N410 Peds GI

Question 1

What causes appendicitis?

Answer 1

The cause of appendicitis is obstruction of the lumen of the appendix, usually by hardened fecal material (fecalith).

Swollen lymphoid tissue, frequently occurring after a viral infection, can also obstruct the appendix.

Another rare cause of obstruction is a parasite such as Enterobius vermicularis, or pinworms, which can obstruct the appendiceal lumen.

The outflow of mucus secretions is blocked and pressure builds within the lumen, resulting in compression of blood vessels. The resulting ischemia is followed by ulceration of the epithelial lining and bacterial invasion.

Question 2

What is GER, when does it occur, what age range?

Answer 2

Transfer of gastric contents into the esophagus. throughout the day, most frequently after meals and at night

Commonly occurs between 4 months old - 1yo

Question 3

GER meds?

Answer 3

H2-receptor antagonists:
(cimetidine [Tagamet], ranitidine [Zantac], or famotidine [Pepcid])

Proton pump inhibitors (PPIs):
esomeprazole [Nexium], lansoprazole [Prevacid], omeprazole [Prilosec], pantoprazole [Protonix], and rabeprazole [Aciphex])

Both reduce gastric hydrochloric acid secretion and may stimulate some increase in the lower esophageal sphincter tone.

PPIs: Take 30 minutes before breakfast & dinner if BID so that the peak plasma concentrations occur with mealtimes. Take several days to work.

Question 4

What is Hirschsprung disease (HD)?

Answer 4

Congenital anomaly that results in mechanical obstruction from inadequate motility of part of the intestine;  The absence of ganglion cells in the affected bowel results in a lack of enteric nervous system stimulation.
Ileus Meconium; 
Bilious vomit; 
Abdominal circumference;
Parenteral nutrition;
Mult surgeries (curative)
It is four times more common in males ; 
Diagnosed in the first few months of life

Question 5

Fluid balance consequence of appendicitis?

Answer 5

Hypovolemic shock
The loss of extracellular fluid to the peritoneal cavity leads to electrolyte imbalance and hypovolemic shock.

Progressive peritoneal inflammation results in functional intestinal obstruction of the small bowel (ileus) because intense GI reflexes severely inhibit bowel motility.
The peritoneum represents a major portion of total body surface,

Question 6

First Sx of appendicitis?

Answer 6

The first symptom of appendicitis is usually colicky, cramping, abdominal pain located around the umbilicus

Question 7

What does the McBurney point measure?

Answer 7

Most common point of tenderness in appendicitis.

The McBurney point, located two thirds the distance along a line between the umbilicus and the anterosuperior iliac spine. R lower quadrant

also useful

Question 8

Clinical manifestations of appendicitis?

Answer 8

Right lower quadrant abdominal pain
• Fever
• Rigid abdomen
• Decreased or absent bowel sounds
• Vomiting (typically follows onset of pain)
• Constipation or diarrhea
• Anorexia
• Tachycardia; rapid, shallow breathing
• Pallor
• Lethargy
• Irritability
• Stooped posture
Elevated WBC count >10,000/mm

Question 9

Dx tool for appendicitis?

Answer 9

CT scan

Question 10

Which of the following is the viral pathogen that frequently causes acute diarrhea in young children?
 Giardia organisms 
 Shigella organisms
 Rotavirus 
 Salmonella organisms

Answer 10

Rotavirus is the VIRAL pathogen that most frequently causes diarrhea in young children.
Giardia is a BACTERIAL pathogen that causes diarrhea. Shigella is a BACTERIAL pathogen that is uncommon in the United States.
Salmonella is a BACTERIAL pathogen that causes diarrhea.

Question 11

A stool specimen from a child with diarrhea shows the presence of neutrophils and red blood cells. This is most suggestive of which of the following conditions?
  Parasitic infection 
  Fat malabsorption
  Protein intolerance
  Bacterial gastroenteritis

Answer 11

Bacterial gastroenteritis is associated with NEUTROPHILS or RBC in the stool.
The stool will be analyzed for ova and parasites when the bacterial and viral cultures are negative.
Malabsorption is characterized by a stool pH of less than 6 and presence of reducing substances.
Diarrhea that develops after introduction of cow’s milk, fruits, or cereals may be related to protein intolerance.

Question 12

Enteral feedings are ordered for a young child with burns covering 40% of total body surface area. The nurse should know that:
oral feedings are contraindicated.
enteral feedings must be stopped during painful procedures.
presence of a paralytic ileus does not preclude use of enteral feedings.
the feedings will be high carbohydrate and low protein.

Answer 12

Not precluded BY PARALYTIC ILEUS:
Because the small bowel maintains mobility and absorptive capabilities, the placement of a small-bore feeding tube into the duodenum allows for safe delivery of enteral nutrition during periods of paralytic ileus associated with sepsis, trauma, and anesthesia.

Oral feedings are not contraindicated. This is encouraged; however, most children with burns are unable to consume sufficient calories by mouth.

Enteral feedings can continue during procedures. A high-protein, high-calorie diet is recommended.

Question 13

Characteristics of pyloric stenosis?

Answer 13

Pyloric stenosis is a narrowing of the opening from the stomach to the first part of the small intestine (the pylorus).
S/Sx: Projectile vomiting WITHOUT bile.
This most often occurs after the baby is fed.
Typical age 2-12 weeks old.