MID 2 GI Flashcards
Anorexia
- Lack of desire to eat with nausea, abdominal pain, diarrhea, psychological stress
- Side effects of medication and disorders of other organs- cancer, heart disease, kidney disease
Emesis (vomiting)
- Forceful emptying of stomach and intestinal contents
- Nausea and retching (dry heaves) are distinct events that usually precede vomiting
- Consequences of nausea and vomiting: fluid and electrolyte imbalances, acid/base disturbance, hyponatremia, hypokalemia, hypochloremia and metabolic alkalosis
Emesis: Caused by
- Extreme pain
- Distension of the stomach or duodenum
- Motion sickness
- Side effects of medications
- Trauma of ovaries, testes, uterus, bladder or kidney
Nausea
- subjective experience
-associated with conditions like abnormal pain and spinning movements
- hypersalivation and tachycardia associated symptoms
Projectile vomiting
- Vomiting without nausea
- Caused by direct stimulation of the vomiting center by neurological lesions (e.g. increased intracranial pressure, tumors, or aneurysms) involving the brainstem or can be a symptom of GI obstruction
Constipation
- Difficult or infrequent defecation/bowel movements
- Subjective- dependant on normal bowel habits
Primary constipation
- Normal transit (functional)- normal rate, but difficult evacuation: sedentary lifestyle, poor diets- low in fibre, high in refined food, low fluid intake
- Slow transit- impaired colonic motor activity with infrequent bowel movements, straining, abdominal distension (swollen) and palpable stool in sigmoid colon
Pelvic floor dysfunction
difficulty with pelvic floor muscles or anal sphincter e.g. rectal fissures, strictures or hemorrhoids
Secondary constipation
- Caused by medications or neurogenic disorders
- Opiates, antacids and iron tend to inhibit bowel motility
- Endocrine or metabolic disorders e.g. hypothyroidism, diabetes mellitus
- Diverticuli, irritable bowel syndrome and pregnancy are associated with constipation
Constipation: Manifestations
- 25% of the time: straining with defecation Lumpy, hard stools, incomplete emptying sensation, manual maneuvers, <3 bowel movements per week
- Fecal impaction (hard, dry stool retained in the rectum) → rectal bleeding, abdominal or cramping pain, nausea and vomiting, weight loss and episodes of diarrhea
- Straining to evacuate stool → engorgement of the hemorrhoidal veins and hemorrhoidal disease or thrombosis with rectal pain, bleeding and itching
- Passage of hard stools can cause painful anal fissures
Diarrhea
- Presence of frequent loose, watery stools
- > 3 loose stools within 24 hours lasting less than 14 days
- very dangerous in children- lower fluid reserves than adults
- Fluid replacement must be with osmotically balanced products
- Large volume diarrhea: caused by excessive amounts of water or secretions or both in the intestines
- Small-volume diarrhea: volume of feces is not increased, usually results from excessive intestinal motility
- Persistent diarrhea: 14 days-4 weeks
- Chronic diarrhea: >4 weeks
Osmotic diarrhea
- Excessive fluid drawn into the intestinal lumen by osmosis
- Caused by: Non-absorbable sugars, full-strength tube feeds, dumping syndrome
Secretory diarrhea
Excessive secretion of fluids by the intestinal mucosa
Motility diarrhea
- Excessive GI motility (motility diarrhea)- 80% fluid is reabsorbed in small intestine
- Caused by: Resection of the small intestine (short bowel syndrome), surgical bypass of an area of the intestine
Diarrhea: Manifestations
- Systemic effects: dehydration, electrolyte imbalance, weight loss
- Infection with diarrhea- fever, with or without vomiting or cramping pain
- Chronic diarrhea caused by IBD- fever, cramping pain and bloody stools
- Malabsorption syndromes- fat in stools, bloating, diarrhea
Abdominal pain
- Presenting symptom of a number of GI diseases
- Caused by stretching (mechanical), inflammation or ischemia
- Can be acute or chronic
