Pediatric GI Disorders Exam II
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Pediatric GI Disorders Exam II
pediatric GI Disorders
Pediatric GI Disorders, Exam II
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
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
What are health conditions relating to fluid imbalance
Radiant heat (phototherapy)
Increased respiratory rate
Vomiting and diarrhea
Fistulas, blood loss, drainage tubes
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)
How does sodium relate to dehydration?
main determinant of equilibrium
How does acidosis relate to dehydration?
What happens with decreased extracellular water when one is dehydrated?
What happens when there is inadequate perfusion during dehydration?
When does one need an IV?
If in moderate to severe category
What happens when one is in a starved state?
Increased keto-acid production
What happens when there is decreased renal perfusion?
Excretion of urea and hydrogen with resultant uremia and acidosis
What is isotonic dehydration?
Serum sodium between 130-145 meq/L
sodium and fluid loss is equal
most common type in children
: fluid boluses
What is hypernatremic dehydration?
Serum Na greater than 145 mEq/L
Excess water loss or sodium intake
: improper formula diultion
What is hyponatremic dehydration
Serum Na less than130 mEq/L
: GI loss
What are diseases of the GI tract?
Gastroenteritis-stomach, sm intestine
What lab tests would you run for GI problems?
WBC, RBC, Culture, Fat, pH, clinitest, e-lytes (stool)
What do you see age-dependent on the child?
: e coli
less than 2 yrs
viral less than 2 yrs
What is Biliary Atresia?
Obliterative disease of the bile duct system
Unknown etiology->severe liver damage
: KASAI PROCEDURE (damaged duct and gallbladder removed, creates bild duct)
Liver transplant needed eventually
What are complications of biliary atresia?
gigantic spleen (splenonmaly)
fractures (bc can't absorb minerals)
What is lactose intolerance?
Decreased enzyme lactase to digest mild sugar
What are s/s of lactose intolerance?
What is celiac disease?
gluten sensitive enteropathy
disease of proximal sm intestine
abnormal mucosa with permanent intolerance to gluten
What are s/s of celiac?
Most often appear after 1/5 yrs
Stools-waters, pale, foul odor
TX for celiac?
Corn, rise, millet subs
Dx via jejunal biopsy
Resolution after gluten removed from diet
What is short gut syndrome?
Malabsorption disorder occurs as result of decreased mucosal surface area usually due to extensive resection of sm intestine
: Trauma, Vascular injury/NEC, Chron's disease
What is Necrotizing Enterocolitis?
Highly lethal disease in newborns characterized by ischemic necrosis of the GI tract that frequently leads to perforation
: distal ileum & colon
What are s/s of NEC?
Bld in stool
Later...signs of peritonitis occur
What are perinatal complications predisposing to NEC?
low apgar score
resus in delivery room
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
What is intussusception?
Invagination or telescoping of one portion of the intestine onto another
What are S/S of intussusception?
sudden onset of pain, distended, sausage mass RUQ, current jelly stools
What is TX for intussusception?
Enema causes bowel to straighten out 95%; surgery 5%; can recur
What is pyloric stenosis?
Narrowing canal between stomach and duadenum
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
What is an omphalocele?
Herniation of abdominal viscera and contents through the base of the umbilical cord/covered
Contains bowel and liver
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
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.
What is tx for gastroshcisis?
Loosely covered saline soaked drape, wrap abdomen in a plastic drape
Fluid therapy, temp control, ventillation, antibiotics, TPN
What is a diaphragmatic hernia?
Ab contents herniated through diaphragm into pleural cavity
40-50% mortality before ECMO
: ECMO/chronic long disease
ECMO=Extracorpeal Membranous Oxygenation