GI Dysfunctions of the Newborn

Question 1

what are signs of dehydration

Answer 1

sunken fontanel
loss of weight
poor skin turgor
dry oral mucous membranes
decreased urine output
increased urine specific gravity
hypernatremia

Question 2

when is hydration considered adequate

Answer 2

when urine output is 1-3ml/kg/hr (shoot for 1)

Question 3

when is nutritional intake considered adequate

Answer 3

when there is a consistent weight gain of 20-30g per day

Question 4

is it normal to see a loss of 10% of body weight within first 5-7 days of baby’s life

Answer 4

yes they will start gaining it back

Question 5

what should always be done before feedings

Answer 5

measure abd girth and auscultate abd to make sure they have bowel sounds

Question 6

infection, inflammation and necrosis of the bowel

Answer 6

necrotizing enterocolitis (NEC)

Question 7

what infants are at risk for NEC

Answer 7

premature babies

Question 8

how can the bacteria stick to the walls of of the bowel (NEC)

Answer 8

because the mucus starts sloughing off and if mucous is not there then the bacteria can stick a lot easier

Question 9

assessment finding of NEC (usually see symptoms around 3 days of life)

Answer 9

apnea
bradycardia/tachycardia
unstable temp
abd distention
bloody stools
increased residuals (BRIGHT green)
lethargy
abnormal high/low WBC

Question 10

failure of the esophagus to develop as a continuous passage

Answer 10

esophageal atresia (EA)

Question 11

failure of the trachea and esophagus to separate into distinct structures

Answer 11

tracheoesophageal fistula (TEF)

Question 12

what goes hand in hand with a fistula

Answer 12

cardiac anomaly

Question 13

who is more at risk for EA and TEF

Answer 13

preterm babies

Question 14

as soon as we know about EA or TEF what should be done

Answer 14

babies need to be NPO

Question 15

what are the CM of EA and TEF

Answer 15

coughing
choking
cyanosis
apnea
resp distress during feedings
abd distention

Question 16

if there is gas in the stomach what is this

Answer 16

TE fistula

Question 17

how do they dx TEF and EA

Answer 17

hx and physical of mom

xray

Question 18

how does gastric decompression work in baby with TEF or EA

Answer 18

tube is put down and to suction in blind pouch to keep secretions from pooling there

Question 19

what is the surgical repair for TEF or EA

Answer 19

cervical esophagostomy= drainage of saliva through a stoma in the neck

Question 20

for post op of a TEF or EA what is done before feeding are started

Answer 20

swallow study with contrast

Question 21

protrusion of abd organs through opening in the diaphragm

Answer 21

congenital diaphragmatic hernia

Question 22

what side is congenital diaphragmatic hernia on

Answer 22

left side

Question 23

what are CM of congenital diaphragmatic hernia

Answer 23

resp distress
absent breath sounds in affected area
tachypnea
cyanosis
impaired cardiac output
possible shock
acidosis
concave abd

Question 24

is congenital diaphragmatic hernia a surgical emergency

Answer 24

yes and it is done within a couple of hours of birth (high mortality)

Question 25

what should be done before the baby with a congenital diaphragmatic hernia leaves the room
and how should they be positioned

Answer 25

needs to be intubated and gastric decompressions

should be positioned head and thorax higher than abdomen

Question 26

intestines protrude through abdominal wall at umbilicus

Answer 26

umbilical hernia

Question 27

for a small hernia what is done

Answer 27

usually it will close on its own by 1-2 years of age but if it doesn’t by 4-5 years of age surgery is indicated

Question 28

abd contents are herniated THROUGH the umbilical cord and exposed contents are covered by a translucent 2 layer membrane sac

Answer 28

omphalocele

Question 29

is sx done right away for an omphalocele

Answer 29

no but if they need to they will push the organs back in where they came from and suture

Question 30

for an omphalocele what is “paint and wait”

Answer 30

betadine is put around it and cover it, wait for skin to grow over the omphalocele and when this happens a compression device will be put around it

Question 31

how is an omphalocele protected from trauma or drying

Answer 31

warm, sterile, saline soaked dressing with a layer of sterile plastic wrap

Question 32

abdominal contents herniated outside of abd wall with NO covering membrane and umbilical cord is intact

Answer 32

gastroschisis (usually by the right side)

Question 33

how is the gastroschisis sx done

Answer 33

first sx will get everything in the silo bag

second sx with close the abd

Question 34

allows gradual return or intestines to abd cavity over 5-10 days, then closure

Answer 34

prosthetic silo

Question 35

for a baby who has a silo/ gastroschisis when should a doctor be called immediately

Answer 35

if the baby does not have any bottom pulses (could put pressure on the vena cava)

Question 36

absence of anal opening

Answer 36

imperforate anus