GI Dysfunctions of the Newborn Flashcards
what are signs of dehydration
sunken fontanel loss of weight poor skin turgor dry oral mucous membranes decreased urine output increased urine specific gravity hypernatremia
when is hydration considered adequate
when urine output is 1-3ml/kg/hr (shoot for 1)
when is nutritional intake considered adequate
when there is a consistent weight gain of 20-30g per day
is it normal to see a loss of 10% of body weight within first 5-7 days of baby’s life
yes they will start gaining it back
what should always be done before feedings
measure abd girth and auscultate abd to make sure they have bowel sounds
infection, inflammation and necrosis of the bowel
necrotizing enterocolitis (NEC)
what infants are at risk for NEC
premature babies
how can the bacteria stick to the walls of of the bowel (NEC)
because the mucus starts sloughing off and if mucous is not there then the bacteria can stick a lot easier
assessment finding of NEC (usually see symptoms around 3 days of life)
apnea bradycardia/tachycardia unstable temp abd distention bloody stools increased residuals (BRIGHT green) lethargy abnormal high/low WBC
failure of the esophagus to develop as a continuous passage
esophageal atresia (EA)
failure of the trachea and esophagus to separate into distinct structures
tracheoesophageal fistula (TEF)
what goes hand in hand with a fistula
cardiac anomaly
who is more at risk for EA and TEF
preterm babies
as soon as we know about EA or TEF what should be done
babies need to be NPO
what are the CM of EA and TEF
coughing choking cyanosis apnea resp distress during feedings abd distention
if there is gas in the stomach what is this
TE fistula
how do they dx TEF and EA
hx and physical of mom
xray
how does gastric decompression work in baby with TEF or EA
tube is put down and to suction in blind pouch to keep secretions from pooling there
what is the surgical repair for TEF or EA
cervical esophagostomy= drainage of saliva through a stoma in the neck
for post op of a TEF or EA what is done before feeding are started
swallow study with contrast
protrusion of abd organs through opening in the diaphragm
congenital diaphragmatic hernia
what side is congenital diaphragmatic hernia on
left side
what are CM of congenital diaphragmatic hernia
resp distress absent breath sounds in affected area tachypnea cyanosis impaired cardiac output possible shock acidosis concave abd
is congenital diaphragmatic hernia a surgical emergency
yes and it is done within a couple of hours of birth (high mortality)
what should be done before the baby with a congenital diaphragmatic hernia leaves the room
and how should they be positioned
needs to be intubated and gastric decompressions
should be positioned head and thorax higher than abdomen
intestines protrude through abdominal wall at umbilicus
umbilical hernia
for a small hernia what is done
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
abd contents are herniated THROUGH the umbilical cord and exposed contents are covered by a translucent 2 layer membrane sac
omphalocele
is sx done right away for an omphalocele
no but if they need to they will push the organs back in where they came from and suture
for an omphalocele what is “paint and wait”
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
how is an omphalocele protected from trauma or drying
warm, sterile, saline soaked dressing with a layer of sterile plastic wrap
abdominal contents herniated outside of abd wall with NO covering membrane and umbilical cord is intact
gastroschisis (usually by the right side)
how is the gastroschisis sx done
first sx will get everything in the silo bag
second sx with close the abd
allows gradual return or intestines to abd cavity over 5-10 days, then closure
prosthetic silo
for a baby who has a silo/ gastroschisis when should a doctor be called immediately
if the baby does not have any bottom pulses (could put pressure on the vena cava)
absence of anal opening
imperforate anus
