GI peds Flashcards

1
Q

Alimentary canal (hollow, muscular tube)

A

Oral cavity
Pharynx
Esophagus
Stomach
Small intestine
Large intestine

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2
Q

Accessory glands and organs

A

Salivary glands
Liver
Biliary duct system
Pancreas

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3
Q

late signs of dehydration

(late and saggy)

A

flaccid, not crying, sagging skin, doesn’t feel pain

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4
Q

infant and children exchange of fluid is

A

isotonic

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5
Q

maintenance fluid

A

D5 1/2

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6
Q

no pee, no

A

K

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7
Q

max K

A

20 meq in 500 mL bag - check this

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8
Q

3.5 kg - 10 kg

A

x 100 mL to calculate - max is 1000

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9
Q

10 - 20 kg

A

x 50 mL = max 500

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10
Q

20kg +

A

20 mL

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11
Q

max fluids

A

max 2400 mL

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12
Q

things to consider when feeding infants

A

they will tell you when they’re not hungry. don’t force them.

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13
Q

GI assessment for dehydration

A

percus, ausclate - order is important: visualize first - should be round and soft, not firm, shouldn’t see veins, will sound resonant, ausculate, percus, then belly tickles, then palpate, then go down, urine and bowel samples, x-ray, CT, least invasive to most, then labs.

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14
Q

if pt is dehydrated, first do

A

oral rehydration like pedialyte.

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15
Q

stool labs

A
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16
Q

qwacking (sp?)

A

checking stool for blood, can do parasitic

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17
Q

close monitoring of (for dehydration)

A

I/O

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18
Q

albumin for

A

heart failure

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19
Q

assessment - wound care - is bleeding normal?

A

minimal to low bleeding, can expect a little drainage from peritoneal - this is normal. change abd pad 2x in shift - this is expected.

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20
Q

ostomies

A

expected, bowel resections

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21
Q

cleft lip and cleft palate- what type of infection is common?

A

you can one without the other, but cleft palate always has a cleft lip. if hard palate involved, affects airway. ear infections are common. feeding - ESSR - elevate, suck, swallow, rest.

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22
Q

logans bow

A

after cleft surgery to protect kids from putting things in their mouth

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23
Q

esophageal atresia

A

a congenital disorder in which a baby’s esophagus does not form properly during pregnancy - will vomit up food or choke.

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24
Q

trans esophageal fistula

A

esophagus (the tube that leads from the throat to the stomach) and the trachea. will get cyanosis.

