Pediatric Nutrition, Digestion, & Elimination Flashcards
What is cleft lip or cleft palate ?
facial malformations that occur during embryonic development
- may appear separately or together
- most common fetal abnormality
What are the causes of cleft lip or palate ?
- no 100% proven risk factors
- defect in cell migration that results in a failure or the maxillary or premaxillary process to come together
- between 4th and 10th week of embryo development
- can sometimes be seen in high definition 20 week ultrasounds
What are some associated problems of cleft lip and palate ?
- inability to form anterior seal when feeding (lip)
- decreased ability to suck (palate)
- improper drainage of middle ear which causes an increased risk of ear infections
- speech, hearing, dental, secretions
How do we feed an infant with cleft lip or palate ?
- hold infant in upright position during feedings (prevents back up into ears)
- pigeon bottle
- special needs feeder
- Mead-Johnson Cleft Palate Nurser
- breastfeeding
- obturator
- burping
What are some Post-Op care for a Cheiloplasty (cleft lip repair) ?
surgery at 2-3 months
- cleansing of suture line (gentle patting)
- keep moist (petroleum jelly) to prevent cracks or bleeding
- elbow immobilizers to prevent infant from reaching the suture
- pain control
- resume feedings as tolerated
- avoid hard objects or suction in oral cavity
- home within 24 hours
What is some Post-Op care for a Palatoschisis (cleft palate repair) ?
surgery at 6-12 months (best outcome with speech development before 12 months)
- watch for respiratory difficulties
- elbow immobilizers
- no hard or sharp objects in mouth
- monitor suture line
- feeding modifications: syringe feeding
What is Celiac Disease ?
intolerance to the dietary protein gluten
- intestinal intolerance that produces mucosal lesions
- chronic disease with severity varying greatly among children
What is the pathophysiology of Celiac Disease ?
villus atrophy in the small bowel in response to the protein gluten
- specifically the gliadin component of gluten
- leads to malabsorption
What causes Celiac Disease ?
genetic predisposition
- CD4+ T-cells play a critical role in the immune response characteristic of celiac disease
When is Celiac disease typically first noticed ?
noticed several months after induction of gluten in diet
- around 1-5 yrs of age
What are some clinical manifestations of Celiac disease ?
- ulcer and tooth enamel erosion
- diarrhea, bloating (abdominal distention), constipation
- stomach pain and nausea
- brittle nails, acne, or eczema
- impaired fat absorption (diarrhea/steatorrhea)
- general malnutrition: muscle wasting, anemia, anorexia
How is Celiac disease diagnosed ?
- biopsy of small intestine
- genetic and serologic testing
How is Celiac disease managed ?
primarily through diet
- gluten free diet
- corn and rice become substitute grain foods
- possible lactose restrictions
What foods are allowed for someone with Celiac’s ?
- fruit and vegetables
- beans, peas, lentils
- rice
- corn
- soy
- potato
- eggs
- millet
- buckwheat
- nut flours
What foods not allowed for someone with Celiac’s ?
many processed foods contain gluten as a thickener or filler (read labels for all foods)
- oats
- wheat
- barley
- rye
- certain dairy products like yogurt or ice cream that contain thickeners or fillers
- most bread, pasta, cereals and baked goods
What is Celiac Crisis ?
when Celiac’s disease is left untreated it can cause:
- lactose intolerance
- vitamin deficiencies
- impaired growth
- osteomalacia (disease that weakens bones)
- Non Hodgekin’s Lymphoma (cancer in lymphatic system)
What disease fall under Inflammatory Bowel Disease (IBD) ?
- ulcerative colitis
- Crohn’s disease
What can both diseases in inflammatory bowel disease (IBD) cause ?
- GI symptoms: frequent stools, crampy abdominal pain
- extraintestinal and systemic inflammatory responses
- exacerbation and remission without complete resolution
- growth failure
What is the pathophysiology of Ulcerative Colitis ?
- humoral response mediated by T-helper 2 cells
- inflammation typically limited to colon and rectum
- mucosa and submucosa continuously along the bowel (varying degrees of ulceration, bleeding, and edema)
What is the pathophysiology of Crohn’s disease ?