- Can be parietal (somatic), visceral or referred
Parietal pain
from parietal peritoneum, more localized and intense than visceral pain, aggravated by movement
Visceral pain
arises from organs themselves, arises from a stimulus (distension, inflammation, ischemia) acting on an abdominal organ, poorly localized, diffuse or vague with a radiating pattern
Referred pain
visceral pain felt at some distance from a disease or affected organ
Upper GI bleed: Where is it
esophagus, stomach, or duodenum
Upper GI bleed: Caused by
- Bleeding varices
- Varicose veins of esophagus (most common)
- Peptic ulcers
- Tear at the esophageal-gastric junction (Mallory-Weiss syndrome) caused by severe retching
Upper GI bleed: Manifestations
hematemesis (vomiting of blood)= emesis of frank, bright red bleeding or dark, grainy digested blood (coffee grounds)
Lower GI bleed: Where is it
Jejunum, ileum, colon or rectum
Lower GI bleed: Caused by
- Polyps
- Diverticulitis
- Inflammatory disease
- Cancer
- Hemorrhoids
Lower GI bleed: Manifestations
- melena= black, tarry, foul-smelling stool- caused by digestion of blood in GI tract
- hematochezia= bright red blood passed from rectum
- Occult bleeding= presence of blood in ordinary stool or gastric secretions, no evidence of it until sent to lab
Massive GI bleed
- Blood volume depletion- hypovolemic shock
- Decreased cardiac output, decreased systolic BP, increased HR
- Compensatory constriction of peripheral arteries
- Compensatory failure
- Decreased blood flow to skin= pallor (pale)
- Decreased blood flow to kidneys= low urine output
- Decreased blood flow to GI= abdominal pain, bowel infarction (death of tissue), liver necrosis
- Decreased blood flow to brain= anxiety, confusion, stupor (numbness), coma
- Decreased coronary blood flow= angina, myocardial infarct, heart failure
Dysphagia
Difficulty swallowing
Achalasia
rare form of dysphagia
Dysphagia and Achalasia: Caused by
- Mechanical obstruction of esophagus- tumors, diverticular herniations
- Functional disorder- neurological or muscular disorders which interfere with voluntary swallowing e.g. cerebrovascular disease, Parkinson’s, MS, muscular dystrophy
Dysphagia and Achalasia: Manifestations
- Stabbing pain at the level of obstruction
- Discomfort after swallowing
- Regurgitation of undigested food
- Unpleasant taste sensation
- Vomiting
- Aspiration
- Anorexia- low weight
Acid reflux (gastroesophageal reflux)
- lower esophageal sphincter (LES) does not properly close, allowing stomach acid to backup, which irritates the lining of the esophagus
- Intermittent/acute
Acid reflux: Manifestations
- Burning sensation in the center of your chest that lasts from several minutes to an hour or two
- A feeling of chest pressure or pain that is worse if you bend over or lie down
- A sour, bitter, or acidic taste in the back of your throat
- A feeling that food is “stuck” in your throat or the middle of your chest
GERD (gastroesophageal reflux disease)
- Chronic- acid reflux that does not go away
- Reflux of acid and pepsin from the stomach to the esophagus that causes esophagitis (inflammation of lining of esophagus)
GERD: Caused by
- Abnormalities in LES function (resting tone lower than normal), esophageal motility, gastric motility or emptying
- Vomiting, coughing, lifting, bending, obesity or pregnancy increases abdominal pressure contributing to reflux
GERD: Risk factors
- Age
- Obesity
- hiatal hernia (stomach bulges up into your chest through an opening in diaphragm)
- Medications that relax the LES
Intestinal obstruction and paralytic ileus
- Any condition that prevents the flow of chyme through the intestinal lumen
- Simple obstruction: Mechanical blockage by lesion, most common
- Functional obstruction or Paralytic ileus: Failure of intestinal motility often occurring after intestinal or abdominal surgery, acute pancreatitis, or hypokalemia , inability of the intestines to conduct peristalsis
Small intestine obstruction: Manifestations