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25
normal stool amount for infants
6-8 a day
26
loose watery
diarrhea
27
corona virus smells
metalic
28
constipation is a
sign of something else - dietary, innervation, psychological, etc....
29
intestinal irriations
UC and crohns
30
UC
usually just colon and rectum. usually diagnosed in teenage years.
31
crohns
any part of digestive tract. usually an immune response where cells attack lining of gut. both UC and crohns need bowel rest.
32
UC and crohns treatment
managing stress and diet. might need an ostomy for bowel rest.
33
intacaception (sp)
part of intestines goes into another section - very painful.
34
intusseception - treatment
saline enemas can help, surgery last option,
35
appendicitis - what causes it?
most common surgery for young children, side to clutch is called mcburn site. fecolith = is what causes appendicitis - piece of poop that covers the opening into the appendicitis.
36
appendicitis - assessment - check for 1 thing
rebound tenderness, do scans to see if it's ruptured, if it hasn't popped - give IV antibiotics, if that's ok, switch to oral antibiotics.
37
appendicitis - 90% of time
end up doing appendectomy. usually go home by day 3.
38
how to calculate daily fluid maintenence requirements
100 ml/kg for 1st 10 kg body weight 50 ml/kg for 2nd 10 kg body weight 20 ml/kg for remaining body weight To find volume per hour Divide total amt by 24 hrs to obtain rate in ml/hr
39
skin temp - what percentages?
Cool hands or feet = 5% loss Cool to elbows and knees = 10% loss Cool to shoulders and hips = 15% loss
40
no tears until
2 months
41
The distribution of water between the ECF and ICF depends on active transport of:
potassium into cells (intra cellular) sodium out of cells (extra cellular)
42
Isotonic (Isonatremic) Dehydration
Primary type of dehydration for all children Sodium and water loss in equal balance Vascular loss = shock
43
Hypotonic (Hyponatremic) Dehydration
Low serum Na+ Too much free water replacement Osmotic shift from ECF to ICF Vascular shock
44
Hypertonic (Hypernatremic) Dehydration
Increased intake of sodium Concentrated formulas, rehydration fluid, intravenous fluid Osmotic shift to ECF
45
dehydration - CAUTION:
CAUTION: Do not add Potassium (K+) until serum electrolytes are checked and child has urine output noted NO Pee…. NO K+
46
INGESTION OF FOREIGN BODIES
Most common cause of accidental death age 6 months to 3 years Coins, peanuts, nuts, vegetables, metal or plastic objects, and bones most frequently aspirated items Risk of airway obstruction, perforation, acid burns, esophageal erosion
47
ERCP (ercept is a contrast)
Contrast medium is injected into the duodenal papilla to allow radiographic exam of pancreatic ducts and hepatobiliary tree
48
stool specimen
Container may need to be sterile or contain preservative May need to be refrigerated or transported immediately Specimen may come from diaper but not contaminated by urine
49
newborn stool - First meconium should be passed when?
First meconium should be passed within 24 to 36 hours of life; if not assess for Hirschsprung disease Hypothyroidism Meconium plug Meconium ileus (CF)
50
Constipation in exclusively breast-fed infant
almost unheard of Infrequent stool may occur because of minimal residue from digested breast milk Formula-fed infants may develop constipation
51
Encopresis (pass the feces)
Inappropriate passage of feces Often with soiling
52
HIRSCHSPRUNG DISEASE (sprung ganglions)
Absence of ganglion cells in colon. mechanical obstruction from inadequate motility of large intestine. Lack of nerve innervation causes absence/alteration in peristalsis
53
Clinical Manifestations of Hirschsprung Disease (can't relax bc I'm sprung)
Aganglionic segment of colon, Accumulation of stool with distention, Failure of internal anal sphincter to relax, Enterocolitis may occur
54
Hirschsprung Disease - s/sx - neonate - what about stool?
Inability to pass meconium/stool within first 24-48 hrs On inspection may have Abdominal distention Easily palpable stool masses
55
Hirschsprung Disease - s/sx - child - what about vomiting? (sprung feces)
Bile-stained or fecal vomiting Irritability Lethargy Wt loss Dehydration
56
Hirschsprung Disease - treatment
Type of surgery depends on extent/location of aganglionic bowel Less extensive—single surgery without colostomy Two stages Temporary ostomy Second stage “pull-through” procedure
57
GERD
Wait & See” approach No therapy is needed for infant who is thriving and has no respiratory complications Avoid offending foods Weight loss in some cases Pharmacologic interventions
58
feeding alterations - GERD - what to do with liquid?
Thickening feedings Upright positioning Small frequent feedings
