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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
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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
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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
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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
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What are the three main processes that are needed to convert nutrients into usable energy?
- Digestion
- Absorption
- Metabolism
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Which types of digestions are used to help the GI tract digest nutrients?
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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
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Which chemicals are involved in digestion?
- 1. enzymes
- 2. hormones
- 3. hydrochloric acid
- 4. mucus
- 5. water and electrolytes
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What type of children/adults are more likely to consume pica?
- children with:
- autism
- development delay
- retardation
- adults with:
- anemia
- renal failure
- some cultures
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Which intestine consist of more absorption of water, absorption of sodium, role of colonic bacteria?
Large intestine
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What is the principal role of small intestines?
absorption
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What types of foods consists of food picas?
- dry rice
- coffee grounds
- lose teas
- uncooked cereals
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Define PICA?
- eating disorder characterized by excessive and compulsive ingestion of food or non foods
- putting food deliberately in their mouth and not necessarily swallowing it
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What types of things are nonfoods PICA?
- clay
- soil
- stones
- laundry starch
- feces
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what types of things might a child complain of if the have consumed PICA?
- abdominal pain
- GI problems
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Foreign bodies ingestions are most common in which age group?
6 mos to 3 years of age
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Iron and Zinc deficiency is clearly associated with which disorder?
PICA
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What are the main signs of almost all GI dysfunctions in children?
- Failure to thrive
- spitting up or regurgitation
- projectile vomiting
- nausea
- constipation
- encopresis (overflow of incontinent stool causing soiling)
- diarrhea
- hypo/hyper or absent bowel sounds
- abdominal distention
- abdominal pain
- GI bleeding
- hematemesis
- hematochezia (passage of bright red blood thru the rectum)
- melena (passage of dark-colored, tarry stools)
- jaundice
- dysphagia
- dysfunctional swallowing
- fever
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What should we teach our patients family about ingesting foreign bodies?
- Prevention
- 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
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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
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Define obstipation?
really long intervals without stools
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Define Encopresis
hard stool with loose stool around the impactation
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What can be the causes of constipation?
- opioids
- iron
- Hirschsprung disease
- hypothyroidism
- Idiopathic
- environmental
- withholding stool
- meconium not passed
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Will infants that are exclusively breastfed be constipated?
no
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What types of things may cause an infant to become constipated?
- switching to formula
- switching to solid foods
- mix between breast and formula
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How can we treat constipation for a child?
- treat underlying cause
- encourage normal bowel habits
- increase fluids & fibers
- increase fruit & veggies
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Define Hirschsprung disease?
congenital anomaly that results in mechanical obstruction from inadequate motility of part of the intestine
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Which individuals are more likely to have hirschsprung disease?
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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
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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
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What is the major complication seen with hirschsprung?
Entercolitis
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what are signs/symptoms of a patient with hirschsprung disease?
- ABDOMINAL DISTENTION
- vomiting
- constipation progessing
- delayed meconium passage
- ribbon like foul smelling stool
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How can we diagnose hirschsprung disease?
- x-ray
- barium enema
- anorectal manometric exam
- rectal biopsy showing no ganglion cells
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How do we treat Hirschsprung disease?
- sugery-remove the portion that is missing ganglion
- (temporary ostomy first)
- (then put colon back together)
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What should the nurse do for an infant that is important to hirschsprung disease?
- per-op:
- assess for first passage of meconium
- stool patterns in infants
- teach patients about disease
- teach about colostomy care
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What is important for the nurse to monitor after a child has had surgery to correct hirschsprung?
- s/sx of entercolitis
- f&e replacement
- Give TPN
- monitor for s/sx of perforation
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Define gastroesophageal reflux?
the transfer of gastric contents into the esophagus
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Which individuals are more likely to develop GER?
everyone
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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
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what manifestations change GER from being normal to being a problem?
- consistency of regurgitation
- failure to thrive
- bleeding
- dysphagia
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What are signs/symptoms of GER that are seen in children?
- bloody emesis/stools
- failure to thrive
- weight loss
- anemia
- irritability
- apnea
- recurrent PNA
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How can we diagnose GER in infants?