- Colicky pains (pain in abdomen)
- Nausea and vomiting
- Pain- severe initially, then diminishes
- If ischemia occurs: the pain loses its colicky character and becomes more constant and severe, sweating (diaphoresis), tachycardia, fever, leukocytosis, abdominal distension (gas accumulating-swelling), rebound tenderness, progression to necrosis, perforation (hole), peritonitis (redness and swelling) and sepsis
Lower in small intestine obstruction: Manifestations
- More pronounced distension
- Greater length of intestine is proximal to obstruction
- Vomiting (late sign)
- Constipation
- Rarely diarrhea
- Increased bowel sounds
Large intestine obstruction: Manifestations
- Hypogastric pain
- Abdominal distension
- Pain varies- dependent on ischemia and peritonitis
- Vomiting (late sign)
Gastritis
Inflammation of gastric mucosa
Acute gastritis: Caused by
injury of the protective mucosal barrier caused by: Medications (NSAIDs), chemicals, H. pylori infection
Acute gastritis: Manifestations
- vague abdominal discomfort
- Epigastric tenderness
- Bleeding
Chronic gastritis
Tends to occur in older adults
Chronic gastritis: Caused by
- Chronic inflammation
- Mucosal atrophy (waste)
- Epithelial metaplasia (replacement of cells by other kinds of cells)
Peptic ulcer disease
Break or ulceration in the protective mucosal lining of the lower esophagus, stomach or duodenum
Peptic ulcer disease: Caused by
- H. pylori bacteria- affects mucous and allows stomach acid to damage lining
- Medications e.g. NSAIDs- irritate and damage lining
Peptic ulcer disease: Risk factors
- Age> 70 years
- Alcohol consumption
- Smoking
- Injury or trauma
Stress ulcer
- Acute form of peptic ulcer that accompanies physiological stress of severe illness or major trauma
- Primary sign of a stress ulcer is bleeding
- Can be classified as ischemic ulcers or Cushing ulcers
Ischemic ulcer
Develop within hours of an event such as hemorrhage, multisystem trauma, severe burns (Curling ulcers- most common site is duodenum), heart failure or sepsis
Cushing ulcer
- Stress ulcer associated with severe brain trauma or brain surgery
- Most common site is stomach
Gastrectomy
- Surgery to remove all or part of the stomach
- Indication for gastrectomy: recurrent or uncontrolled bleeding- perforation of stomach or duodenum
Gastrectomy: Complications
- Dumping syndrome
- Alkaline reflux gastritis
- Diarrhea
- Weight loss
- Anemia- iron malabsorption
Dumping syndrome
- Rapid emptying of residual stomach (stomach component remaining after surgical resection)
- Causes an osmotic shift of fluid from the vascular compartment to the intestinal lumen, which decreases plasma volume → cramping pain, nausea, vomiting, diarrhea, weakness, pallor, hypotension
Alkaline reflux gastritis
Inflammation caused by reflux of bile and pancreatic secretions from the duodenum into the stomach → nausea, vomiting bile, epigastric pain
Ulcerative colitis
- Restricted to large intestine - originate in rectum and may extend to entire colon
- Ulcerations (ulcer=sore) of the mucosa in the colon
- Chronic condition
- Peak occurrence 20-40 years of age and then between 50-70
- Men > women
- Possible related to abnormal immune response in the GI tract- genetic factors
- Stress does not cause the disorder but can increase severity
- Can have remission and exacerbation
Mild ulcerative colitis
- Less mucosal involvement
- Fewer bowel movement
Severe ulcerative colitis
- Involve entire colon
- Abdominal pain, fever, tachycardia, frequent diarrhea, bloody stools, continuous cramping pain
Crohn’s disease
- Mouth to rectum (anywhere in GI tract- distal small intestine and proximal large intestine most common sites)
- Idiopathic (no known reason for inflammation) inflammatory disorder
- Spreads with discontinuous transmural involvement- skips from place to place (patchy lesions), not like colitis which progresses from rectum
Crohn’s disease: Manifestations
