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dalindsay81
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What are some pediatric differences r/t GI?
- Liver fx immature at birth
- Enzymes deficient until 4-6 months
- Abdominal distention from gas common with infants
- Stomach capacity smaller
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What are infants and children at risk for fluid, acid-base, and electrolyte imbalance?
- variations in total body water
- proportion in various compartments (high daily fluid requirement)
- little fluid volume reserve
- Basal metabolic rate, increased % BSA
- Decreased ability to excrete Na
- Greater insensible water loss
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What are health conditions relating to fluid imbalance
- Radiant heat (phototherapy)
- Increased respiratory rate
- Fever
- Vomiting and diarrhea
- Fistulas, blood loss, drainage tubes
- Renal disease
- Hemorrhage
- Burns
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What happens when fluid status is compromised?
- Body mechanisms activated
- Kidney (conservation, under 2 years immature)
- Shifts from one compartment to another (accumulation of fluid in a third space such as the peritoneal cavity)
- Changes in the filtration process (edema)
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How does sodium relate to dehydration?
main determinant of equilibrium
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How does acidosis relate to dehydration?
main consequence
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What happens with decreased extracellular water when one is dehydrated?
decreased perfusion
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What happens when there is inadequate perfusion during dehydration?
decreased oxygenation
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When does one need an IV?
If in moderate to severe category
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What happens when one is in a starved state?
Increased keto-acid production
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What happens when there is decreased renal perfusion?
Excretion of urea and hydrogen with resultant uremia and acidosis
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What is isotonic dehydration?
- Serum sodium between 130-145 meq/L
- sodium and fluid loss is equal
- most common type in children
- TX: fluid boluses
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What is hypernatremic dehydration?
- Serum Na greater than 145 mEq/L
- Excess water loss or sodium intake
- ETIOLOGIES: improper formula diultion
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What is hyponatremic dehydration
- Serum Na less than130 mEq/L
- ETIOLOGIES: GI loss
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What are diseases of the GI tract?
- Acute diarrhea
- Chronic diarrhea
- Gastroenteritis-stomach, sm intestine
- Enteritis-sm intestine
- Colitis-lg int/colon
- Enterocolotis-lg int/colon/stomach
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What lab tests would you run for GI problems?
WBC, RBC, Culture, Fat, pH, clinitest, e-lytes (stool)
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What do you see age-dependent on the child?
- 1-3 months: e coli
- 2-4 yrs: shigella
- less than 2 yrs: salmonella
- viral less than 2 yrs
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What is Biliary Atresia?
- Obliterative disease of the bile duct system
- Unknown etiology->severe liver damage
- TX: KASAI PROCEDURE (damaged duct and gallbladder removed, creates bild duct)
- Liver transplant needed eventually
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What are complications of biliary atresia?
- liver scarring
- infxn
- portal htn
- bleeding
- gigantic spleen (splenonmaly)
- ascites
- itching
- jaundice
- fractures (bc can't absorb minerals)
- poor nutrition
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What is lactose intolerance?
Decreased enzyme lactase to digest mild sugar
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What are s/s of lactose intolerance?
- watery diarrhea
- acidic stools
- positive clinitest
- wt loss
- dehydration
- FTT
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What is celiac disease?
- gluten sensitive enteropathy
- disease of proximal sm intestine
- abnormal mucosa with permanent intolerance to gluten
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What are s/s of celiac?
- Most often appear after 1/5 yrs
- Diearrhea
- Stools-waters, pale, foul odor
- Anorexia, FTT
- Abdominal pain
- Vomiting
- Lactose intolerance
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TX for celiac?
- Nutritionist
- Corn, rise, millet subs
- Dx via jejunal biopsy
- Resolution after gluten removed from diet
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What is short gut syndrome?
- Malabsorption disorder occurs as result of decreased mucosal surface area usually due to extensive resection of sm intestine
- ETIOLOGY: Trauma, Vascular injury/NEC, Chron's disease
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What is Necrotizing Enterocolitis?
- Highly lethal disease in newborns characterized by ischemic necrosis of the GI tract that frequently leads to perforation
- Common sites: distal ileum & colon
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What are s/s of NEC?
- Bile aspirates
- Bld in stool
- Ab distention
- Poor feeding
- Apneic episodes
- Jaundice
- Later...signs of peritonitis occur
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What are perinatal complications predisposing to NEC?
- cyanosis
- apnea
- hypothermia
- low apgar score
- breech delivery
- resus in delivery room
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What is treatment of Short Gut Syndrome?
- Serial Transverse Enteroplasty (STEP)
- Goal Increase length of sm intestine so pt can tolerate nutrition through GI tract and wean from IV nutrition
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What is intussusception?
Invagination or telescoping of one portion of the intestine onto another
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What are S/S of intussusception?
sudden onset of pain, distended, sausage mass RUQ, current jelly stools
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What is TX for intussusception?
Enema causes bowel to straighten out 95%; surgery 5%; can recur
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What is pyloric stenosis?
Narrowing canal between stomach and duadenum
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What are s/s of pyloric stenosis
- projectile vomiting, decreased wt, dehydration, olive shaped mass RUQ visibe, peristalic waves move L to R instead of R to L
- TX: surgery
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What is an omphalocele?
- Herniation of abdominal viscera and contents through the base of the umbilical cord/covered
- Contains bowel and liver
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What is TX for omphalocele?
- Loosely cover membranes with saline soaked pad and a plastic drape to prevent water loss, drying
- IV fluids, TPN, antibiotics
- Surgical correction
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What is gastroschisis?
Bowel herniates through a defect in the ab wall to the right of the umbilical cord and through the rectus muscle. No membrane covering exposed bowel.
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What is tx for gastroshcisis?
- Loosely covered saline soaked drape, wrap abdomen in a plastic drape
- Fluid therapy, temp control, ventillation, antibiotics, TPN
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What is a diaphragmatic hernia?
- Ab contents herniated through diaphragm into pleural cavity
- 40-50% mortality before ECMO
- TX: ECMO/chronic long disease
- ECMO=Extracorpeal Membranous Oxygenation
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