59
GERD surgery (gerd has a nissan)
Surgical intervention—Nissan fundoplication
60
appendicitis - late complaints (late appendicitis is rigid)
Constipation or diarrhea Tachycardia, rapid shallow breathing Pallor Lethargy Rigid abdomen
61
appendicitis - complications
Peritonitis from perforation
62
symptoms of Peritonitis - what about stomach?
fever, abdominal distention/rigidity, sudden relief of pain, decreased bowel sounds, N/V
63
appendicitis - diagnosis - what type of scan?
Based on signs and symptoms Pain at Mc Burney Point (right lower quadrant) Child guards against anyone trying to examine abdomen Moderately elevated WBC count CT scan
64
appendicitis - treatment after rupture
Antibiotics Might not need immediate surgery Remove abscess when stable IV fluids NG suction Surgical removal of appendix with irrigation May need delayed closure of incision to prevent wound infection Drain (Penrose or Jackson-Pratt)
65
Meckel Diverticulum (meckel doesn't hurt)
-painless rectal bleeding -abd pain Signs of intestinal blockage
66
Ulcerative Colitis (UC) - what starts the pain?
Vasoconstriction starts painful chain of events
67
UC and crohns - s/sx - acute
Gradual onset of symptoms with periods of remission and exacerbation Acute Cramping/colicky pain in RLQ, diarrhea and flatulence, fever, bloody stools
68
UC and crohns - s/sx - chronic - diarrhea for how long?
Chronic Diarrhea (4-6/day), Pain in RLQ, Excess fat in stool, wt loss, weakness/fatigue, cramping, abdominal distention
69
UC and crohns - nutrition
High-protein, high-calorie, low-fiber Supplement with iron, folic acid, vitamins Enteral formulas
70
UC and crohns - meds
Corticosteroids, aminosalicylates, anti-infectives, immunosuppressive agents
71
Hypertrophic Pyloric Stenosis
Constriction of the pyloric sphincter with obstruction of the gastric outlet, prevents stomach from empyting,
72
Hypertrophic Pyloric Stenosis - s/sx in 1st few weeks of life - same as any blockage - is alkylosis or acidosis?
Projectile vomiting Failure to thrive Dehydration Metabolic alkalosis more common in boys
73
Pyloric Stenosis - vomit will have what? (bloody stenosis is delayed)
Distended upper abdomen Vomitus positive for blood Hypocalcemia, hyponatremia, hypokalemia, hypochloremia
74
Intussusception - symptoms (sliding inception, sliding jelly)
Classic presentation—“currant jelly–like stools” Caused from leaking blood and mucous into intestinal lumen
75
Intussusception - treatment (blow out inception)
Attempt conservative treatment (nonsurgical) first Air enema (radiologist-guided in IR) With or without contrast Hydrostatic (saline) or barium enema (ultrasound-guided) If unsuccessful, progress to surgery treatment Surgical reduction and fixation Or Excision of nonviable segment of colon
76
lower GI bleed - what symptoms? (low tar)
tarry stools
77
Atresia (A for absent)
Atresia—absence of normal opening or normally patent lumen May involve any portion from mouth to anus Most are apparent at birth Crucial stage of embryonic development was affected
78
Surgical Correction of Cleft Lip - what ages?
Closure of lip defect precedes correction of the palate Birth-3 mo old
79
Surgical Correction of Cleft Palate - better before what? (nice palate from 12 - 18)
Typically 12 to 18 months of age before speech pattern development Must be free from ear and respiratory infections
80
barium - make sure what after surgery?
make sure bowel movements go back to normal after a few days
81
high fiber foods
popcorn
82
neonate - hersprung disease - what is the stool like? (sprung like a ribbon)
When stool passes its liquid or ribbon-like
83
intusseception - Classic triad of symptoms (PMS during inception)
Abdominal pain Abdominal mass Blood stool
84
intusseception - symptoms (colicky inception)
Colicky pain with screaming, drawing knees to chest, sweating, grunting
85
surgery of cleft palate - not allowed to do what after surgery?
Not allowed to suck post-op
86
cleft palate surgery - must be what BEFORE surgery?
Must be weaned from bottle/breast before surgery
87
kasai procedure (kasai is a tree)
treats biliary atresia**** a type of surgery to remove the diseased bile ducts to the base of the liver and re-establish bile flow from the liver using a portion of the child's intestine
88
intussusception (inception slides)
a serious condition in which part of the intestine slides into an adjacent part of the intestine
89
pyloric stenosis - palpation? (pyl the olives on)
Palpation= olive-shaped bulge below right costal margin Distended upper abdomen
90
pyloric stenosis - alkolosis or acidosis?
ABG- metabolic alkalosis Ultrasound and endoscopy show hypertrophied sphincter Upper GI shows delayed gastric emptying