GI peds Flashcards
Alimentary canal (hollow, muscular tube)
Oral cavity
Pharynx
Esophagus
Stomach
Small intestine
Large intestine
Accessory glands and organs
Salivary glands
Liver
Biliary duct system
Pancreas
late signs of dehydration
(late and saggy)
flaccid, not crying, sagging skin, doesn’t feel pain
infant and children exchange of fluid is
isotonic
maintenance fluid
D5 1/2
no pee, no
K
max K
20 meq in 500 mL bag - check this
3.5 kg - 10 kg
x 100 mL to calculate - max is 1000
10 - 20 kg
x 50 mL = max 500
20kg +
20 mL
max fluids
max 2400 mL
things to consider when feeding infants
they will tell you when they’re not hungry. don’t force them.
GI assessment for dehydration
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.
if pt is dehydrated, first do
oral rehydration like pedialyte.
stool labs
qwacking (sp?)
checking stool for blood, can do parasitic
close monitoring of (for dehydration)
I/O
albumin for
heart failure
assessment - wound care - is bleeding normal?
minimal to low bleeding, can expect a little drainage from peritoneal - this is normal. change abd pad 2x in shift - this is expected.
ostomies
expected, bowel resections
cleft lip and cleft palate- what type of infection is common?
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.
logans bow
after cleft surgery to protect kids from putting things in their mouth
esophageal atresia
a congenital disorder in which a baby’s esophagus does not form properly during pregnancy - will vomit up food or choke.
trans esophageal fistula
esophagus (the tube that leads from the throat to the stomach) and the trachea. will get cyanosis.
normal stool amount for infants
6-8 a day
loose watery
diarrhea
corona virus smells
metalic
constipation is a
sign of something else - dietary, innervation, psychological, etc….
intestinal irriations
UC and crohns
UC
usually just colon and rectum. usually diagnosed in teenage years.
crohns
any part of digestive tract. usually an immune response where cells attack lining of gut. both UC and crohns need bowel rest.
UC and crohns treatment
managing stress and diet. might need an ostomy for bowel rest.
intacaception (sp)
part of intestines goes into another section - very painful.
intusseception - treatment
saline enemas can help, surgery last option,
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.
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.
appendicitis - 90% of time
end up doing appendectomy. usually go home by day 3.
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
skin temp - what percentages?
Cool hands or feet = 5% loss
Cool to elbows and knees = 10% loss
Cool to shoulders and hips = 15% loss
no tears until
2 months
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)
Isotonic (Isonatremic) Dehydration
Primary type of dehydration for all children
Sodium and water loss in equal balance
Vascular loss = shock
Hypotonic (Hyponatremic) Dehydration
Low serum Na+
Too much free water replacement
Osmotic shift from ECF to ICF
Vascular shock
Hypertonic (Hypernatremic) Dehydration
Increased intake of sodium
Concentrated formulas, rehydration fluid, intravenous fluid
Osmotic shift to ECF
dehydration - CAUTION:
CAUTION: Do not add Potassium (K+) until serum electrolytes are checked and child has urine output noted
NO Pee…. NO K+
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
ERCP
(ercept is a contrast)
Contrast medium is injected into the duodenal papilla to allow radiographic exam of pancreatic ducts and hepatobiliary tree
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
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)
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
Encopresis
(pass the feces)
Inappropriate passage of feces
Often with soiling
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
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
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
Hirschsprung Disease - s/sx - child - what about vomiting?
(sprung feces)
Bile-stained or fecal vomiting
Irritability
Lethargy
Wt loss
Dehydration
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
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
feeding alterations - GERD - what to do with liquid?
Thickening feedings
Upright positioning
Small frequent feedings
GERD surgery
(gerd has a nissan)
Surgical intervention—Nissan fundoplication
appendicitis - late complaints
(late appendicitis is rigid)
Constipation or diarrhea
Tachycardia, rapid shallow breathing
Pallor
Lethargy
Rigid abdomen
appendicitis - complications
Peritonitis from perforation
symptoms of Peritonitis - what about stomach?
fever, abdominal distention/rigidity, sudden relief of pain, decreased bowel sounds, N/V
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
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)
Meckel Diverticulum
(meckel doesn’t hurt)
-painless rectal bleeding
-abd pain
Signs of intestinal blockage
Ulcerative Colitis (UC) - what starts the pain?
Vasoconstriction starts painful chain of events
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
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
UC and crohns - nutrition
High-protein, high-calorie, low-fiber
Supplement with iron, folic acid, vitamins
Enteral formulas
UC and crohns - meds
Corticosteroids, aminosalicylates, anti-infectives, immunosuppressive agents
Hypertrophic Pyloric Stenosis
Constriction of the pyloric sphincter with obstruction of the gastric outlet, prevents stomach from empyting,
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
Pyloric Stenosis - vomit will have what?
(bloody stenosis is delayed)
Distended upper abdomen
Vomitus positive for blood
Hypocalcemia, hyponatremia, hypokalemia, hypochloremia
Intussusception - symptoms
(sliding inception, sliding jelly)
Classic presentation—“currant jelly–like stools”
Caused from leaking blood and mucous into intestinal lumen
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
lower GI bleed - what symptoms?
(low tar)
tarry stools
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
Surgical Correction of Cleft Lip - what ages?
Closure of lip defect precedes correction of the palate
Birth-3 mo old
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
barium - make sure what after surgery?
make sure bowel movements go back to normal after a few days
high fiber foods
popcorn
neonate - hersprung disease - what is the stool like?
(sprung like a ribbon)
When stool passes its liquid or ribbon-like
intusseception - Classic triad of symptoms
(PMS during inception)
Abdominal pain
Abdominal mass
Blood stool
intusseception - symptoms
(colicky inception)
Colicky pain with screaming, drawing knees to chest, sweating, grunting
surgery of cleft palate - not allowed to do what after surgery?
Not allowed to suck post-op
cleft palate surgery - must be what BEFORE surgery?
Must be weaned from bottle/breast before surgery
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
intussusception
(inception slides)
a serious condition in which part of the intestine slides into an adjacent part of the intestine
pyloric stenosis - palpation?
(pyl the olives on)
Palpation= olive-shaped bulge below right costal margin
Distended upper abdomen
pyloric stenosis - alkolosis or acidosis?
ABG- metabolic alkalosis
Ultrasound and endoscopy show hypertrophied sphincter
Upper GI shows delayed gastric emptying
