Pyloric Stenosis-Achalasia

Question 1

Hypertrophy or hyperplasia of the muscle surrounding the sphincter and is difficult for the stomach to empty

Answer 1

Pyloric Stenosis

Question 2

is the opening between the lower portion of the stomach and the beginning portion of the intestine, the duodenum

Answer 2

Pyloric Sphincter

Question 3

Signs and Symptoms of Pyloric Stenosis

Answer 3

*Projectile vomiting almost immediately after each feeding at 4 to 6 weeks of age
* Vomitus usually smells sour because it has reached the stomach
*The infant is usually hungry immediately after vomiting
*Metabolic Alkalosis and marked deficits of Sodium and Potassium will result
*Signs of dehydration
*Palpate the right upper quadrant of the abdomen for pyloric mass, it feels round, firm approximately the size of an olive
*Gastric peristaltic wave are seen running across the abdomen from left to right especially after feeding

Question 4

Therapeutic Management of Pyloric Stenosis

Answer 4

Pyloromyotomy

Question 5

the muscle of the pylerus is split down to the mucosa, allowing for a large lumen, performed before electrolyte imbalance

Answer 5

Pyloromyotomy

Question 6

Preoperative Care of PS

Answer 6

*Fluid and electrolyte replacement based on laboratory determinations
*Baseline weight is essential for establishing the extent of dehydration

Question 7

Postoperative Care of PS

Answer 7

*Frequent feedings of small amount of fluid. Approximately 4 to 6 hours after surgery Bubbled well after feeding
*Position on their left side after feeding may aid the flow of fluid through the pyloric valve by gravity
*Continue to monitor daily weights to confirm that the child is receiving adequate fluid

Question 8

Is the invagination of one portion of the intestine into another

Answer 8

Intussusception

Question 9

When does Intussusception disorder occur?

Answer 9

Second half of the first year of life

Question 10

Reason why intuchuchu happens in Younger than 1 year old

Answer 10

Idiopathic reasons

Question 11

Reason why intuchuchu happens in older than 1 year old

Answer 11

lead point in the intestine

Question 12

Signs and symptoms of intuchuchu

Answer 12

*Draw up their legs suddenly and cry as if they are in severe pain
*After the peristaltic wave that caused the discomfort passes, they are symptom free
*Intense abdominal pain approximately occurs every 15 minutes
*Vomiting
*After 12 hours, blood appears in the stool described as “Currant Jelly” appearance

Question 13

If necrosis has occur in intuchuchu

Answer 13

Elevated temperature
Peritoneal irritation
Increase White Blood Cell count
Often rapid pulse

Question 14

Therapeutic management of intuchuchu

Answer 14

Surgery to straighten the invaginated portion
Reduction by instillation of a water-soluble solution, Barium Enema.
Air (pneumatic insufflation)

Question 15

Is a twisting of the intestine

Answer 15

Volvulus

Question 16

The twist (volvulus) can cause?

Answer 16

obstruction of the passage of feces and compromise of the blood supply to the loop of the intestine involved

Question 17

When does volvulus occur

Answer 17

First 6 months of life

Question 18

Signs and symptoms of volvulus

Answer 18

*Intense crying and pain
*Pulling up the legs
*Abdominal distention and vomiting
*an abdominal examination, which reveals an abdominal mass.
*A sonogram or lower barium x ray also will show the obstruction

Question 19

Therapeutic management of volvulus

Answer 19

Surgery to relieve the Volvulus and reattach the bowel so it is no longer free moving

Question 20

Is a sensitivity or abnormal immunologic response to protein, particularly the gluten factor of protein found in grains, wheat, rye, oats and barley

Answer 20

Celiac Disease

Question 21

What happens when child with celiac disease consume gluten

Answer 21

his or her immune system reacts by damaging the small intestine (a), and the minute, fingerlike protrusion that line the small intestine, called villi (b), are damaged destroyed

Question 22

permits nutrients from food to be absorbed into the bloodstream

Answer 22

villi

Question 23

Signs and symptoms of celiac disease

Answer 23

*Steatorrhea, bulky, foul smelling, fatty stools
*Deficiency of fat soluble vitamins A,D,E,K (the vitamins are not absorbed because the fat is not absorbed)
*Malnutrition
*Distended abdomen from the fat, bulky stools
*Rickets may occur, because Vitamin D is one of the vitamins not absorbed
*Hypoprothrombinemia, iron deficiency anemia and hypoalbuminemia due to Vitamin k deficiency

Question 24

When is Diagnosis made for children with CD

Answer 24

Can be made between 6 to 18 months after the child has started on solid foods

Question 25

Therapeutic management of CD

Answer 25

*Gluten free diet
*Children need to have water soluble forms of Vitamins A and D administered
*Iron and Folate to correct anemia

Question 26

Is the absence of ganglionic innervation to the muscle of a section of the bowel- in most instances, the lower portion of the sigmoid colon just above the anus

Answer 26

Hirschsprung Disease

Question 27

When is HD apparent?

Answer 27

apparent until 6 to 12 months of age

Question 28

Signs and Symptoms of HD

Answer 28

*Chronic constipation or ribbon like stools (stools passing through such a small, narrow segment look like ribbons)
*Thin and undernourished, abdomen is large and distended

Question 29

Therapeutic Management of HD

Answer 29

*Repair of a ganglionic megacolon involves dissection and removal of the affected section, with anastomosis of the intestine
*Generally treated in the newborn by two-stage surgery:
a. First temporary colostomy is established
b. Bowel repair at 12 to 18 months of age

Question 30

Preoperatively: (HD)

Answer 30

*If a child is to be cared for at home, help the parents learn about a minimal residue diet. Fried foods and highly seasoned foods are omitted
* Stool softener to be given daily

Question 31

is a neuromuscular disturbance in which the gastroesophageal sphincter and the lower portion of the esophagus are lax and thus allow easy regurgitation of the gastric contents into the esophagus.

Answer 31

Gastroesophageal Reflux (Achalasia)

Question 32

Signs and Symptoms of Achalasia

Answer 32

*Regurgitation occurs immediately after feeding.
*Vomiting appears effortless and is not projectile
*Irritable and may experience periods of apnea

Question 33

Management of achalasia

Answer 33

*Feed infants a formula thickened with rice cereal (I tbsp. cereal per 1 oz. of formula or breast milk), while holding in an upright position and keep them upright in an infant chair for 1 hour after feeding.
*H2 receptor antagonist such as Ranitidine (Zantac) or proton pump inhibitor such as Omeprazole (Prisolec) prescribed daily to reduce possibility of the stomach acid contents irritating the esophagus.