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Acute Test #2 > GI Dysfunction > Flashcards

GI Dysfunction Flashcards

1
Q

assessment

A
  • abdomen (inspection, auscultation, palpitation)
  • nutrition
  • stool (consistency, colour, smell, pattern, continence, seepage, changes)
  • family hx
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2
Q

diagnostic procedures for GI dysfunction

A
  • abdominal ultrasound
  • barium/contrast enema (make sure barium is passed can = obstruction)
  • CT of abdomen (metformin)
  • endoscopy
  • GI series
  • Intraesophageal pH probe
  • abdominal radiographs
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3
Q

why cant you take metformin with CT contrast

A
  • contrast induced nephropathy

- can decrease kidney function and cause metformin buildup

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4
Q

lab tests for GI dysfunction (7)

A
  • CBC
  • bilirubin
  • electrolytes
  • liver enzymes
  • stool for occult blood
  • stool for ova/parasites
  • CRP (inflammation)
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5
Q

gastroesophageal reflux

A
  • 50% of infants 0-3 months
  • painful regurgitation that increases in frequency
  • linked to ALTE (apparent life threatening events
  • apnea from reflux
  • most grow out of it and dont progress to GERD
  • overfeeding is big cause
  • less likely with breastfed
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6
Q

gastroesophageal reflux treatment

A
  • dependent on severity (give time to work ~1 wk)
  • nutrition changes
  • position changes
  • movement
  • mothers nutrition
  • air bubbles
  • overfeeding
  • PPIs if other changes dont work
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7
Q

pyloric stenosis

A
  • pylorus is narrow or won’t open
  • males more than females
  • 2-4 wk after birth
  • projectile vomiting due to increased intake
  • child looks hungry, failure to gain weight because cant absorb
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8
Q

pylorus

A
  • opening between stomach and small intestine
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9
Q

pylorotomy

A
  • surgery for pyloric stenosis where pylorus is cut open
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10
Q

diagnosis of pyloric stenosis

A
  • ultrasound

- can sometimes feel olive like structures in stomach

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11
Q

intussesception

A
  • bowel telescopes upon itself = two layers of bowel touching
  • unknown cause
  • more in males than females
  • abrupt pain and onset
  • red and jelly stools
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12
Q

diagnosis of intussesecption

A
  • hx
  • ultrasound
  • barium enema
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13
Q

treatment for intussesception

A
  • barium enema sometimes works as weight can pull it back down
  • if that doesn’t work then surgery
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14
Q

Hirschprung disease

A
  • segment of bowel is missing nerve endings to stool is harder to pass through that section
  • congenital
  • constipation, no wight gain, ribbon stools
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15
Q

diagnosis of Hirschprungs disease

A
  • biopsy
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16
Q

treatment of Hirschprungs disease

A
  • bowel resection
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17
Q

encopresis

A
  • constipation + soiling

- 3-5yrs

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18
Q

encopresis treatment

A
  • behaviour management
  • diet (increased fibre, fruits, probiotics)
  • Medical management with lactulose (usually doesn’t work) or PEG to clear them out
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19
Q

appendicitis

A
  • inflammation of the appendix
  • caused by obstruction (stool) in the appendices lumen
  • may lead to perforation (fluid into preineum)
  • school aged/teens
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20
Q

manifestations of appendcitis

A
  • periumbilical cramps, abdominal tenderness, fever
  • pain in rt lower quad becomes constant (McBurneys point)
  • progression of symptoms: nausea, vomiting, rebound tenderness
21
Q

manifestations of appendix rupture

A
  • sudden relief of pain

- usually causes diarrhea incontinence

22
Q

diagnosis of appendicitis

A
  • fever + elevated WBC
  • ultrasound
  • CT (most reliable but want to avoid as radiation)
  • may see elevated CRP
23
Q

management of appendicitis

A
  • immediate surgical removal (laparoscopic)
  • NPO, IV antibiotics/fluids, pain management
  • discharge home next day
  • DB & C and ambulation
24
Q

management of ruptured appendix

A
  • treat rupture first to avoid increase fluid in peritoneal cavity
  • prolonged antibiotic use, pain management
  • open appendectomy
  • drain, irrigation, packing
  • usually back with access if not treated long enough
25
Q