- Fistulas - abnormal hole between 2 hollow organs, between 2 loops of intestine, between intestine and bladder or vagina
- Anemia from malabsorption of vitamin B12 and folic acid
- Asymptomatic for years
- Diarrhea= major symptom
- Weight loss
- Abdominal pain
Irritable bowel syndrome
- Recurrent abdominal pain with altered bowel habits
- Associated with anxiety, depression and reduced quality of life
- More common in females
Irritable bowel syndrome: Manifestations
- Lower abdominal pain or discomfort and bloating
- Recurrent abdominal pain with altered bowel habits (constipation and diarrhea)
- Pain- occurs during the day with stress or 1-2 after meals, relieved with defecation
Diverticula
herniations or saclike outpouchings of the mucosa and submucosa through the muscle layers, usually in the wall of the sigmoid colon
Diverticulosis
Asymptomatic diverticular disease
Diverticulitis
Inflammatory stage of diverticulosis
Diverticular disease of the colon: Caused by
- unknown- idiopathic
- associated with increased intracolonic pressure, abnormal neuromuscular function and alterations in intestinal motility
Diverticular disease of the colon: Risk factors
- Older age
- Genetic predisposition
- Obesity
- Smoking
- Diet
- Lack of physical activity
- Medication use- NSAIDs and aspirin
Diverticular disease of the colon: Manifestations
- Vague or absent (asymptomatic)
- Cramping in lower abdomen
- Diarrhea
- Constipation
- Distention or flatulence may occur
- If the diverticula become inflamed or abscesses form (i.e. diverticulitis), the individual develops fever, leukocytosis (increased WBC count), and tenderness in left lower quadrant
Appendicitis
- Inflammation of the vermiform appendix- projection from the apex of the cecum
- Most common emergency surgery of the abdomen
- 10-19 years of age
Appendicitis: Caused by
- Obstruction of the lumen with stool, tumors or foreign bodies → bacterial infection
- Obstruction does not allow drainage→ intraluminal pressure increases → decreases mucosal blood flow → hypoxia → mucosa ulcerates → increasing bacterial invasion → edema and inflammation → gangrene develops from thrombosis of blood vessels → perforation follows
- If perforation occurs, contents spill into abdominal cavity → peritonitis → most common and dangerous complication
Appendicitis: Manifestations
- Initially- vague epigastric pain, cramping sensation
- Over 24 hours- pain becomes more localized
- Anorexia
- Nausea or vomiting
- Low-grade fever
- Rebound tenderness on palpation
- Following rupture- brief cessation of pain- fatal if it is untreated
Obesity
- BMI>30
- Increases risk for all diseases
Obesity: Caused by
- Genetics
- Sedentary lifestyle
- Over eating
- Culture
- Causes of obesity are complex and involve the interaction of adipokines produced by fat cells and other body weight control signals at the level of the hypothalamus
Visceral obesity
- Distribution of body fat is localized around the abdomen and upper body
- “Apple shape”
Peripheral obesity
- Distribution of body fat is extraperitoneal and distributed around the thighs and buttocks
- “Pear shape”
Normal weight obesity (NWO)
- Individuals with normal body weight and BMI with percentage of body fat >30%
- Risk for metabolic dysregulation, increases in inflammatory cytokines, insulin resistance, increased risk for cardiovascular disease and higher mortality
Metabolically healthy obesity (MHO)
- Obese but have no metabolic-obesity associated complications and decreased risk for morbidity and mortality
- Delays obesity-related complications until an older age
Malnutrition
- Lack of nourishment from inadequate amounts of calories, protein, vitamin or minerals
- Can be consuming calories, but not enough essential vitamins and minerals
Starvation
- Decreased energy intake leading to weight loss
- Extreme state of malnutrition
Short-term starvation
- 3-4 days of total dietary abstinence or deprivation
- Glycogenolysis: glycogen in liver is converted to glucose
