Peds GI Disfunctions
Card Set Information
Peds GI Disfunctions
A Child with Gastrointestinal Alteration
What are some important differences in a child's GI system?
Infants have almost no saliva
Swallowing not under voluntary control until 6 weeks
Peristalsis can reverse in infancy and is faster
Neonatal liver is immature--> v vit/min breakdown and absorbtion
Large intestine is shorter-->less time to absorb water/nutrients-->looser stools.
Why is it important to correct cleft palate early in infancy?
Will improve speach early on.
What is Esophageal Atresia and Tracheoesophageal Fistula
• Esophagus terminates before it reaches the stomach
is present that forms an unnatural connection with the trachea (fistula)
What are nursing implications for esophageal atresia/tracheoesophageal fitula?
: History of Polyhydraminos
• 3 C’s
: Coughing, Choking, Cyanosis
• Excessive salivation/drooling
• Surgical Emergency!, ie gtube or surgical correction
What is a Hiatal hernia?
• Protrusion of portion of the stomach through the esophageal hiatus of the diaphragm
Other childhood hernias?
Congenital diaphramatic hernia: Opening in the diaphragm through which abdominal contents herniate into thoracic cavity-->resp distress/HF.
Umbilical hernia: Incomplete closure of umbilical ring allows abdominal contents to push outward at umbilicus during straining and crying
What is gastroschisis?
Protrusion of intraabdominal contents through defect in abdominal wall lateral to umbilical ring
There is never a peritoneal sac
Tx for gastroschisis?
If large, contents are suspended to return to gut by gravity
Eventual Surgical closure
What is oomphalocele?
Protrusionof intrabdominal contents into base of umbilical cord.
sac is present and covered with peritoneum
What is encopresis?
Fecal incontinence (uncontroled pooping) due to:
--change in diet
What would be some concerns if baby has not passed first meconium withing 24-36hrs?
» Caused by meconium that has reduced water content
» Initial manifestation of CF
» Luminal obstruction of the distal small intestine by abnormal meconium
What is most common illness in children <5yrs?
– F/E assessment and management
– Reintroduction of an adequate diet
– BRAT diet?
What is Recurrent abd pain/Irritable bowel syndrome?
diffuse abdominal pain unrelated to meals or activity; alternating constipation and diarrhea; mucus in stool
reduce bowel spasms
What is infectious gastroenteritis?
Caused by a group of bacteria, viruses, and parasites capable of causing
serious communicable diarrhea
What are some risks for aquiring infectious gastroenteritis?
• Children in daycare centers, preschools, and long-term care facilities
• Giardia is most common pathogen seen in daycare settings
• Rotavirus is the most common GI pathogen in infants and young children
SnSs of infectious gastroenteritis?
Diarrhea of varying amount and consistency
Tx and nursing implications of infectious gastroenteritis?
Dehydration is a potential complication
Diagnosis is made by rectal of stool culture
Hydration and F/E balance are priority!
What is appendicitis?
• Inflammation and infection of the vermiform appendix
• Most common cause of emergency surgery in children and adolescents
: viral infection, impacted fecal material, foreign bodies, and parasites
• Cardinal symptom
pain in RLQ at McBurney point
Additional SnSs of appendicitis?
• Diarrhea or constipation
• Fever and chills
• Rupture of appendix-->Sudden relief of pain
Tx for appendicitis?
• Observe possible sepsis/shock if rupture has occurred
• Pain Medication/comfort measures
• No heat application!
• If ruptured
: IV antibiotics
Crohn's vs Ulcerative colitis?
What is hypertrophic pyloric stenosis?
SnSs: projectile nonbilious vomiting
olive-shaped mass in RUQ
strong peristaltic waves LUQ --> RUQ
: surgical release of the pyloric muscle
What is intussusception?
• Invagination (telescoping) of a section of the intestine into the distal bowel that causes bowel obstruction
• Primarily occurs in children under 2 years of age
• Pediatric emergency!
SnSs of Intussusception?
Paroxysmal (sudden onset) pain
: Bloody mucous stool (“currant jelly”) and a slightly tender sausage-shaped abdominal mass.
: hydrostatic reduction with barium or air enema
If unsuccessful or patient is too ill, surgical reduction is completed
What is Volvulus?
• Malrotation or twisting of the bowel that results in bowel obstruction
: bilious vomiting and pain
What is Hirschsprung Diseas?
• Also called congenital aganglionic megacolon
• Mechanical obstruction from inadequate motility of intestine
• Absence of ganglion cells in colon
SnSs of Hirschsprung disease/ananglionic megacolon?
• Absence of meconium stool within 24-36 hours after birth
S/S of bowel obstruction
: vomiting, abdominal pain and distension, failure to thrive
Ribbon-like stools that are foul smelling
: Surgical removal of aganglionic portion
What is Tx for Hirschsprung disease?
– Temporary ostomy
– Second stage—“pull-through” procedure
Nursing considerations when caring for pt with Hirschsprung disease?
• Preoperative care
– Abdominal circumference
– Enterocolitis management
• Postoperative care
– Treatment of colostomy
• Discharge care
– Extensive teaching
What is Celiac disease?
AKA gluten enteropathy or topical sprue
Results from the
inability to digest the protein part of wheat, barley, rye, and oats.
Life-long deficiency that requires diet modications
: considered genetic
: diarrhea and growth failure
: serum transglutaminase
What is biliary atresia?
• Obstruction or absence of the extrahepatic bile ducts
• Leads to significant cellular damage and eventual liver failure and death
• Clinical manifestations
: healthy at birth.
: acholic (without color) stool, bile-stained urine, and hepatomegaly
Tx of Biliary atresia?
• Surgery to aid in bile drainage (Kasai procedure)
• Hepatic dysfunction will still persist
• Liver Transplantation
• Nutritional support
– Malabsorption of fats, vitamins
– Fat-soluble vitamin deficiencies
– Growth failure