GI Dysfunction Flashcards
assessment
- abdomen (inspection, auscultation, palpitation)
- nutrition
- stool (consistency, colour, smell, pattern, continence, seepage, changes)
- family hx
diagnostic procedures for GI dysfunction
- abdominal ultrasound
- barium/contrast enema (make sure barium is passed can = obstruction)
- CT of abdomen (metformin)
- endoscopy
- GI series
- Intraesophageal pH probe
- abdominal radiographs
why cant you take metformin with CT contrast
- contrast induced nephropathy
- can decrease kidney function and cause metformin buildup
lab tests for GI dysfunction (7)
- CBC
- bilirubin
- electrolytes
- liver enzymes
- stool for occult blood
- stool for ova/parasites
- CRP (inflammation)
gastroesophageal reflux
- 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
gastroesophageal reflux treatment
- 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
pyloric stenosis
- 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
pylorus
- opening between stomach and small intestine
pylorotomy
- surgery for pyloric stenosis where pylorus is cut open
diagnosis of pyloric stenosis
- ultrasound
- can sometimes feel olive like structures in stomach
intussesception
- bowel telescopes upon itself = two layers of bowel touching
- unknown cause
- more in males than females
- abrupt pain and onset
- red and jelly stools
diagnosis of intussesecption
- hx
- ultrasound
- barium enema
treatment for intussesception
- barium enema sometimes works as weight can pull it back down
- if that doesn’t work then surgery
Hirschprung disease
- segment of bowel is missing nerve endings to stool is harder to pass through that section
- congenital
- constipation, no wight gain, ribbon stools
diagnosis of Hirschprungs disease
- biopsy
treatment of Hirschprungs disease
- bowel resection
encopresis
- constipation + soiling
- 3-5yrs
encopresis treatment
- behaviour management
- diet (increased fibre, fruits, probiotics)
- Medical management with lactulose (usually doesn’t work) or PEG to clear them out
appendicitis
- inflammation of the appendix
- caused by obstruction (stool) in the appendices lumen
- may lead to perforation (fluid into preineum)
- school aged/teens
manifestations of appendcitis
- periumbilical cramps, abdominal tenderness, fever
- pain in rt lower quad becomes constant (McBurneys point)
- progression of symptoms: nausea, vomiting, rebound tenderness
manifestations of appendix rupture
- sudden relief of pain
- usually causes diarrhea incontinence
diagnosis of appendicitis
- fever + elevated WBC
- ultrasound
- CT (most reliable but want to avoid as radiation)
- may see elevated CRP
management of appendicitis
- immediate surgical removal (laparoscopic)
- NPO, IV antibiotics/fluids, pain management
- discharge home next day
- DB & C and ambulation
management of ruptured appendix
- 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
gastroenteritis
- 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
common age for gastroenteritis
- under 5 yrs
- because they are putting everything in their mouth
manifestations of gastroenteritis
- mild to sever diarrhea
gastroenteritis assessment
- onset, frequency, & consistency of stools
- frequency & amount of vomiting
- vitals
- weight management
- voiding, diet, other ppl sick around them
diagnosis of gastroenteritis
- hx, physical exam
- lab findings
- dehydration
bloodwork for gastroenteritis
- electrolyte concern
- most worried about K+
- kidney function must be confirmed before adding K+ to IV
management of gastroenteritis
- dependent on severity of dehydration & electrolyte imbalance
- monitor ins/outs
- isolation (contact)
- slowly reintroduce foods (bland, avoid sugar)
electrolyte bloodwork for peds
- capillary lytes
- can get falsely high K+ amount from squeezing capillary
- causes lysis of hemoglobin and release of K+
can gravol be given for gastroenteritis?
- not given because sedation results in less fluid intake
- ondansetron (Zofran) can be given
can Imodium be given for gastroenteritis?
- not given due to risk of obstruction
oral rehydration
- 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
parenteral rehydration phase 1
- expand extracellular volume
- isotonic fluids (NS)
- 20-40ml/kg over 2hrs
parenteral rehydration phase 2
- replace losses
- determine % of dehydration
- 1.5x maintenance
- may add K+ here
parenteral rehydration phase 3
- return to normal
- slow down IV and drink
daily fluid requirements
- 100ml/kg for frist 10 kg
- 50ml/kg for next 10kg
- 20ml/kg for remainder
inflammatory bowel disease
- ulcerative colitis
- Crohn’s disease
ulcerative colitis
- inflammation and ulceration of rectum and colon
- 15-25 peak then 50-70
- affects only mucosa and submucosa
- bleeding, diarrhea, abdominal pain
diagnosis of ulcerative colitis
- scope
- colonoscopy
- blood work (WBC, CRP)
management of ulcerative colitis
- nutritional management (no residue diet - bland, no seeds, no raw veggies, nothing hard to digest)
- medications
- surgery
- NPO or blood transfusion if severe
medications for ulcerative colitis
- antimicrobial - prevent secondary infection
- 5-ASA - decrease inflmmation
- corticosteroids - decrease inflammation
- immunosuppressants - suppress immune response
Crohn’s disease
- 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
diagnosis of Crohn’s disease
- scope (upper GI)
- colonoscopy
management of Crohn’s disease
- diet therapy
- medications
- TPN
- elemental diet (predigested nutrients)
- surgery
medications for Crohn’s disease and why
- 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
examples of immunomodulators
- remicade
- Humira
