PED GI disorders
Card Set Information
PED GI disorders
What are the primary functions of the GI tract?
1. process and absorb nutrients
2. excretes waste and toxins
3. maintain fluid and electrolyte balance
4. secretes hormones
What type of stomach does an infant have compared to an adult?
more round and horizontal
the stomach is smaller but the emptying time is faster
What is meconium and its importance?
Meconium is a thick greenish black material containing epithelial cells, digestive tract secretions, and residue of swallowed amniotic fluid.
Means the GI tract is patent
What is the swallowing mechanism of the Gi tract introduced in an infant?
its an automatic reflex action in the first 3 months.
Infant has no voluntary control of swallowing until the striated muscles in the throat establish their cerebral connections until about 6 months of age
What are the three main processes that are needed to convert nutrients into usable energy?
Which types of digestions are used to help the GI tract digest nutrients?
What are the three types of muscles that are used in the motility of digestion?
1. circular muscles=churn and mix food particles
2. longitudinal muscles=propel the food mass
3. sphincters muscles= control the passage of the food mass to the next segment
Which chemicals are involved in digestion?
3. hydrochloric acid
5. water and electrolytes
What type of children/adults are more likely to consume pica?
Which intestine consist of more absorption of water, absorption of sodium, role of colonic bacteria?
What is the principal role of small intestines?
What types of foods consists of food picas?
eating disorder characterized by excessive and compulsive ingestion of food or non foods
putting food deliberately in their mouth and not necessarily swallowing it
What types of things are nonfoods PICA?
what types of things might a child complain of if the have consumed PICA?
Foreign bodies ingestions are most common in which age group?
6 mos to 3 years of age
Iron and Zinc deficiency is clearly associated with which disorder?
What are the main signs of almost all GI dysfunctions in children?
Failure to thrive
spitting up or regurgitation
encopresis (overflow of incontinent stool causing soiling)
hypo/hyper or absent bowel sounds
hematochezia (passage of bright red blood thru the rectum)
melena (passage of dark-colored, tarry stools)
What should we teach our patients family about ingesting foreign bodies?
teach family about safe environment
where and when to seek advice
if object is left to pass should assess stool for object usually within 3-4 days
any sharp object or batter was ingested needs immediate attention
What is the definition of constipation?
an alteration in the frequency, consistency, or ease of passing stool
more than 3 days without stool or painful blood stooling in children
really long intervals without stools
hard stool with loose stool around the impactation
What can be the causes of constipation?
meconium not passed
Will infants that are exclusively breastfed be constipated?
What types of things may cause an infant to become constipated?
switching to formula
switching to solid foods
mix between breast and formula
How can we treat constipation for a child?
treat underlying cause
encourage normal bowel habits
increase fluids & fibers
increase fruit & veggies
Define Hirschsprung disease?
congenital anomaly that results in mechanical obstruction from inadequate motility of part of the intestine
Which individuals are more likely to have hirschsprung disease?
What is the patho of hirschsprung disease?
absence of ganglion cells in the affected areas of the intestine causing a lack of enteric nervous system stimulation which decreases the internal sphincter's ability to relax
What is the main manifestation that differential hirschsprung from other disease?
Hirschsprung child will be constipated from 6 months of age and gradually get worse. NOT ACUTE CONSTIPATION
What is the major complication seen with hirschsprung?
what are signs/symptoms of a patient with hirschsprung disease?
delayed meconium passage
ribbon like foul smelling stool
How can we diagnose hirschsprung disease?
anorectal manometric exam
rectal biopsy showing no ganglion cells
How do we treat Hirschsprung disease?
sugery-remove the portion that is missing ganglion
(temporary ostomy first)
(then put colon back together)
What should the nurse do for an infant that is important to hirschsprung disease?
assess for first passage of meconium
stool patterns in infants
teach patients about disease
teach about colostomy care
What is important for the nurse to monitor after a child has had surgery to correct hirschsprung?
s/sx of entercolitis
monitor for s/sx of perforation
Define gastroesophageal reflux?
the transfer of gastric contents into the esophagus
Which individuals are more likely to develop GER?
What should you teach a patient who has concerns that their infant is spitting up too much?
its normal and its good thing they are removing bacteria from the breast milk
what manifestations change GER from being normal to being a problem?
consistency of regurgitation
failure to thrive
What are signs/symptoms of GER that are seen in children?
failure to thrive
How can we diagnose GER in infants?
upper GI series
measure pH in esophagus thru nose for 24 hours
How do we treat GER?
If child is thriving and no respiratory complications do nothing
if child is having problems:
add rice to feedings/thickening foods
avoid certain foods that cause reflux
small frequent meals
keep child upright after meals
If a child with GER is failing to thrive and has other major complications what's the best treatment for child?
What is considered a cause of recurrent abdominal pain in 4-25% of school age children?
Irritable bowel syndrome
What types of things will children complain of with having irritable bowel syndrome?
alternating diarrhea and constipation
bloating/feeling abdominal distention
lower abdominal pain
feeling of urgency when defecating
feeling of incomplete evacuation of the bowel
How do we treat IBS?
develop regular bowel habits
relief of symptoms
What patients are most likely to develop acute appendicitis?
children 10-12 years of age
What's the ominous sign of acute appendicitis?
What are signs/symptoms of acute appendicitis?
right lower quadrant pain
If appendix has not ruptured what is the likely treatment for this patient?
surgery to remove appendix
If appendix has ruptured what is the likely treatment for this patient?
IV antibiotics and fluids
NPO post op
would expect a child under the age of 2 have appendicitis? if so what is the prognosis?
not expect a child under 2
if the do not good
What causes appendicitis?
obstruction of the lumen of the appendix usually by hard fecal material, foreign body, kinked appendix, viral infection
How can we diagnose appendicitis?
difficult to diagnose
roscens sign feel pain in lower quadrant
What is the most common congenital malformation of the GI tract?