- history/physical
- growth chart
- barium swallow
- x-ray
- upper GI series
- measure pH in esophagus thru nose for 24 hours
- endoscopy
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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
- some drugs
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If a child with GER is failing to thrive and has other major complications what's the best treatment for child?
Nissen fundoplication
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What is considered a cause of recurrent abdominal pain in 4-25% of school age children?
Irritable bowel syndrome
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What types of things will children complain of with having irritable bowel syndrome?
- alternating diarrhea and constipation
- flatulence
- bloating/feeling abdominal distention
- lower abdominal pain
- feeling of urgency when defecating
- feeling of incomplete evacuation of the bowel
- psychosocial effects
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How do we treat IBS?
- develop regular bowel habits
- relief of symptoms
- increase fiber
- antispasmodics
- emotional support
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What patients are most likely to develop acute appendicitis?
- children 10-12 years of age
- boys=girls
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What's the ominous sign of acute appendicitis?
periumbilical pain
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What are signs/symptoms of acute appendicitis?
- periumbilical pain
- nausea
- right lower quadrant pain
- vomiting
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If appendix has not ruptured what is the likely treatment for this patient?
- antibiotics/ancef/cefalosporins
- surgery to remove appendix
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If appendix has ruptured what is the likely treatment for this patient?
- IV antibiotics and fluids
- NG suction
- surgery
- NPO post op
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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
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What causes appendicitis?
obstruction of the lumen of the appendix usually by hard fecal material, foreign body, kinked appendix, viral infection
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How can we diagnose appendicitis?
- difficult to diagnose
- Heel strike
- roscens sign feel pain in lower quadrant
- UA
- CBC
- CT scan
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What is the most common congenital malformation of the GI tract?
Meckel Diverticulum
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Define Meckel Diverticulum
a fistula formed from the small intestine to the umbiliculus
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What are some signs/symptoms of Meckel diverticulum
- usually asymptomatic in older children
- symptoms in children is bleeding, obstruction, and inflammation
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How do we diagnose Meckel diverticulum?
- history/physical exam
- meckel scan
- r/o other problems
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What is the primary treatment for a patient with Meckel diverticulum?
surgical removal if no severe hemorrhaging in present
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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
- IV fluids
- NGT
- emotional support
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What two disease are considered inflammatory bowel disease?
- ulcerative colitis
- crohn's disease
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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
- more disabling
- serious complications
- hard to treat medical/surgical
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What are the main distinguishing differences of ulcerative colitis?
- removal of colon will cure
- affects only the left colon
- extraintestinal and systemic inflammatory
- disabling
- inflammation affects mucosa/submucosa
- continuous segments along the length of the bowel
- ulcerations
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How do we diagnose any IBD?
- history/physical exam
- biopsy
- CBC
- ESR
- X-ray
- Albumin
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Which is the best test that diagnose 70% of IBD?
circulating perniculear anitneutrophil antibody
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What are our goals for treating a patient with IBD?
- control inflammatory process
- long term remission
- promote growth and development
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What are signs of ulcerative colitis?
- failure to thrive
- bleeding
- edema
- inability to absorb nutrients
- bloody diarrhea
- occult fecal stool
- abdominal pain
- increase in ESR
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What are signs of Crohn's Disease?
- diarrhea
- pain
- cramping
- fever
- growth retardation
- weight loss
- malabsorption
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What are differential clinical manifestations in ulcerative colitis?
- rectal bleeding-common
- diarrhea-often severe
- pain-less frequent
- anorexia-mild or moderate
- weight loss- moderate
- growth retardation-usually mild
- anal and perianal lesions-rare
- fistulas and strictures-rare
- rashes-mild
- joint pain-mild to moderate
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What are differential clinical manifestations in Crohn's Disease?
- rectal bleeding-uncommon
- diarrhea-moderate to severe
- pain-common
- anorexia-may be severe
- weight loss-may be severe
- growth retardation-may be severe
- anal and perianal lesions-common
- fistulas and strictures-common
- rashes-mild
- joint pain-mild to moderate
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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
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what is the most common cause of peptic ulcers?
- infection from H.Pylori
- alcohol and smoking
- stressful life events
- NSAIDs and ASA
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What are the symptoms that we look at to diagnose peptic ulcers?
