensures the incision stays intact. No pacifiers either.
No forks or spoons.
Teach parents how to suction to keep the area from crusting.
What is Esophageal Atresia?
Atresia defintion
When the esophagus is not a continuous, closed off tube from mouth to the stomach.
- this impacts nutrition but also respiratory
Atresia = blind pouch
What is a Tracheoesophageal Fistula?
The trachea and esophagus don’t fully separate creating a direct aspiration risk due to food going into airway
If there is an esophageal atresia present & there is not connection to the esophagus and stomach, what is one intervention that MUST be done?
Before any type of surgery - can the pouch or part of esophagus that ends be full of fluid (for EA or TEA)?
After fixing any of these issues with surgery, how far can you put suction back?
Suctioning. If you don’t suction, the food and fluids can overflow into the airway too. Catheter should be premeasured. If you dislocate anything, call surgeon.
No the fluid needs to be suctioned out before and thereafter surgery.
Only put suction back as far as it mean to go. If you don’t know, find out asap.
What nutrition is done for a EA or atresia?
Parental nutrition with dextrose and electrolytes so that they can stay balanced.
Main esophageal airway abnormalities from picture?
1) The esophagus abruptly ended before getting to the stomach
2) The esophagus ended but the trachea and second half of esophagus were attached which led to the stomach
3) The whole esophagus and trachea were connected in a giant tube
Why might someone with a EA or TAE develop cyanosis or aspiration?
BC of the close proximity to the trachea
How cans someone with EA or TAE develop polyhydraminos?
What gives this away?
Increased amniotic fluid - bc they aren’t able to drink their amniotic fluid so to speak and so the fluid stays in the amniotic sac.
Weight & measuring the fundus can give this away
How can chemical pneumonitis ensue with an EA or TAE?
Gastric contents either go directly to the trachea or they get aspirated into the trachea.. the acidity causes pneumonia.
What is type H of the EA/TAE?
How can this appear later on in life?
It was the presentation of the esophagus and trachea being in one large tube.
It may present later on in life with respiratory issues due to the half and half ability of the defect to function normally. But eventually catch up w you w your resp. system having issues.
What if the anatomy between the organs is too far apart to repair in one surgery of the EA/TAE?
Substitute?
Will choose to do it over time & use weight pouches to stretch the tissue so that one day they connect. Don’t wanna stretch too far tho incase it is too narrow.
- The distance will determine amount of surgical stages need after this
Can substitute a portion of the colon
Which study helps determine which anomaly you have for an EA//TAe?
radiographic study
What is an Omphalocele?
An Omphalcele is when the abdominal wall fails to keep abdominal organs inside you - but the peritoneal sac is still surrounding the organs.
What other anomalies is an Omphalocele associated with?
Cardiac Neuro Skeletal GU imperforated anus ileal atresia bladder exstrophy Trisomy 18
Why should you be careful about clamping the umbilical cord in regards to an omphalocele?
How can you tell how well you can close the abdomen?
The Omphalocele could be a bulge in the cord
By how much content is sticking out
What is Gastroschisis ?
Is this associated w other anomalies?
Is there a membrane to cover the organs?
How does this effect fluids?
Hernia of the bowel through abdomen to the right of the umbilical cord and then through the rectus muscle
No other anomalies.
No membrane or sac around contents
Due to no covering, there’s a large amount of fluid loss. and hyponatremia concern present.
To avoid heat loss in Gastroschisis or hernia - what do you do?
Can they just shove this hernia back in?
Short gut?
positioning?
Use sterile dressing w saline to cover the contents
or use bowel bag to cover and immobilize it (needs to be done before surgical repair)s
No. They must be patient and might have to do some abdominal stretching w gravity in silo. Otherwise, breathing problems due to increased pressure
They may end up with a short gut due to the need to shorten it to make it fit.
positioning in small, rotational ways as to relieve pressure of child or infant
Gastroschisis diagonosis?
Sometimes done inutero by sonogram
Complications of Gastroschisis and repair?
Infection
Evisceration - is it coming back out?
Obstruction - is the bowel functioning?
After gastroschisis repair how soon should you introduce enteral feeds?
What type of ventilation may the infant need?
How long might they do gastric decompression?
What type of pump?
How to flush?
As early as possible. If the bowel is functioning, then you can probably start parental nurtition.
mechanical ventilation
Just until there is a return in bowel functioning.
Salam sump w blue pigtail air vent. It just makes sure the secretion don’t back up the pump.
Just flush w air. Can also get suctioned onto mucosa.
What is Hirschsprungs disease?
What is an obvious product of this in a neonate infant? What will the infant stomach look like?
What about older kids with Hirschsprungs?
Absence of ganglion cells in the colon that causes the inner sphincter to not be able to open for stool to pass
causing colon to dilate and get backed up
Infant can’t pass the meconium in 48 hrs like they are meant to.
Distended abdomen since they can’t poop. Might even vomit
Some of the same things bu now they may have ribbon like bad smelling stool
How to dx Hirschsprungs?
What is surgical tx?
What if the colon is super dilated?
Biopsy done to see if there is ganglion absence of the colon
Surgically remove the aganglionic segment causing the hold up
Do colostomy so it can rest & then go in and remove it the aganglionic parts
Post-op before Hirschsprungs ganglion surgery?
Do ostomy care and education.
Educate parents on possibility of follow up for rectal dilation.
Help parent cope with feeling guilty .