- Gluconeogenesis: formation of glucose from noncarbohydrate molecules
Long-term starvation
- Several days of dietary abstinence
- Breakdown of ketone bodies and fatty acids
- Eventually, proteolysis (protein breakdown) begins, and death ensues if nutrition is not restored
Refeeding syndrome
- Life-threatening
- Potentially fatal shifts in fluids and electrolytes (hypophosphatemia, hypomagnesemia and hypokalemia) that may occur in malnourished patients receiving artificial refeeding (whether enterally or parenterally). These shifts result from hormonal (insulin release) and metabolic changes and may cause serious clinical complications
Cirrhosis
- Widespread destruction of hepatic cells
- Inflammatory disease of the liver that causes fibrosis (thickening and scarring of tissue) and nodular regeneration
- Causes progressive irreversible liver damage, usually over a period of years
Cirrhosis: Caused by
- Hepatitis
- Exposure to toxins e.g. acetaldehyde (product of alcohol metabolism)
Alcohol liver disease: Mildest form- alcoholic fatty liver
- Caused by: relatively small amounts of alcohol
- Reversible with cessation of drinking
- Characterized by an excessive accumulation of fat inside the liver cells- makes it hard for the liver to function properly
Alcohol liver disease: Precursor of cirrhosis- alcoholic hepatitis
- Characterized by the inflammation of the liver leading to the degeneration of liver cells
- Stage might last for some years but will eventually progress irreversible fibrous if the patient continues to drink
Alcohol liver disease: Alcoholic cirrhosis
- Cell damage initiates an inflammatory response that results in excessive collagen formation
- Permanent fibrosis and scarring alter the structure of the liver and obstruct biliary and vascular channels → jaundice (bile obstruction), portal hypertension/shunting/varices (enlarged veins) (vascular obstruction)
- Impaired the hepatocytes’ ability to oxidize fatty acids, synthesize enzymes and proteins, degrade hormones, and clear portal blood of ammonia and toxins
Alcoholic liver disease: Complications
- portal hypertension
- varices
- splenomegaly
- hematemesis
- ascites
- jaundice
- hepatic encephalopathy
- hepatorenal syndrome
Portal hypertension
- High BP in the portal venous system
- Disease that obstructs or impedes blood flow in any part of the venous system including the vena cava
Varices
- Abnormally dilated vessel with a tortuous course
- Common in lower esophagus and stomach
- Rupture can be life threatening
Splenomegaly
- Spleen becomes enlarged due to increased pressure in splenic vein
- Thrombocytopenia- enlarged spleen holds too many platelets
Hematemesis
Most common sign of portal hypertension due to esophageal varices
Ascites
- Abnormal buildup of fluid in the abdomen trapped in peritoneal space- reduces amount of fluid available for normal physiological function
- Biggest cause= cirrhosis
Jaundice
Yellow or greenish pigmentation of skin or sclera of the eyes caused by increases in plasma bilirubin concentration (hyperbilirubinemia)
Hepatic encephalopathy
- Decline in brain function that occurs as a result of severe liver disease because liver cannot adequately remove toxins from your blood
- Characterized by impaired behavioral, cognitive and motor function
- Can develop quickly in hepatitis or slowly in cirrhosis
Hepatorenal syndrome
Renal failure caused by liver disease
Viral hepatitis
- Infection of the liver caused by a strain of hepatitis virus (A, B,C, D and E)
- All types cause hepatic cell necrosis, Kupffer cell (liver macrophages) hyperplasia, and infiltration of liver tissue by mononuclear phagocytes → obstruct bile flow and impair hepatocyte function
Hepatitis A
- transmission: fecal-oral, parenteral, sexual
- incubation period (days take for symptoms to show): 30 days
- chronic hepatitis: No
- Age group: children
- Prevention: Ig and vaccine
Hepatitis B
