GI Disorders Flashcards
What is Hirschsprung Disease?
It is a congenitial aganglionic megacolon that is more common in male.
Where does Hirschsprung Disease most often occur?
Internal sphincter, rectum, and a few cm of sigmoid.
What is the pathophysiology of Hirschsprung Disease?
It is the absence of ganglion cells and the internal sphincter is unable to relax.
What are Clinical Manifestations of Hirschsprung Disease in a newborn?
Failure in passing meconium, Refusal to feed, Bilious vomiting, Abdominal distention
What are clinical manifestations of Hirschsprung Disease in a infant?
Failure to thrive, Constipation, Abdominal distention, Episodes of diarrhea and vomiting
What are clinical manifestations of Hirschsprung Disease in a Childhood?
Constipation, Ribbon like foul smelling stool, Abdominal distention, Visiable peristalsis, easily palpable fecal mass, undernourished, anemic appearance.
Diagnostic evaluation of Hirschsprung Disease in a Neonate, Infant and children?
Neonate- suspected when failure to pass meconium within 24-48 hours.
Infant and children-H and Chronic pattern of constipation.
How will the rectum be on evaluation in someone with Hirschsprung Disease?
It will be empty of feces and internal sphincter will be tight.
What is GER?
Transfer of gastric contents into the esophagus.
When does GER occur most often?
after meals or at night.
What are clinical manifestations of GER in an adult?
heartburn, dyspepsia, hypersalivation.
What are clinical manifestations of GER in in infant?
passive regurgitation or emesis, excessive crying, irritability, arching of the back, stiffening, weight loss, FTT, resp problems.
What are clinical manifestation of GER in children?
Heartburn, abdominal pain, noncardiac chest pain.
What is esophagitis?
Inflammation of the esophagus
What is Barrett’s esophagus?
Esophageal metaplasia, flat epithelial cells change to columnar epithelial cells, precancerous lesion.
What are diagnostic evaluation of GER?
H & P, upper GI seris, 24 hour pH monitoring study is the GOLD STANDARD in the dx.
Treatment for GER?
Nissem fundoplication
No therapy is needed in the infant who is thriving and has no respiratory complications (thickening of foods and feeding upright in infants.), avoid food such as caffeine, citrus, tomatoes, alcohol, peppermint
Small frequent meals
Drugs- Tagament, zantac, Pepcid, prevacid, Prilosec.
Nursing Care GER?
Teach the parents about feedings, positioning, and medications, foods to avoid.
What is hypertrophic pyloric stenosis?
Circumferential muscle of the pyloric sphincter becomes thickened, elongation and narrowing of pyloric canal can cause outlet obstruction and compensatory dilation, hypertrophy and hyperperistalsis of the stomach.
What can hypertrophic pyloric stenosis cause?
projectile vomiting, dehydration, metabolic alkalosis, and failure to thrive.
What is the pathophysiology of hypertrophic pyloric stenosis.
Circulat muscle of the pylorus thickens which causes a narrowing of the pyloric canal b/w stomach and duodenum. The lumen becomes partially or completely obstructed. Hypertrophied pylorus may be palpable as an olive-like mass in the upper abdomen.
What are clinical manifestations of Hypertrophic pyloric stenosis?
Non bilious vomiting
Vomiting at 3 weeks of age
Dehydration
Weight loss
No evidence of pain or discomfort except chronic hunger
Distended upper abdomen
Palpable olive mass in epigastrium right of the umbilicus.
How is hypertrophic pyloric stenosis diagnosed?
Physical exam it would reveal an olive shaped mass
Ultrasound will reveal an elongated mass surrounding a long pyloric canal
How is pyloric stenosis treated?
Pyloromyotomy
Small frequent feedings 4-6 hours after surgery of glucose, water, or electrolyte solution.
What are some nursing care for hypertrophic pyloric stenosis?
Restore hydration and electrolyte imbalance(usually with NaCl + K Infant is NPO I &O's Daily weights Care of the NG tube Educate, support, and reassure family
What is intussusception?
intestinal obstruction in children between 3 months and 3 years
Pathophysiology of intussusception?
Proximal segment of the bowel telescopes into a more distal segment, mesentery comes with it.
What are the clinical manifestations of intussusception?
Sudden onset of crampy abdominal pain Inconsolable crying Drawing up knees to chest Between episodes child seems normal Bilious vomiting Abdominal mass Bloody stools
Diagnostic studies of intussusception?
BARIUM ENEMA
Rectal exam- mucus, bloody
Abdominal x-ray ( barium enema would be contradicted when using this form)
What is appendicitis?
Inflammation of the appendix
What causes appendicitis?
Obstruction of the opening of the appendix due to fecal matter, swollen lymphoid tissue or parasites
What are clinical manifestation of appendicitis?
Abdominal pain Rigid abdomen fever tachycardia possible vomiting constipation or diarrhea anorexia pallor lethargy and/or irritability
Pre-operative Nursing care for a person with appendicitis?
Prepare the client and family for surgery
Maintain good hydration
Give F & E
Post-operative nursing care for a person with appendicitis?
Begin feeding clear liquid and advancing as tolerated
Teach S/S of infection, how to assess the incision, demonstrate proper hand hygiene,
encourage parents to be active in child’s care.
What is the number one complication for appendicitis?
Peritonitis
What are some nursing actions for Peritonitis (complication of appendicitis)
Pain management (abdominal pain) Maintain IV fluid therapy Administer IV antibiotics for infection Provide pre and post operative care Surgical wound care Provide psychosocial support for family and child.
What is the patho of Crohn’s disease
inflammation of all the layers of the bowels, ulcerations are deep, longitudinal, and penetrate, “cobblestone appearance”
Where can Crohn’s disease occur in the GI track?
Anywhere, “Skip lesions”
What are clinical manifestations of Crohn’s disease?
Diarrhea colicky abdominal pain in the RLQ Small intestine=weight loss Rectal bleeding sometimes a mass is felt in the right iliac fossa
What are some complications of Crohn’s disease?
Perineal abscess
Fistulas
Nutritional problems
risk for small intestine cancer
What is the patho of Ulcerative Colitis?
Starts in the rectum and moves in a continual fashion towards the cecum. Inflammation of the mucosal lay
What is Ulcerative Colitis?
Disease of the colon and rectum.. LLQ
What are clinical manifestations of ulcerative colitis?
Bloody diarrhea
Abdominal pain
Mild
Moderate- 4-5 stools a day, increase bleeding and fever
Severe- 10-20 stools a day, very bloody, contain mucus
What are some complications of Ulcerative Colitis?
Risk for colon cancer
Toxic Megacolon is more common (risk for perforation and emergency colectomy)
Nursing care for Crohn’s and Ulcerative Colitis?
Rest the bowel Control the inflammation Combat infection Correct malnutrition Alleviate any stress Provide symptomatic relief Improve quality of life
Drugs used for Crohn’s and Ulcerative Colitis?
Aminosalicylates (sulfasalazine)- should take folic acid daily
Anitmicrobials-used first
Corticosteroids(prednisolone and entocort)- take calcium supplements, do not remisison, give for shortest time frame possible
Immunosuppressant (methotrexate)-maintains remission, requires CBC monitoring
Biological and targeted therapy (remicade, humira, cimzia, tysabril)
