GI (Peds)

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ariabarr1
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138131
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GI (Peds)
Updated:
2012-02-27 23:30:29
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Pediatrics
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GI (Peds)
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  1. Diarrhea
    • Significant World Problem
    • 10% of all hospitalization in US
    • 20% of death for children in developing countries
    • Children most at risk
  2. Children More at Risk for Problems Due to...
    • Intestinal mucosa more permeable to water
    • Deceased ability to absorb with inflammation
    • Lack of enzymes which icrease gas
    • Mobility faster, effect absorption
  3. Acute Diarrhea
    • <14 days
    • Infection: rotavirus #1 cause in US
    • Secondary to UTI or URI
    • Parasites: Jigardia
    • Diet: apple juice, high sugar/fructose content
    • Medication/Antibiotics
  4. Chronic Diarrhea
    • Metabolic/Absorption/Genetic Disorders: Celiac Disease; Cystic Fibrosis
    • Inflammatory Disorders: Crohn's vs Ulcerative Colitis
    • Bowel Damage/Short Gut
    • Diet: Lactose Intolerance
  5. Celiac Disease
    • Do not have the enzyme to digest gluten
    • Can impair growth in children
    • Foods high in gluten: white flour, wheat, barley, rye (pasta, bread, cakes, cookies)
  6. Cystic Fibrosis
    • Learn to immediately hide feces
    • Do not absorb well so they have greasy smelly stools
  7. Crohn's Disease
    Continuous bleeding in the stool (mouth to anus)
  8. Ulcerative Colitis
    • Bleeding from the colon
    • Cure by removing colon
  9. Questions to ask diarrhea pt's
    • How long
    • How often
    • Things that make worse/better
    • Color, smell, etc
    • Meds
    • Pain or discomfort
    • Traveling
    • Fluids
    • Fever?
  10. Clinical Manifestations Diarrhea
    • Malabsorption: foul smelling and greasy appearance
    • Bacterial gastroenteritis: (+) for neutrophils and RBC
    • Parasitic infection or Protein intolerance: (+) for eosinophils
  11. Treatment for Diarrhea
    • Fluids: oral rehydration or IV fluid
    • Early reintroduction of food: BRAT diet
    • Medication: Antimicrobial therapy for (+) culture or febrile infant; Avoid antidiarrheal agents
  12. Newborn (stomach capacity)
    10-20 ml
  13. One Week (stomach capacity)
    30-90 ml
  14. 2-3 weeks (stomach capacity)
    75-100 ml
  15. 1 month (stomach capacity)
    90-150 ml
  16. 3 month (stomach capacity)
    150-200 ml
  17. 1 year (stomach capacity)
    210-360 ml
  18. 2 year (stomach capacity)
    500 ml
  19. Vomiting and Retching
    • Green, bilious
    • Curdled stomach contents
    • Fever+Diarrhea+Vomiting
    • Change with Level of Conscience (LOC)/with or without headache
    • Localized pain with vomiting
    • Forceful, projectile (infants)
  20. Emesis Treatment
    • Fluids: Oral rehydration and/or IV (continue fluids in small frequent amounts)
    • Treating the source
    • Positioning and burping
    • Pain/anti-nausea meds
    • Cleaning of the mouth
  21. Gastroesophageal Reflux (GER)
    • Regurgitation of gastric contents into the esophagus due to a lax cardiac sphincter
    • Symptoms: heartburn, bad breath, very irritable (babies), not want to eat, may be connected with respiratory infections, may cause apnea spells, may have diarrhea/blood stools (irritated esophagus)
    • Risk Groups: preemies, cystic fibrosis, short gut, neurological disorders, vents
    • Testing/Diagnosis: Upper GI (barium swallow), esophageal pH study (24hr), endoscopy, MRI, Ultrasound
    • Treatment: Positioning (slightly uprights), Nissen Fundoplication (wrap stomach around esophagus to make a valve; cannot get rid of gases as easily so distention occurs), Tube Feedings (run feedings over a longer period of time), Medications (protonix-decreases secretions, xantac, reglan-increasing mobility)
  22. Constipation
    • Infants: congenital, diet (esp. formulas with iron-slows down)
    • Early Childhood: diet (too much milk, too little fiber), developmental (fear of toilet, ignoring urge)
    • School Age: environment (diet and lack of exercise), behavioral (stress)

