Week 3 GI

Question 1

What causes cleft lip/cleft palate

Answer 1

Failure of the maxillary processes to fuse between 5 to 12 weeks gestation. Failure of the tongue to move down at the correct time prevents the palatine processes from fusing

Question 2

Risk factors that increase likelihood of cleft palate & RX

Answer 2

Advanced maternal age
Poor maternal care (vitamins, nutrition, drugs taken by mother, genetically linked, linked to poor income → lack of access to care
Rx → FOLIC ACID

Question 3

Nursing management to facilitate feeding in cleft lip/palate

Answer 3

Cannot create suction; now newborns and infants feed
Use palate shield and bottles with nozzle-type attachment
OG / NG tubes

Question 4

Diagnosis of esophageal atresia and tracheoesphageal fistula

Answer 4

Sx: THREE Cs – cyanosis, choking, coughing à if you have secretions ending in a blind pouch, it will either come back up or go into the lungs
Soon after birth, placing NG / OG tube – continuous suctioning
Might see a distending abdomen - air trapping

Question 5

Gastroschisis VS omphalocele

Answer 5

Gastroschisis – ABD is open, contents exposed

Omphalocele – muscle has not formed but membrane is containing contents but they are visible

Question 6

RX for Gastroschisis

Answer 6

create silo à meshy prosthetic sack that covers ABD. Top of sack is a cinch string that is tightened over time to put contents back under cover.

Question 7

RX for Gastroschisis, omphalocele

Answer 7

folic acid

Question 8

Anal stenosis and anal atresia

Answer 8

Narrowing or complete covering of rectum

Question 9

Anal stenosis

Answer 9

wall is thickened or constricted
Decreased normal stool passage
Reports of ribbon like stool

Question 10

Umbilical hernia

Answer 10

a weakness in umbilical ring – stomach contents protruding into abd. Can resolve on its own, older children may need surgery.

Question 11

Meckel’s diverticulum

Answer 11

Omphalomesenteric duct fails to atrophy. One of the most common congenital anomalies. Happens a lot in utero but don’t see sx until much much older (may have been plagued with GI sx for a while though)

Question 12

S/S of Meckel’s Diverticulum

Answer 12

Inflammation
Rectal bleeding
Intestinal obstruction

Question 13

Hirschsprung disease

Answer 13

adequate motility that causes mechanical obstruction – congenital link
Congenital absence of ganglion cells in the rectum and colon
Can cause mega colin

Question 14

S/S in newborn

Answer 14

want to see that meconium
over time back in doctor’s office with really infrequent stooling
abd distension
bile stained emesis → bowel contents backing up
can get ostomies
going to see failure to thrive, dev. Delays, severe constipation/ diarrhea
chronic care over time → diet, stool modifications forever
prevent dehydration
rectal stimulation

Question 15

Pyloric stenosis presentation

Answer 15

Child presents with massive vomiting (exorcist) within 20 minutes it’s coming back up; then they are hungry again
Increased peristalsis prior to vomiting
Hyperactive bowel sounds
Olive shaped mass
In pyloric stenosis, the hypertrophied pyloric muscle (feels like a small olive) causes symptoms of projectile vomiting and visible peristalsis.
Picked up on ultrasound based on clinical presentation
At SEVERE risk for dehydration and F/E imbalance – needs to be corrected prior to OR.
Quick OR visit

Question 16

What is Intussesception

Answer 16

part of the intestine folds into the section next to it. It typically involves the small bowel and less commonly the large bowel. Symptoms include abdominal pain which may come and go, vomiting, abdominal bloating, and bloody stool.

Question 17

Three mechanisms allow reflux to occur

Answer 17

Lower esophageal relaxations
Incompetent lower esophageal sphincter
Anatomic disruption of esophagogastric junction

Question 18

Those at risk for GERD

Answer 18

Preemies

Those w/TEF repairs

Question 19

Appendicitis is cause by

Answer 19

Caused by an obstruction of the appendiceal lumen, causing edema

Question 20

Presentation of appendicitis

Answer 20

⅔ the distance on right side along umbilicus to superior iliac crest→ highly acute pain
Rebound tenderness (pain upon release)

Question 21

Three hepatic disorder

Answer 21

Biliary atresia
Viral hepatitis
Cirrhosis

Question 22

Signs of hepatic disorder

Answer 22

Jaundice
Unconjugated bilirubin floating around system → can become toxic if not corrected
Progressive yellowing of skin that moves upwards
Phototherapy
Helps body reabsorb quicker
Easy bruising, intense itching
White or clay-colored stools 
Tea-colored urine

Question 23

Potential Signs of Gastrointestinal Emergencies in Infants

Answer 23

Excessive salivation with cyanosis, coughing, and choking in newborn
Esophageal atresia and tracheoesophageal fistula
Abdominal viscera outside the abdominal cavity when born
Gastroschisis and omphalocele
Anorectal malformations