gastroenteritis

A
  • inflammation of stomach or intestines
  • may be accompanied by vomiting and diarrhea
  • bowel absorption decreased due to inflammation
  • common cause is rotovirus and norwak virus
  • dehydration & electrolyte balance
26
Q

common age for gastroenteritis

A
  • under 5 yrs

- because they are putting everything in their mouth

27
Q

manifestations of gastroenteritis

A
  • mild to sever diarrhea
28
Q

gastroenteritis assessment

A
  • onset, frequency, & consistency of stools
  • frequency & amount of vomiting
  • vitals
  • weight management
  • voiding, diet, other ppl sick around them
29
Q

diagnosis of gastroenteritis

A
  • hx, physical exam
  • lab findings
  • dehydration
30
Q

bloodwork for gastroenteritis

A
  • electrolyte concern
  • most worried about K+
  • kidney function must be confirmed before adding K+ to IV
31
Q

management of gastroenteritis

A
  • dependent on severity of dehydration & electrolyte imbalance
  • monitor ins/outs
  • isolation (contact)
  • slowly reintroduce foods (bland, avoid sugar)
32
Q

electrolyte bloodwork for peds

A
  • capillary lytes
  • can get falsely high K+ amount from squeezing capillary
  • causes lysis of hemoglobin and release of K+
33
Q

can gravol be given for gastroenteritis?

A
  • not given because sedation results in less fluid intake

- ondansetron (Zofran) can be given

34
Q

can Imodium be given for gastroenteritis?

A
  • not given due to risk of obstruction
35
Q

oral rehydration

A
  • treatment of choice for dehydration caused by diarrhea
  • no fruit juice/sports drink as increased sugar = increase diarrhea
  • milk products ok
  • increase intake slowly by small amounts
36
Q

parenteral rehydration phase 1

A
  • expand extracellular volume
  • isotonic fluids (NS)
  • 20-40ml/kg over 2hrs
37
Q

parenteral rehydration phase 2

A
  • replace losses
  • determine % of dehydration
  • 1.5x maintenance
  • may add K+ here
38
Q

parenteral rehydration phase 3

A
  • return to normal

- slow down IV and drink

39
Q

daily fluid requirements

A
  • 100ml/kg for frist 10 kg
  • 50ml/kg for next 10kg
  • 20ml/kg for remainder
40
Q

inflammatory bowel disease

A
  • ulcerative colitis

- Crohn’s disease

41
Q

ulcerative colitis

A
  • inflammation and ulceration of rectum and colon
  • 15-25 peak then 50-70
  • affects only mucosa and submucosa
  • bleeding, diarrhea, abdominal pain
42
Q

diagnosis of ulcerative colitis

A
  • scope
  • colonoscopy
  • blood work (WBC, CRP)
43
Q

management of ulcerative colitis

A
  • nutritional management (no residue diet - bland, no seeds, no raw veggies, nothing hard to digest)
  • medications
  • surgery
  • NPO or blood transfusion if severe
44
Q

medications for ulcerative colitis

A
  • antimicrobial - prevent secondary infection
  • 5-ASA - decrease inflmmation
  • corticosteroids - decrease inflammation
  • immunosuppressants - suppress immune response
45
Q

Crohn’s disease

A
  • any part of GI tract from mouth to anus
  • peak at 15-30
  • most common in terminal ileum and colon
  • non bloody diarrhea and abdominal pain
  • transmural inflammation
  • skip lesions, granulomas, fistulas, cobblestone appearance
  • extra intestinal symptoms sometimes before GI
46
Q

diagnosis of Crohn’s disease

A
  • scope (upper GI)

- colonoscopy

47
Q

management of Crohn’s disease

A
  • diet therapy
  • medications
  • TPN
  • elemental diet (predigested nutrients)
  • surgery
48
Q

medications for Crohn’s disease and why

A
  • antimicrobial - prevent secondary infection
  • corticosteroids - decrease inflammation
  • immunosuppressants - suppress immune response
  • immune modulators (humera, remicaid) —> tumor necrosis factor inhibitors, tumour necrosis factors may be attacking body
49
Q

examples of immunomodulators

A
  • remicade

- Humira

Acute Test #2 (4 decks)

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