NRS 220: Peds Ch. 24
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What is Pyloric Stenosis?
A hypertrophic obstruction of the circular muscle of the pyloric canal.
What does hypertrophy of the circular muscle cause?
Stenosis of the passage between the stomach and the duodenum, partially obstructing the lumen of the stomach.
What is a major result of hypertrophic obstruction in pyloric stenosis?
What is projectile vomiting?
Vomiting in which the contents may be ejected up to 3ft from the infant.
When does symptoms usually occur in pyloric stenosis?
At 2-8wks of birth.
What are some clinical manifestations of pyloric stenosis?
The infant is always hungry, appears irritable, fails to gain weight, and has fewer and smaller stools. The infant may become dehydrated and develop metabolic alkalosis.
What is a common lab value finding in infants with pyloric stenosis?
Hypochloremia and metabolic alkalosis.
What is the treatment of choice for pyloric stenosis?
When palpating the abdomen of an infant with pyloric stenosis what is felt?
An olive shaped mass in the right upper quadrant.
When can feedings begin post op in an infant treated for pyloric stenosis and how?
4-6hrs post op and with small, frequent feedings of clear liquids. If tolerated, advance the infant to formula or breast milk feedings.
How often should the infants temperature be monitered?
What is Hirschsprung Disease?
A congenital anomaly in which inadequate motility causes mechanical obstruction of the intestine.
What causes the inadequate motility and obstruction in Hirschsprung disease?
The absence of autonomic parasympathetic ganglion cells in the colon
What are signs and symptoms in a newborn for Hirschsprung Disease?
failure to pass meconium in the first 48hrs of birth, abdominal distention, refusal to suck, and bile stained emesis.
What are the signs and symptoms of Hirschsprung Disease in older children?
Failure to gain weight, constipation, abdominal distention, and vomiting
What's the most reliable test to diagnose Hirschsprung's disease?
A rectal biopsy.
What's the treatment for Hirschsprung Disease?
Surgical removal of the aganglionic bowel with a temporary colostomy (if the patient has a severe case of the disease). If not, then surger
What's a serious complication that can occur in a patient with Hirschsprung disease post op?
Entercolitis (GI bleeding and diarrhea
What is intussusception?
When one protion of the intestine prolapses and then invaginates or telescopes into another causing an obstruction.
What is the most common site of intussusception?
The ileocecal valve.
How is intussusception diagnosed?
By the history of the child and radiographs and ultrasound of the abdomen.
What are some signs/ symptoms of Insussusception?
Abrupt onset w/ acute abdominal pain, with vomiting and passage of brown stool; as condition worsens the stool becomes red and resemble currant jelly; a mass in the RUQ or mid upper abdomen may be palpable.
What are some treatments of Intussusception
A barium enema during the x-ray. It may cause hydrostatic pressure which will move the bowels. Also surgery to reduce invaginated bowel and remove necrotic tissue.
What is GERD in infants?
It's a pathological condition in infants manifested by poor weight gain, esophagitis, neurobehavioral changes, and persistent respiratory sx's or complications.
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