GI Diseases Flashcards
List the agents that cause Infectious Diarrhea.
- Rotavirus
- Escherichia coli (E. coli)
- Salmonella
- Clostridium Difficilie (C. diff)
What is the etiology of each Infectious Diarrhea agent?
- Rotavirus = virus
- E. coli = bacteria
- Salmonella = bacteria
- C. diff = bacteria
What are some unique characteristics of Rotavirus?
- Most common cause of diarrhea < 5 yrs
- Vaccine preventable (e.g. Rotarix)
What are some unique characteristics of E. coli?
- undercooked beef, lettuce, petting zoos
- produce. E. coli OH157:H7 linked with acute renal failure.
What are some unique characteristics of Salmonella?
- turtles
- bloody diarrhea
What are some unique characteristics of C. diff?
- C. difficile spores are not killed by alcohol, and the most effective way to remove them from hands is through handwashing
- WASH HANDS / Probiotics
What is Meconium?
- Meconium – First stool
- Sticky, greenish-black stool
- Amniotic fluid and cells swallowed in utero
When should Meconium be passed? What do you assess for if it is not passed within that time period?
Should be passed within 24 hours of life; if not, assess for:
- Hirschsprung disease – lack of ganglion cells
- Hypothyroidism – metabolism slow
- Cystic Fibrosis – thick mucous
Describe the pathophysiology of Hirschsprung Disease.
- Absence of ganglion (nerve) cells in colon and rectum
- Colon expands - accumulation of stool with distention
Hirschsprung Disease manifestations?
Delayed meconium passing, bilious vomiting, large stools (older children)
How is Hirschsprung Disease diagnosed?
- X-ray
- barium enema
- Confirm diagnosis with rectal biopsy
GER (Gastroesophageal Reflux) manifestations?
Regurgitation of gastric contents into the esophagus
GERD (Gastroesphageal Reflux Disease) manifestations?
Tissue damage to esophagus
What concerns are there regarding GERD?
Concern when Failure to Thrive (FTT) – decreased growth (height/weight) or dysphagia develop
How is GER/GERD managed?
- Feeding alterations in infant
- Thickening feedings (rice)
- Upright positioning
- Frequent burping during feeds
- Pharmacologic : H2 receptor antagonists (Cimetidine, Pepcid)-reduce gastric hydrochloric acid secretion.
- Surgical intervention—Nissen fundoplication
Acute Appendicitis manifestations?
- 1st - intermittent periumbilical crampy pain
- 2nd - Moves to McBurney’s point (RLQ)
- Fever, decreased appetite, nausea, vomiting, diarrhea
- Suspect appendix has ruptured if patient has a sudden relief of pain
How is Acute Appendicitis diagnosed?
- Ultrasound
- CT Scan
How do you treat a child with a non-ruptured appendix?
Non-Ruptured - laparoscopy surgery, IV antibiotics, can go home same day
How do you treat a child with a ruptured appendix?
Can result in peritonitis – open abdominal surgery - substantial IV antibiotics, longer hospitalization
Crohn’s Disease manifestations?
- Chronic gastrointestinal inflammation of any part of the GI tract (Mouth to the anus).
- Skip lesions - regions of inflammation separated by healthy bowel
- RLQ Pain
- Abdominal pain and distention
- Bloody stools
- Diarrhea
Ulcerative Colitis manifestations?
- Diffuse inflammation of rectal and colon mucosa
- LLQ pain
- Abdominal pain and distention
- Bloody stools
- Diarrhea
What symptoms do Crohn’s Disease and Ulcerative Colitis share?
- Abdominal pain
- Bloody stools
- Diarrhea
- Weight loss
- Fatigue
Crohn’s Disease and Ulcerative Colitis complications?
- Anemia - bloody stools
- Fluid and electrolyte imbalance due to diarrhea
- Weight loss and growth failure due to malabsorption of nutrients
- Immunosuppression due to meds
- Impact on quality of life due to frequent hospitalization
How is Crohn’s Disease and Ulcerative Colitis treated?
- Medication
- Corticosteroids-reduce inflammation
- Immunomodulators (suppress the immune systems abnormal response)
- Anti-diarrheal medication
- Probiotics
- Pain management
- Nutritional supplements
Describe the pathophysiology of Cleft Lip and Palate.
- Malformation occurring during fetal development
- Cleft lip results from incomplete fusion of the oral cavity
- Cleft palate results from incomplete fusion of the palate
- Combination of environment and genetic factors: Smoking, alcohol, use anticonvulsants, steroids, during pregnancy
Cleft Lip and Palate complications?
- speech
- feeding
- dental problems
How is Cleft Lip and Palate managed?
- Special Needs Feeder (Haberman)
- Surgical repair at 3 months
Describe post-operative care for Cleft Lip and Palate.
- Manage pain
- Avoid pacifiers, spoons, sippy cups, and other sucking toys
- Elbow/arm restrains to arms
Describe the pathophysiology of Hypertrophic Pyloric Stenosis (HPS).
- Constriction of the pyloric sphincter with obstruction of gastric outlet
- Not present at birth but develops in the first few weeks of birth
Hypertrophic Pyloric Stenosis (HPS) manifestations?
- Nonbilious projectile vomiting (30 minutes to an hour after eating)
- Infant is “always hungry”
- Dehydration may occur
- Metabolic alkalosis
- Olive-like pyloric mass may be palpated in the upper abdomen
How is Hypertrophic Pyloric Stenosis (HPS) treated?
Pyloromyotomy
Describe the pathophysiology of Intussusception.
- Telescoping of one portion of intestine into another (Intestine then folds into itself)
- Etiology unknown
- Usually involves the small bowel
Intussusception manifestations?
- Abdominal pain: intermittent episodes of pain-infant draws knees to chest, excessive irritability and crying. In between these episodes, infant appears comfortable.
- Vomiting
- Palpable abdominal “sausage like” mass RLQ
- Currant jelly–like stools (mixture of blood and mucus)
- Decreased appetite
How is Intussusception diagnosed?
- Clinical Symptoms
- Ultrasound
How is Intussusception managed?
- Air enema with or without contrast radiologically- The air may help move the intestine back into its normal position.
- Saline enema
- Surgery to reduce or remove segment
Describe the etiology of Short Bowel Syndrome (SBS).
- A malabsorptive disorder
- Portions of the bowel damaged or missing
- Usually as result of small bowel resection often related to necrotizing enterocolitis (NEC) in premature infant.
Short Bowel Syndrome (SBS) nursing considerations?
- Nutritional support (e.g., TPN, enteral feeding)
- Monitor for complications associated with central lines (infection) and TPN administration (liver failure)