What is Meckels Diverticulum ?
What can this lead to?
Meckels Diverticulum is when there is a remnant due to the old yolk sac connection remaining kinda open.
- not always an issue but can develop a blockage or inflammation issues
Can even lead to an obstruction
What is bleeding like in Meckels Diverticulum?
What about stool?
Can be red and abrupt or tarry and old.
Stool may end up jelly like and red or black colored
Meckels Diverticulum diagnosis?
Meckels scan is done where there is radioisotope taken up by gastric mucosa
and
CBC, Coag, BMP
Meckels Diverticulum treatment ?
preop?
post op?
Surgical removal
Before , monitor bleeding and F&E
After, decompress stomach so no n/v
Take care of the wound
Fluids
Anorectal Malformations defintion?
When the anus is not normal essentially. Can vary in degree:
Imperforate anus or skin covering it
Stenosis of the anus
Cloaca or common channel of genitals
Anorectal Malformation signs
1) They can see it visually
2) Abdominal distention, can’t pass meconium due to no perforation, dimpling in rectal area
What is used to diagnose Anorectal Malformation?
MRI
VCUG/IV
Ultrasound
How is Anorectal Malformation treated?
Dilation but can also do surgery if needed
Post op anorectal malformation surgery
Can you take rectal temp?
What if the bowel training is delayed?
How to reposition?
ostomy?
No rectal temps whatsoever
Educate parents on the delay and how to deal w it
Just try to keep as much pressure off of anal area
Care for stoma
What is celiac?
Who is it rare in?
Gluten protein sensitivity that is unusual which causes villi atrophy and can’t absorb
Asians and African Americans
How early might you see symptoms of celiac?
4-6 months of age or whenever you start with solid foods. But it can take a couple months to see it
Celiac symptoms?
FTT Chronic diarrhea Abd distention and pain Muscle wasting Ulcers Fatigue
Markers for celiac?
Proper diagnosis? Results?
Transglutamine and antienomyseal antibodies
Upper GI biopsy done
- small intestine will be inflamed, hyperplasia, and atrophy
Good substitute foods for celiac?
Type of diet to eat?
Rice
Millet
Corn
High protein & high calories
Low fiber
Food labels to avoid for celiac?
Common intolerance w celiac?
Hydrolyzed veggie oil
Meat fillers
Lactose intolerance
What is Hypertropic Pyloric Stenosis?
How will the infant show symptoms? What about their abdomen?And at what age?
When the pyloric muscle thickens to the point it causes an obstruction from the stomach
Well at first the infant will look fine but then as time goes on, they’ll start projectile vomiting. Bc the stomach can’t empty.
Abdomen may have an olive shaped movable mass
2-8 weeks old
Hypertropic Pyloric Stenosis affects males or females more?
Males
How does Hypertropic Pyloric stenosis affect infant nutrition? What can this cause?
Will this cause metabolic alkalosis or acidosis?
The food never makes it to the intestines , so they are starving.
This can cause peristalsis waves of the stomach
Hypertropic Pyloric Stenosis will cause metabolic alkalosis.
Recap - All symptoms you might find with Hypertropic Pyloric stenosis
- projectile vomiting that occurs after couple week
- olive mass in abdomen
- stomach waves
- metabolic alkalosis
- thin due to no nutrition
Diagnosis for Hypertropic Pyloric stenosis?
- Symptoms, abdominal ultrasound or xray, upper GI
Treatment for Hypertropic Pyloric stenosis?
When will feedings be introduced after surgery? What do you do in the meantime?
It will always be surgical to thin down the pyloric muscle.
4-6 hrs later to see if it worked
- give fluids
Preop needs for Hypertropic Pyloric stenosis?
F&E
Gastric decompression
Post op needs for Hypertropic Pyloric stenosis
incision care
fluids until feedings begin
- make sure you monitor the feedings
What is an Intussusception?
Sudden onset of intense abdominal pain due to ileum telescoping into the cecum and thus causes less perfusion.
Who is more prone to intussusception?
More common in males
And kids with cystic fibrosis
Symptoms of intussusception?
Intense abdominal pain - legs pulling up
Jelly stool
Sausage mass
diarrhea, anorexia
Treatment for intussusception?
What is the second option?
What if it takes longer?
Medical reduction with barium or water soluble contrast and air. Successful in most cases.
Then can get a surgical reduction - the longer it takes tho the more risk for bowel necrosis.
intussusception complications?
Nursing care?
Bowel perforation
Peritonitis
F&E
Gi care
Can infants have GERD?
Yes. It is just reflux of gastric contents back up into esophagus. It is only when you have changes in esophagus due to inflammation.
GERD factors
gastric distention coughing CNS disease Hiatal hernia Gastrostomy placement Meds - theophylin can damage sphincters & isoproteronl
GERD symptoms
Passive regurgitation Poor weight gain gagging/choking Apnea vomiting or stools w blood
You can treat GERD with a Nissen Fundoplication. what is it?
Nissen Fundoplication is when the upper stomach is pulled up and wrapped around the esophagus to reduce gastric reflux.
- don’t want it to be too tight tho bc you cant burp or vomit whatsoever and that leads to complications
How to diagnose GERd?
Upper Gi endoscopy or ph probe
How should feedings be with GERD?
Small and frequent. Also make sure they are more thick and allow for burping.
What types of meds are used to control GERD?
antacids
H2 receptor antagonist - dine
proton pump inhibitors - azole