- transmission: parenteral, sexual, placenta
- incubation period: 60-180 days
- chronic hepatitis: Yes
- Age group: Any age
- Prevention: Ig and vaccine
Hepatitis C
- transmission: parenteral, sexual, placenta
- incubation period: 35-60 days
- chronic hepatitis: Yes
- age group: adults
- prevention: education, hygiene
Viral hepatitis: Manifestations (Stage 1= prodromal phase)
- Fever
- Malaise
- Anorexia
- Liver enlargement and tenderness
Viral hepatitis: Manifestations (Stage 2= icteric phase)
- Jaundice
- Hyperbilirubinemia (build up of bilirubin → pigment → jaundice)
Viral hepatitis: Manifestations (Stage 3= recovery phase)
- Symptoms resolve
- Return of normal liver function 2-12 weeks after jaundice
Cholelithiasis
- Gallstone formation
- As a result of the aggregation of cholesterol crystals (cholesterol stones) or precipitates of unconjugated bilirubin (pigmented stones)
- Cause abdominal pain and jaundice
3 types of cholelithiasis
- Cholesterol (associated with 70-80% cholesterol)
- Pigmented black (rare, associated with chronic liver disease and hemolytic disease) or brown (associated with biliary stasis, bacterial infections, biliary parasites)
- Mixed
Cholelithiasis: Manifestations
- Asymptomatic
- Epigastric and right upper quadrant pain/discomfort
- Intolerance for fatty food
- Heartburn
- Flatulence
Cholecystitis
- Acute or chronic
- Caused by gallstone lodged in cystic duct
- Obstruction causes gallbladder to become distended and inflamed
- Pressure against distended wall of gallbladder can cause decreased blood flow, ischemia, necrosis and perforation
Cholecystitis: Risk factors
- Obesity
- Middle age
- Female
- Oral contraceptive use
- Rapid weight loss
- First Nations ancestry
- Gallbladder, pancreas or ileal disease
- Genetic predisposition
Cholecystitis: Manifestations
- Fever
- Leukocytosis
- Rebound tenderness
- Abdominal muscle guarding
Pancreatitis: Risk factors
- cholelithiasis
- Alcoholism
- Obesity
- Peptic ulcers
- Trauma
- dyslipidemia
- Hypercalcemia
- Smoking
- Some medications
- Genetics
Acute pancreatitis
- Mild
- Resolves spontaneously
- Obstruction of the outflow of pancreatic digestive enzymes → accumulation of pancreatic secretions → autodigestion of pancreatic cells and tissues (process whereby pancreatic enzymes destroy its own tissues) → inflammation, vascular damage, coagulation and fat necrosis
- Can also result from alcohol, medications or viral infection
Acute pancreatitis: Manifestations
- Constant mild to severe epigastric pain may radiate to the back
- Fever
- Increased WBC count
- Nausea and vomiting
- Jaundice
Chronic pancreatitis
- Causes progressive fibrotic destruction of pancreas
- Chronic alcohol abuse is most common cause
- May also come from gallstones, smoking, genetics
- Pancreatic parenchyma is destroyed replaced by fibrous tissues, calcification, ductal obstruction and pancreatic cysts
Chronic pancreatitis: Manifestations
- intermittent or continuous abdominal pain
- weight loss
Esophagus cancer: Risk factors
- Malnutrition
- Alcohol
- Tobacco
Esophagus cancer: Manifestations
- Chest pain
- Dysphagia
Stomach cancer: Risk factors
- Salty food
- Red meat
- Nitrates- common in processed meats, also in some leafy green vegetables
Stomach cancer: Manifestations
- Anorexia
- Weight loss
- Vomiting occult blood
- Right upper quadrant (RUQ) pain
Colorectal cancer: Staging
Stage 0:
- Carcinoma in situ
- Cancer cells are only in the inner lining of the colon or rectum (mucosa)
- Cancer cells have not grown past the muscle layer of the mucosa
Stage 1:
- Tumor has grown into the layer of connective tissue that surrounds the mucosa (submucosa) or into the thick outer muscle layer of the colon or rectum (muscularis propria)
Stage 2:
- Involves serosa- or into tissues beyond the muscle layer into other organs
Stage 3:
- Cancer cells in lymph does near the colon or rectum
Stage 4:
- Cancer spread to other parts of the body (distant metastasis) such as to the liver or lungs