Define Meckel Diverticulum
a fistula formed from the small intestine to the umbiliculus
What are some signs/symptoms of Meckel diverticulum
usually asymptomatic in older children
symptoms in children is
, obstruction, and inflammation
How do we diagnose Meckel diverticulum?
r/o other problems
What is the primary treatment for a patient with Meckel diverticulum?
if no severe hemorrhaging in present
What assessments is the nurse responsible for after a child has had surgery for Meckel diverticulum?
assess vs (blood pressure/HR) for blood loss
bed rest for child
monitor blood loss in stool
What two disease are considered inflammatory bowel disease?
What are the main distinguishing differences of crohn's disease?
more extraintestinal and systemic inflammatory
affects entire GI tract from mouth to anus
inflammation in skip lesions
failure to thrive
hard to treat medical/surgical
What are the main distinguishing differences of ulcerative colitis?
removal of colon will cure
affects only the left colon
extraintestinal and systemic inflammatory
inflammation affects mucosa/submucosa
continuous segments along the length of the bowel
How do we diagnose any IBD?
Which is the best test that diagnose 70% of IBD?
circulating perniculear anitneutrophil antibody
What are our goals for treating a patient with IBD?
control inflammatory process
long term remission
promote growth and development
What are signs of ulcerative colitis?
failure to thrive
inability to absorb nutrients
occult fecal stool
increase in ESR
What are signs of Crohn's Disease?
What are differential clinical manifestations in ulcerative colitis?
anorexia-mild or moderate
weight loss- moderate
growth retardation-usually mild
anal and perianal lesions-rare
fistulas and strictures-rare
joint pain-mild to moderate
What are differential clinical manifestations in Crohn's Disease?
diarrhea-moderate to severe
anorexia-may be severe
weight loss-may be severe
growth retardation-may be severe
anal and perianal lesions-common
fistulas and strictures-common
joint pain-mild to moderate
primary ulcers are most common in which age group? stress ulcers?
primary-children older than 6
stress-children younger than 6 months
seen more in boys than girls
what is the most common cause of peptic ulcers?
infection from H.Pylori
alcohol and smoking
stressful life events
NSAIDs and ASA
What are the symptoms that we look at to diagnose peptic ulcers?
epigastric abdominal pain
Which diagnose test is used to measure bacterial colonization in the gastric mucosa?
C urea breath test
What are the major goals of therapy for children with PUD?
What are the best medications to give to a patient with PUD?
antibiotics for H. pylori
what are some common signs of all obstruction disorders of the GI tract?
colicky abdominal pain
rigid and board like abdomen
diminished bowel sounds
Define hypertrophic pyloric stenosis?
pyloric sphincter becomes thickened, resulting in elongation and narrowing of the pyloric canal
What are signs of HPS in infants?
nonbilious vomiting projectile and progressive
infant is hungry and irritable
How do we diagnose HPS?
olive-shaped mass in the epigastrium area
How do we treat HPS?
replace fluid and electorlytes
Which obstruction is the most common cause of intestinal obstruction in children between the ages of 3 months to 3 years?
What is intussusception?
telescoping or invagination of one portion of intestine into another
What are symptoms of a child with intussusception?
sudden acute abdominal pain
child in fetal postion
passage of red, currant jelly-like stools
palpable sausage shaped mass in upper right quadrant
How do we diagnose intussusception?
get an abdominal US first
barium enema and it can cure it at same time
don't do barium enema if in shock
How will we know if the intussesception has been solved?
passage of normal bowel
occurs when intestine is twisted around itself and compromises blood supply
What types of complications will malrotation and volvulus cause?
due to abnormal rotation around the superior mesenteric artery during embryonic development
What characterizes malabsorption syndromes?
malabsorption of nutrients
What types of things may occur from malabsorption syndromes?
failure to thrive
Celiac disease is often used to describe a symptom complex of what four characteristics?
steatorrhea (fatty, foul, frothy, stools)
secondary vitamin deficiencies
How do we treat celiac disease?
remove gluten foods from diet
(wheat, barley, oats)
what are symptoms of celiac disease?
What is the cause of short bowel syndrome?
results of decreased mucosal surface area, usually due to extensive resection of small intestine
what's the first thing nutritional wise we will give a patient with SBS?
WHats the second phase of treating SBS?
enternal feedings asap after surgery
What is the priority of the nurse for a patient after surgery of SBS?
If a patient is vomiting coffee grounds or vomiting blood which area might they have a GI bleed?
upper GI bleed
If a patient has bright red rectal bleeding and tarry stools
what is considered acute diarrhea?
less than 14 weeks
what is considered chronic diarrhea?
longer than 2 weeks
what is the most concerning complication with acute diarrhea?
What is the most concerning complication with chronic diarrhea?
inflammatory bowel disease
When does intractable diarrhea of infancy occur?
chronic diarrhea occur in the first months of life
doesn't respond to treatment
had an infectious diarrhea and not treated then got worse
when is Chronic nonspecific diarrhea seen?
6 months and 4 years old
seen as loose stools with undigestive chunks
normal growth and development
no blood in stools
had an infectious infection cause diarrhea and not treated then got worse
will you see a cleft lip with or with out a cleft palate?
may be separately or together
which age group is likely to develop a cleft palate?
12 to 18 months of age
what causes cleft lip/cleft palate?
failure of the maxillary process to fuse during the 6 week of gestation
whats the best approach to treating cleft lip/cleft palate?
what are some complications with cleft lip/cleft palate?
can a baby with cleft lip/cleft palate still breastfeed?