Lecture 04 GI Dysfunction Flashcards
What are 5 different ways that a child’s GI is different from an adult’s?
- Increased peristalsis/ smaller capacity; stomach empties faster
- Decreased gastric aciditiy
- Immature GI system (affects digestion of some food)
- Infants have no bowel control and increased sensitivity to taste
- Immature liver function
Read and state 5 signs of GI dysfunction in children
- }Growth Failure
- }Spitting
- }Vomiting
- }Nausea
- }Constipation
- }Encopresis
- }Diarrhea
- }Hypo, hyper, absent bowel sounds
- }Abdominal distension
- }Abdominal pain
- }GI bleeding
- }Jaundice
- }Dysphagia
- }Dysfunctional swallowing
- }Fever
What is Hirschsprung’s Congenital Aganglionic Megacolon?
- Ganglion cells are absent in portion of bowel, which results in lack of peristalsis, causing enlargement proximal to defect
- Most common area affected is anorectum, but can occur at any part
- Colon can become very distended, with build up fecal material
- May be asymptomatic several weeks after birth.
- Diagnosis by rectal biopsy
- It’s difficult to pass stool
Hirschsprung’s Assessments (6)
- •Cardinal Sign delayed passage off meconium for 24-48 hours after birth
- •Meconium ileus
- •Signs of obstruction; lack bowel sounds, abdominal distention
- •Food refusal or vomiting
- •Ribbon-like, foul smelling explosive stool with digital exam
- •Extreme (older children) or intermittent recurring constipation
How would you treat Hirschsprung?
Surgical Correction
- }Treatment with enema regime. Repair may be primary take down or two stage with surgical repair with temporary colostomy followed by later re-anastomosis. Both with removal of aganglionic bowel
Post-operatively
- }Pain control
- }IV antibiotics 48 to 72 hours post-op
- }NOTHING per rectum
- }NPO until return of bowel function
- }NG Tube to prevent abdominal distension (primary); monitor losses
- }Teaching includes ostomy care for children with two stage repair
- }What is a priority assessment post-op for any patient? ALWAYS assess for airway, don’t get distracted by post op part
What is GER?
Common in what type of people?
Ger is transfer of gastric contents back into the esophagus, though to occur from transient relaxation of lower esophageal sphincter.
It’s common in preemie babies. About 1.2 of babies less than 2 months old have this, and it’s resolved by 1 year of age.
What are some GER complications?
Frequency and persistence make this problematic
Complications include: FTT, bleeding, respiratory symptoms. Asthma is an issue. Can lead to GERD.
Assessment of Reflux?
- excessive spitting/forceful vomiting
- FTT, weight loss
- Aspiration, may lead to apnea and respiratory infection
- arching and irritability
What are the general intervention steps for GER?
At first none, symptoms typically diminish between 8 weeks to 6 months and resolve by year 1.
Muscale develops and becomes stronger.
If symptomatic with weight loss or aspiration, first medical management attempted, then surgical intervention.
Surgical interventions would invovle suture in muscle to tighten it.
What are some anti reflux precatuions?
Initiate anti reflux precautions
- ◦Small, more frequent feeds
- ◦Frequent burping/bubbling after every ounce
- ◦Thickened formula: stays in stomach
- 1 tsp - 1 Tbs rice cereal/oz formula
- may need larger hole in nipple
- ◦Breast fed less likely to have GER: Ó transit time
- ◦Positional therapy: upright 30 degrees after meals to Ô vomiting; may offer pacifier
- ◦Prone positioning only in severe cases (AAP Safe Sleep 2011)
May require NG feeds if reflux severe and poor weight gain
What are aspiration risk factors for NG Feeds? (5)
- Sedation
- Coughing
- Artificial Airway
- Nasotracheal suctioning
- Decrease LOC
What occurs during the surgical treatment of GERD? (2)
- Nissen Fundoplication, 360 degree wrap of stomach fundus around esophagus.
- Gastrostomy tube is placed at the same time and feeding resumes through the G tube
PO feeds occur when post op swelling goes down, signs would be pt drooling less, tolerating secretions
Severe GER prognosis?
If it can’t be medically manged, it’ll elad to esophageal strictures and scarring, respiratory distress, aspiration pneumonia, and FTT
What is Acute Appendicitis?
Caused by?
Common when?
Acute Appendicitis is inflammation of vermiform appendix (blind sac at the end of cecum), caused by bacterial infection.
Most common organsim is E. Coli.
Most common ab surgery in childhood.
What can acute appendictis lead to?
Acute episodes can quickly progress to perfortation and peritonitis.
early signs are often mistaken for other illnesses.
Rarely occurs in children less than 2 years old.
Appendictis Assessment
Pain
◦Initially pain generalized or periumbilical
◦Pain descends to lower right quadrant with most intense pain at McBurney point
◦Colicky abdominal pain & tenderness◦Rebound tenderness, guarding (very painful) (Rovsing sign)
◦Referred pain indicates presence of peritoneal irritation
- }Nausea, vomiting & anorexia usually after onset of pain
- }May see diarrhea/constipation, lethargy, poor feeding, irritability
- }Labs include: Elevated WBC (15,00 to 20,000) with elevated % bands (shift to the left) indicating inflammatory process
- }Increasing erythrocyte sedimentation rate may indicate worsening condition.
- }Ultrasound or CT may be used to confirm
- }Diagnosis not always straightforward and delay may lead to perforation
Temp
- ◦Low grade (non perforation)
- ◦ >39 C (102.2 F) may indicate perforation or viral illness
How do you know when perforation occurred?
- Signs of peritonitis, plus increased fever, and sudden relief from pain after peroration.
- Ab distention usually increases with return of pain diffuse, and accompanied by rigid guarding of abs
- Tachycardia