    Cure: Fiber, Fluid, and Movement
  23. Congenital Aganglionic Megacolon Hirshsprungs
    • Absence of ganglionic innervation of lower bowel
    • External sphincter normal but internal sphincter fails to relax
    • 4x more males (1:5,000 occurrence)
    • Symptoms: no meconium w/i the 1st 24 hours, hx of constipation alternating with ribbon like foul stools, fussiness and irritability, failure to thrive, distended abdomen
  24. Hirshsprungs Clinical Manifestations
    • Absence of meconium in first 36 hours
    • Alternating constipation with ribbon like stools
    • Fussiness and irritability
    • Failure to thrive
    • Distended abdomen, constipation
  25. Hirshsprungs
    • Diagnosis: Rectal Biopsy (take little pieces to see if there is nerve conduction)
    • Treatment: Soave endorectal pull-through (sometimes colostomy); Bowel program (encourage breastfeeding to avoid constipation
    • NOTHING PER RECTUM!
  26. Anorectal Malformations
    • 1 in 4,000 to 5,000 live births
    • Imperforated Anus: no anal opening
    • Persistent Cloaca: rectum, vagina and urethra are connected
    • Rectal Fistula: can connect with vaginal or urethra
    • Anal Stenosis: narrow opening in rectum/anal area
  27. Persistent Cloaca
    • Complex
    • Rectum, vagina, and urinary tract all open into one common channel
    • The channel opens to the outside through an orifice located in the normal urethral site
  28. Anorectal Malfomration Observations
    • Shape of Buttocks
    • Midline Groove
    • Dimple
    • Stool
  29. Anorectal Malformation Treatment
    • Primarily Surgery: pull-thru, anoplasty, colostomy
    • Dilations
    • Bowel program
  30. Omphalocele (abdominal wall defect)
    • Herniation of abdominal contents thru umbiliical ring
    • Can include liver, bladder and kidneys
    • Strongly associated with chromosomal defects and abnormalities, IUGR
  31. Gastroschisis (abdominal wall defect)
    • Herniation of intestinal contents usually to the right of the umbilicus
    • Associated with young mothers
    • Occurs in many short gut
  32. Nursing Concerns
    • Infection
    • Ileus
    • Heat and Fluid losses
    • Growth and Development Retardation
    • Oral Stimulation
    • Emotional Support
    • Parental Role
  33. Cleft Lip/Cleft Palate
    • 1-700 live births (Asian 2:1000)
    • Genetics, Environment (esp. smoking), Diet, Drugs (including alcohol)
  34. Cleft Lip
    • Possibly effects seal for sucking
    • Biggest problem is very visible; effects bonding and self image. Will need dental F/U
    • Closure done usually 1-3 months (10 rule)
  35. 10 Rule
    • Lip @ 10 weeks
    • Hb @ 10 weeks
    • Weigh @ 10 lbs
    • Cleft Palate @ 10 months
  36. Cleft Palate
    • Effects feeding since unable to get negative pressure with suck and create suction
    • Also effects face shape, teeth formation, speech development, and hearing
    • Surgery delayed until usually until 10 months
    • Do not suction or put anything in the mouth; position instead
  37. Cleft Palate Feeding Issues
    • Positioning
    • Nipples
    • Face signals
    • Burping
  38. Cleft Palate Post-Op Concerns
  39. Cleft Palate Long Term Concerns
    • Dental
    • Speech and Hearing
  40. Acute Appendicitis
    • Inflammatory condition
    • Most common abdominal surgery
    • Children more at risk for rupture
    • Symptoms:
    • anorexia for 12-24 hours, possible vomiting
    • limited movement and rigid positioning to side, especially right hip, with knees flexed
    • rebound tenderness, usually right side
    • termperature
    • Nursing: pain, gas, and infection control
    • AMBULATE, AMBULATE, AMBULATE
  41. Obstructive Disorders
    • Foreign bodies or substances
    • Risk Groups: toddlers and adolescents
    • Special concerns: agents that damage gut (batteries, lead paint, sharps)
    • Nursing consideration: safety training (Ipeac syrup vs activated charcoal)
  42. Pyloric Stenosis
    • Occurs in usually the first 6 months, more males (5x) than females
    • Olive like mass felt in upper right abdomen
    • Value between the stomach and the duodenum enlarges and becomes very thick-can make peristalsis visible
    • Main Symptom: projectile vomiting
    • At risk for: Metabolic Alkalosis
  43. Intussusception
    • Intestines retract into themselves-most frequent intestinal obstruction
    • Classic presentation of acute pain alternating with normal behavior; current jelly-like stools and/or vomiting
    • Dx: barium edema, x-ray, sonogram
  44. Short Bowel Syndrome
    • Common Causes: abdominal wall defects, necrotizing enterocolitis (1-8% of all infants in NICU)
    • Treatments: ostomy, G-tube feedings and/or TPN
    • Complications: fluids/electrolytes, growth retardation, infections, liver dysfunction
  45. NEC (Necrotizing Entrocolitis)
    • Infection in the valve
    • Common cause of Short Bowel Syndrome
    • Abdominal Wall Defects
    • Radiation Injury
    • Volvulus (twisting of the bowel on itself)
  46. Biliary Atresia
    • Liver disorder
    • Intrahepatic and extrahepatic bile ducts do not function shortly after birth. Bile that normally empties into duodenum blocked and progressive damages liver
    • Clinically: urine dark color and stools gray (abdomen distended, change in feeding, jaundice-increased bilirubin after 14 days)
    • Treatment: Kasai procedure (reroutes bile); liver transplant

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