Pediatric GI/GU Flashcards
Nephrotic Syndrome
most common kidney disease in children
-common in toddlers 2-5 yrs
**minimal change type
nephrotic syndrome s/s
massive proteinuria
hypoalbuminemia
edema
hyperlipidemia
nephrotic syndrome dx
urinalysis : proteinuria
labs :
-fibrinogen, aPTT, d-dimer increased
-hypoalbuminemia
-hyperlipidemia
renal US
nephrotic syndrome at high risk for…
- infection
- thromboembolism
- peritonitis
what to do if infection is suspected with nephrotic syndrome…
start broad spectrum abx as soon as possible
proteinuria causes
fever
dehydration
cold temp outside
overexertion
nephrotic syndrome interventions
- give O2
- IV fluids - 20 mL / kg
- IV diuretics
- IV abx
- corticosteroid - prednisone
- fluid restriction
- low sodium
nephrotic syndrome specific labs
Coags
CMP
UA
failure to thrive
-weight for age is <5th percentile
-weight decline that crosses multiple % lines on chart
FTT causes
-inadequate energy intake
-inadequate nutrition absorption
-neglect
organic FTT
chronic disease affecting digestion and absorption
nonorganic FTT
poor growth with no underlying diagnosis
FTT management goal
- Nutrition with appropriate weight gain
- weight gain and monitor labs (PreAlbumin)
- find cause and treat it!!!
- ensure parents are feeding correctly
PreAlbumin
normal is 20-40
appropriate weight gain
4-6 months = double birth weight
0-6 months = 5-7oz / week
FTT complications
- increased risk for short stature
- increase risk for heart disease
- increase risk for childhood disease
- affects brain development
what is the #1 cause that needs to be ruled out with FTT…
ABUSE , may order x-rays to check for harm
emergent FTT
- stabilize kid - rehydrate w/ dextrose
- feed however possible
- figure out what is causing it
- get family involved
- could admit - up to 2 weeks
**want to see weight gain before going home
short bowel syndrome
inefficient length of small intestines
**congenital, illness, traumatic
congenital SBS
intestinal problem baby is born with
-intestinal atresia / stenosis
-gastroschisis
-volvulus
-Hirschsprung’s disease
illness SBS
NECROTIZING ENTEROCOLITIS
-damages the intestines leading to holes or narrowing in intestines
traumatic SBS
includes injury to small bowel that requires removal
-crohn’s disease
-radiation enteritis
-vasculitis
-etc.
SBS s/s
abd pain
weight loss
dehydration
diarrhea
vomiting
mineral / vit deficiency
necrotizing enterocolitis
immature GI tract for premature infants put them at risk
-infection and inflammation
immature gut factors
- decrease blood circulation
- decrease digestion
- lack of adequate structural barrier to bacteria
- decrease secretion of biochemical defenses
NEC / SBS dx
abdominal x-ray
endoscopy / colonoscopy
barium swallow
parenteral feeding
via IV / CVC
-TPN and lipids
enteral feeding
via NG / OG / J tube
-formula
celiac disease
gluten activates an immune response attacking small intestine
celiac foods to avoid…
barely
oats
rye
wheat
maltodextran
gluten!!!
celiac physical presentation
thin extremities
weight loss
foul smelling stool
dental impairments
short stature
delayed puberty
celiac dx
endoscopy / labs / diet change
**HAVE endoscopy done BEOFRE diet changes
celiac crisis
IV rehydration
endoscopy : NPO , consent, IV
-family teaching
-dietician referral
obesity risk for…
heart disease
-uncontrolled HTN and development of diabetes
obesity family support
role models of healthy eating
medication management
-peer influence
-healthy snacks
good eating habits
-no eating in front of TV
-decrease screen time –> promotes movement
-no skipping meals
-provide choices
-nutrition referral –> creates plan together
