peds - Gastrointestinal

Question 1

Cleft Lip

Answer 1

congenital abnormality where there is a slip or gap in the upper lip on or both sides

Question 2

cleft palate

Answer 2

congenital abnormality where there is a split or gap in the hard palate (roof of mouth)

Question 3

Cleft lip/palate assessment

Answer 3

visible defect, monitor resp status, airway patency, nutritional status, weight gain, hydration

Question 4

cleft lip/palate tx

Answer 4

surgically corrected cleft lip 3-6 months, palate 6-24 months

post op: position upright for feeding, cleft palate can be prone to help drain secretions, cleft lip should not be prone as this could disturb suture line, restrain from putting things in mouth that would compromise sutures, no hard foods, straws, pacifiers, no oral or nasal suctioning

Question 5

Feedings for cleft lip/palate

Answer 5

specialized bottle to facilitate good latch, small frequent feedings, upright position, burp frequently as they will swallow a lot of air, may take longer to feed, monitor for aspiration (at risk for feeding to go out nose then be breathed in)

Question 6

tracheoesophageal fistula (TEF)

Answer 6

congenital abnormality in which there is an opening between the trachea and the esophagus

Question 7

esophageal atresia

Answer 7

part of esophagus does not form

Question 8

TEF / esophageal atresia S&S and tx

Answer 8

choking, coughing, cyanosis

surgery
preop: NPO
post op: gradual oral nutrition

Question 9

pyloric stenosis

Answer 9

hypertrophy of muscle fibers of pylorus with a severe narrowing of lumen

Question 10

pyloric stenosis S&S

Answer 10

vomiting right after feeding, infant remains hungry, dehydration, malnutrition, palpable pylorus

Question 11

pylorus stenosis tx

Answer 11

correct dehydration, pyloromyotomy, nutrition after surgery

Question 12

omphalocele

Answer 12

congenital abnormality where abdominal contents protrude through umbilicus while remaining in peritoneal sac; occurs during weeks 9-10 of gestation, dx with U/S

Question 13

omphalocele S&S and complications

Answer 13

visible defect, some also have cardiac defects, lung size can be affected

hypothermia, dehydration, sepsis

Question 14

omphalocele Tx

Answer 14

surgery
preop: keep exposed intestines moist by covering with sterile gauze soaked in saline, IV fluids, IV abx, thermoregulation
postop: parenteral feed, trophic feeds started enterally very gradually, monitor weight, very long hospital stay

Question 15

gastroschisis vs omphalocele

Answer 15

gastroschisis just intestines but not in peritoneal membrane
omphalocele can be any abdominal organs but are still in the peritoneal membrane

Question 16

intussusception

Answer 16

one part of intestine slips inside the other, often occurs where small and large intestine meet

Question 17

intussusception S&S

Answer 17

red currant jelly stools, cyclical abdominal pain, n/v, green, bilious emesis, sausage shaped mass in abdomen

Question 18

intussusception tx

Answer 18

enema to attempt to push intestine back out, if unsuccessful surgical repair is needed

Question 19

Hirschsprung’s

Answer 19

aganglionic megacolon; absence of enteric neurons within they myenteric and submucosal plexus of the rectum and/or colon, no peristalsis, stool builds up and causes the megacolon

Question 20

Hirschsprung’s S&S

Answer 20

ribbon like stool, delayed passage of meconium, swollen belly, vomiting, constipation, gas, irritation

Question 21

Hirschsprung’s tx

Answer 21

surgical removal of portion of colon lacking innervation; ensure adequate nutrition after sx

Question 22

Pyloric stenosis vs Intussusception vs Hirschsprung’s

Answer 22

Pyloric stenosis: olive shaped mass, projectile non-bilious emesis

Intussuception: sausage shaped mass, green bilious emesis, red-currant jelly stool

Hirschsprung’s: not palpable, green/brown emesis, ribbon like stool