- T Helper 1 cytokine profile
- any part of GI tract from mouth to anus (most often affects distal ileum)
- all layers of bowl in discontinuous fashion (ulceration, fibrosis, adhesions, stiffening of bowel wall, stricture formation, and fistulas)
What are some assessments findings or S&S of Ulcerative Colitis ?
- Abdominal pain/cramping (LLQ)
- rectal bleeding
- anorexia/weight loss
- fever
- diarrhea (15-20 per day) where stool may contain blood, mucous or pus
- abdominal distension with firmness and/or tenderness upon palpation
- high pitched bowel sounds
What are some assessment findings or S&S of Crohn’s disease ?
- abdominal pain/cramping in RLQ
- ulcers in the mouth
- anorexia/weight loss
- diarrhea (about 5 per day) with mucus or pus
- abdominal distention with firmness and/or tenderness upon palpation
- high pitched bowel sounds
- steatorrhea (fatty stools)
What are some ways to diagnose Ulcerative Colitis ?
- history and physical exam
- labs (CBC, ESR CRP, stool samples & serologic panel to differentiate from CD)
- the serological panel is a blood test for
immune cells (helper T and T cytokine)
- the serological panel is a blood test for
- sigmoidoscopy or colonoscopy with biopsy
- has ulcerations and/or polyps
- barium enema
- MRI and/or CT
What are some ways to diagnose Crohn’s disease ?
- history and physical exam
- Labs (CBC, ESR, CRP, stool samples, total protein, albumin, vitamin levels & serological panel)
- upper GI series with small bowel follow through
- upper endoscopy and colonoscopy with biopsy
- thickened bowel wall with fissures
- barium enema
- MRI, CTI, and/or US
What is a fissure ?
a small but deeper ulcer
Which type of bowel disease is most likely to cause severe malnourishment?
Crohn’s
- most nutrient absorption occurs in the small intestine
Does medications for IBD cure the disease ?
it’s not curative
- used to maintain remission or to treat complications
What is the purpose of Aminiosalicyclic Acids (Sulfasalazine) ?
reduces inflammation in the intestinal mucosa
- maintenance of remission in mild-moderate ulcerative colitis
- 1st line therapy for Crohn’s when colon is involved
- Sulfasalazine less preferred due to side effects
What is the purpose of corticosteroids (prednisone) ?
reduces inflammation and pain
- used for moderate-severe ulcerative colitis
- to achieve remission in Crohn’s
What are some side effects of Prednisone ?
- growth suppression
- weight gain
- decreased bone density
- hyperglycemia
- use with NSAIDS can increase GI bleeds
What is the purpose of immunosuppressants (Methotrexate) ?
used for children who are steroid resistant or steroid dependent
- increased risk of infection
- decreased platelets, RBC and WBC
- liver damage (jaundice)
- removed by hemodialysis
- folic acid can be given in cases of toxicity
What is the purpose of immunomodulators (Infliximab/Remicade & Adalimumab/Humira) ?
to regulate inflammatory and anti-inflammatory cytokines (suppresses immune system)
- Drug class: biologic response modifier
- closely monitor for infusion reaction or allergic reaction
What are some surgical treatments for Ulcerative Colitis ?
when meds and nutrition therapy fails to prevent complications:
- total proctocolectomy is curative (take all of colon out)
1. with ileal pouch/anal anatomosis
or
2. with permanent ileostomy
What are some surgical treatments for Crohn’s disease ?
not curative
- removal of diseased segments with resection and re-anastomosis of remaining intestine
- repeated resections can lead to Short Bowel Syndrome
What is an Ileal pouch/J-pouch ?
a pouch made out of the ileum (last part of small intestine) that holds the feces like the rectum used to do
- stapled to the anus so they still use the restroom normally out of anus
What are some possible complications of IBD ?
- Toxic Megacolon: more common with ulcerative colitis
- Fissures, strictures, abscesses, and fistulas: more common with Crohn’s
- malnutrition, growth failure: more common with crohn;s
- rectal bleeding/hemorrhage: more common with ulcerative colitis
- colorectal cancer: more common with ulcerative colitis (anything that changes the lining of the GI tract has the potential for cancer)
