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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
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
- Renal disease
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
- TX: fluid boluses
What is hypernatremic dehydration?
- Serum Na greater than 145 mEq/L
- Excess water loss or sodium intake
- ETIOLOGIES: improper formula diultion
What is hyponatremic dehydration
- Serum Na less than130 mEq/L
- ETIOLOGIES: GI loss
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
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?
- 1-3 months: e coli
- 2-4 yrs: shigella
- less than 2 yrs: salmonella
- viral less than 2 yrs
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
What are complications of biliary atresia?
- liver scarring
- portal htn
- gigantic spleen (splenonmaly)
- fractures (bc can't absorb minerals)
- poor nutrition
What is lactose intolerance?
Decreased enzyme lactase to digest mild sugar
What are s/s of lactose intolerance?
- watery diarrhea
- acidic stools
- positive clinitest
- wt loss
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
- Anorexia, FTT
- Abdominal pain
- Lactose intolerance
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
- ETIOLOGY: 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
- Common sites: distal ileum & colon
What are s/s of NEC?
- Bile aspirates
- Bld in stool
- Ab distention
- Poor feeding
- Apneic episodes
- Later...signs of peritonitis occur
What are perinatal complications predisposing to NEC?
- low apgar score
- breech delivery
- 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
- TX: surgery
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
- Surgical correction
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
- TX: ECMO/chronic long disease
- ECMO=Extracorpeal Membranous Oxygenation