- epigastric abdominal pain
- nocturnal pain
- oral regurgitation
- heartburn
- weight loss
- hematemesis
- melena
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Which diagnose test is used to measure bacterial colonization in the gastric mucosa?
C urea breath test
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What are the major goals of therapy for children with PUD?
- relieve discomfort
- promote healing
- prevent complications
- reduce recurrence
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What are the best medications to give to a patient with PUD?
- PPI
- H2-blocker
- antibiotics for H. pylori
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what are some common signs of all obstruction disorders of the GI tract?
- colicky abdominal pain
- abdominal distention
- vomiting
- constipation/obstipation
- dehydration
- rigid and board like abdomen
- diminished bowel sounds
- respiratory distress
- shock
- sepsis
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Define hypertrophic pyloric stenosis?
pyloric sphincter becomes thickened, resulting in elongation and narrowing of the pyloric canal
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What are signs of HPS in infants?
- nonbilious vomiting projectile and progressive
- infant is hungry and irritable
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How do we diagnose HPS?
- olive-shaped mass in the epigastrium area
- be palpated/US
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How do we treat HPS?
- replace fluid and electorlytes
- NGT
- pyloromyotomy
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Which obstruction is the most common cause of intestinal obstruction in children between the ages of 3 months to 3 years?
Intussusception
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What is intussusception?
telescoping or invagination of one portion of intestine into another
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What are symptoms of a child with intussusception?
- sudden acute abdominal pain
- inconsulable crying
- child in fetal postion
- passage of red, currant jelly-like stools
- palpable sausage shaped mass in upper right quadrant
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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
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How will we know if the intussesception has been solved?
passage of normal bowel
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Define volvulus?
occurs when intestine is twisted around itself and compromises blood supply
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What types of complications will malrotation and volvulus cause?
- intestinal perforation
- peritonitis
- necrosis
- death
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Define malrotation?
due to abnormal rotation around the superior mesenteric artery during embryonic development
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What characterizes malabsorption syndromes?
- chronic diarrhea
- malabsorption of nutrients
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What types of things may occur from malabsorption syndromes?
- failure to thrive
- digestive defects
- absorptive defects
- anatomic defects
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Celiac disease is often used to describe a symptom complex of what four characteristics?
- steatorrhea (fatty, foul, frothy, stools)
- general malnutrition
- abdominal distention
- secondary vitamin deficiencies
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How do we treat celiac disease?
- remove gluten foods from diet
- (wheat, barley, oats)
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what are symptoms of celiac disease?
- anemia
- muscle wastings
- steatorrhea
- malnutrition
- anorexia
- abdominal distention
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What is the cause of short bowel syndrome?
results of decreased mucosal surface area, usually due to extensive resection of small intestine
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what's the first thing nutritional wise we will give a patient with SBS?
TPN
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WHats the second phase of treating SBS?
enternal feedings asap after surgery
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What is the priority of the nurse for a patient after surgery of SBS?
monitor TPN
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If a patient is vomiting coffee grounds or vomiting blood which area might they have a GI bleed?
upper GI bleed
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If a patient has bright red rectal bleeding and tarry stools
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what is considered acute diarrhea?
less than 14 weeks
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what is considered chronic diarrhea?
longer than 2 weeks
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what is the most concerning complication with acute diarrhea?
dehydration
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What is the most concerning complication with chronic diarrhea?
- inflammatory bowel disease
- food allergies
- celiac disease
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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
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when is Chronic nonspecific diarrhea seen?
- 6 months and 4 years old
- seen as loose stools with undigestive chunks
- normal growth and development
- not malnuroished
- no blood in stools
- had an infectious infection cause diarrhea and not treated then got worse
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will you see a cleft lip with or with out a cleft palate?
may be separately or together
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which age group is likely to develop a cleft palate?
12 to 18 months of age
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what causes cleft lip/cleft palate?
failure of the maxillary process to fuse during the 6 week of gestation
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whats the best approach to treating cleft lip/cleft palate?
muti-team approach
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what are some complications with cleft lip/cleft palate?
- sucking problems
- speech developments
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can a baby with cleft lip/cleft palate still breastfeed?
yes
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