Colorectal cancer: Risk factors
- Polyps - larger polyp the greater the risk
- IBD
- Diverticulitis
- High-fat
- High refined carbs
- Low fiber diet
- Genetics- family history of colorectal cancer puts you at greater risk
Colorectal cancer: Manifestations
- Pain
- Mass
- Anemia
- Bloody stool
- Distension
Pancreas cancer: Risk factors
- Chronic pancreatitis
- Smoking
- Alcohol
- Diabetes in women
- Family history
- High-fat foods
- Processed meat
- Obesity
Pancreas cancer: Manifestations
- Weight loss
- Weakness
- Nausea and vomiting
- Abdominal pain
- Depression
- Jaundice - due to bile duct obstruction
Liver cancer: Risk factors
- Hep B,C,D
- Cirrhosis
Liver cancer: Manifestations
- Pain
- Anorexia
- Weight loss
- Ascites
- Jaundice
Cleft lip and cleft palate
- Caused by the incomplete fusion during the second month of development
- Syndrome associated with other malformations
- Nonsyndromic occurs alone
Cleft lip and cleft palate: Caused by
- Maternal alcohol and tobacco use
- Maternal diabetes mellitus
- Folate deficiency
Esophageal atresia
esophagus ends in a blind pouch- does not connect properly
Tracheoesophageal fistula
connection between trachea and esophagus- air enters stomach, regurgitated secretions enter lungs
Esophageal atresia and tracheoesophageal fistula: Caused by
- Environmental exposure to Tapazole (medication to treat hyperthyroidism)
- ½ have one or more other birth defects
- Infectious disease
- Alcohol or smoking
- Maternal diabetes
- Maternal age
Esophageal atresia and tracheoesophageal fistula: Manifestations
- Drooling at birth
- Inability to swallow secretions
- Choking with feeding
- Respiratory distress- abdomen may fill with air becoming distended and interferes with respiration- may show intermittent cyanosis
Pyloric stenosis
- Narrowing and distal obstruction of the pylorus
- Unknown cause- multifactorial- genetic and environmental factors
- Muscle fibers thicken so the pyloric sphincter becomes enlarged and inflexible
- Extra effort to force gastric contents may cause muscle layers of stomach to become hypertrophied as well
Pyloric stenosis: Manifestations
- 2-8 weeks after birth
- Forceful, nonbilious vomiting immediately after feeding
- Constipation due to no fluid reaching intestines
Hirschsprung’s disease
- Functional obstruction of colon
- Absence of nerve cells in part of colon causes decreased peristalsis- distension to proximal colon- causing ‘megacolon’
Hirschsprung’s disease: Manifestations
- Delayed passage of meconium (newborn first poop)
- Mild to moderate constipation
- Poor feeding
- Poor weight gain
- Increasing distension
- Watery diarrhea as water may pass obstruction
Intussusception
- Telescoping of proximal segment of intestine into a distal segment- causing mechanical obstruction
- Most common cause of small bowel obstruction in children
- Most occur between 5-7 months of age
Intussusception: Manifestations
- Colicky abdominal pain
- Irritability
- Knees drawn to chest
- Abdominal mass
- Vomiting
- Bloody stools
Hernias
- Bowel protrudes through weakening in abdominal wall ligament- bulge in groin or scrotum (typically comes and goes)- May get bigger if child is straining or crying- Straining makes hernia easier to see
- Most common in newborns
- May not be noticeable for several weeks or months after birth
Hernias: Caused by
Weakness in abdominal muscles
Failure to thrive
- Physical sign that a child is receiving inadequate nutrition for optimal growth and development
- Deceleration in weight gain
- Usually presents before 18 months
Failure to thrive: Caused by
- Multifactorial condition- biological, psychosocial, and environmental contributions
- 80% will have no underlying medical condition
- Inadequate intake
- Inadequate absorption
- Excessive caloric expenditure
Failure to thrive: Manifestations
- Feeding problems
- delayed growth
- dry skin
- sparse hair
- poorly developed musculature
- decreased subcutaneous fat
