PED GI disorders

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  1. 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
  2. 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
  3. 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
  4. 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
  5. What are the three main processes that are needed to convert nutrients into usable energy?
    • Digestion
    • Absorption
    • Metabolism
  6. Which types of digestions are used to help the GI tract digest nutrients?
    • Mechanical
    • Chemical
  7. 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
  8. Which chemicals are involved in digestion?
    • 1. enzymes
    • 2. hormones
    • 3. hydrochloric acid
    • 4. mucus
    • 5. water and electrolytes
  9. What type of children/adults are more likely to consume pica?
    • children with:
    • autism
    • development delay
    • retardation
    • adults with:
    • anemia
    • renal failure
    • some cultures
  10. Which intestine consist of more absorption of water, absorption of sodium, role of colonic bacteria?
    Large intestine
  11. What is the principal role of small intestines?
    absorption
  12. What types of foods consists of food picas?
    • dry rice
    • coffee grounds
    • lose teas
    • uncooked cereals
  13. 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
  14. What types of things are nonfoods PICA?
    • clay
    • soil
    • stones
    • laundry starch
    • feces
  15. what types of things might a child complain of if the have consumed PICA?
    • abdominal pain
    • GI problems
  16. Foreign bodies ingestions are most common in which age group?
    6 mos to 3 years of age
  17. Iron and Zinc deficiency is clearly associated with which disorder?
    PICA
  18. 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
  19. 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
  20. 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
  21. Define obstipation?
    really long intervals without stools
  22. Define Encopresis
    hard stool with loose stool around the impactation
  23. What can be the causes of constipation?
    • opioids
    • iron
    • Hirschsprung disease
    • hypothyroidism
    • Idiopathic
    • environmental
    • withholding stool
    • meconium not passed
  24. Will infants that are exclusively breastfed be constipated?
    no
  25. What types of things may cause an infant to become constipated?
    • switching to formula
    • switching to solid foods
    • mix between breast and formula
  26. How can we treat constipation for a child?
    • treat underlying cause
    • encourage normal bowel habits
    • increase fluids & fibers
    • increase fruit & veggies
  27. Define Hirschsprung disease?
    congenital anomaly that results in mechanical obstruction from inadequate motility of part of the intestine
  28. Which individuals are more likely to have hirschsprung disease?
    • Males
    • Down syndrome
  29. 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
  30. 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
  31. What is the major complication seen with hirschsprung?
    Entercolitis
  32. what are signs/symptoms of a patient with hirschsprung disease?
    • ABDOMINAL DISTENTION
    • vomiting
    • constipation progessing
    • delayed meconium passage
    • ribbon like foul smelling stool
  33. How can we diagnose hirschsprung disease?
    • x-ray
    • barium enema
    • anorectal manometric exam
    • rectal biopsy showing no ganglion cells
  34. How do we treat Hirschsprung disease?
    • sugery-remove the portion that is missing ganglion
    • (temporary ostomy first)
    • (then put colon back together)
  35. 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
  36. 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
  37. Define gastroesophageal reflux?
    the transfer of gastric contents into the esophagus
  38. Which individuals are more likely to develop GER?
    everyone
  39. 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
  40. what manifestations change GER from being normal to being a problem?
    • consistency of regurgitation
    • failure to thrive
    • bleeding
    • dysphagia
  41. What are signs/symptoms of GER that are seen in children?
    • bloody emesis/stools
    • failure to thrive
    • weight loss
    • anemia
    • irritability
    • apnea
    • recurrent PNA
  42. 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
  43. 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
  44. If a child with GER is failing to thrive and has other major complications what's the best treatment for child?
    Nissen fundoplication
  45. What is considered a cause of recurrent abdominal pain in 4-25% of school age children?
    Irritable bowel syndrome
  46. 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
  47. How do we treat IBS?
    • develop regular bowel habits
    • relief of symptoms
    • increase fiber
    • antispasmodics
    • emotional support
  48. What patients are most likely to develop acute appendicitis?
    • children 10-12 years of age
    • boys=girls
  49. What's the ominous sign of acute appendicitis?
    periumbilical pain
  50. What are signs/symptoms of acute appendicitis?
    • periumbilical pain
    • nausea
    • right lower quadrant pain
    • vomiting
  51. If appendix has not ruptured what is the likely treatment for this patient?
    • antibiotics/ancef/cefalosporins
    • surgery to remove appendix
  52. If appendix has ruptured what is the likely treatment for this patient?
    • IV antibiotics and fluids
    • NG suction
    • surgery
    • NPO post op
  53. 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
  54. What causes appendicitis?
    obstruction of the lumen of the appendix usually by hard fecal material, foreign body, kinked appendix, viral infection
  55. How can we diagnose appendicitis?
    • difficult to diagnose
    • Heel strike
    • roscens sign feel pain in lower quadrant
    • UA
    • CBC
    • CT scan
  56. What is the most common congenital malformation of the GI tract?
    Meckel Diverticulum
  57. Define Meckel Diverticulum
    a fistula formed from the small intestine to the umbiliculus
  58. What are some signs/symptoms of Meckel diverticulum
    • usually asymptomatic in older children
    • symptoms in children is bleeding, obstruction, and inflammation
  59. How do we diagnose Meckel diverticulum?
    • history/physical exam
    • meckel scan
    • r/o other problems
  60. What is the primary treatment for a patient with Meckel diverticulum?
    surgical removal if no severe hemorrhaging in present
  61. 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
  62. What two disease are considered inflammatory bowel disease?
    • ulcerative colitis
    • crohn's disease
  63. 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
  64. 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
  65. How do we diagnose any IBD?
    • history/physical exam
    • biopsy
    • CBC
    • ESR
    • X-ray
    • Albumin
  66. Which is the best test that diagnose 70% of IBD?
    circulating perniculear anitneutrophil antibody
  67. What are our goals for treating a patient with IBD?
    • control inflammatory process
    • long term remission
    • promote growth and development
  68. 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
  69. What are signs of Crohn's Disease?
    • diarrhea
    • pain
    • cramping
    • fever
    •  growth retardation
    • weight loss
    • malabsorption
  70. 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
  71. 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
  72. 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
  73. what is the most common cause of peptic ulcers?
    • infection from H.Pylori
    • alcohol and smoking
    • stressful life events
    • NSAIDs and ASA
  74. What are the symptoms that we look at to diagnose peptic ulcers?
    • epigastric abdominal pain
    • nocturnal pain
    • oral regurgitation
    • heartburn
    • weight loss
    • hematemesis
    • melena
  75. Which diagnose test is used to measure bacterial colonization in the gastric mucosa?
    C urea breath test
  76. What are the major goals of therapy for children with PUD?
    • relieve discomfort
    • promote healing
    • prevent complications
    • reduce recurrence
  77. What are the best medications to give to a patient with PUD?
    • PPI
    • H2-blocker
    • antibiotics for H. pylori
  78. 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
  79. Define hypertrophic pyloric stenosis?
    pyloric sphincter becomes thickened, resulting in elongation and narrowing of the pyloric canal
  80. What are signs of HPS in infants?
    • nonbilious vomiting projectile and progressive
    • infant is hungry and irritable
  81. How do we diagnose HPS?
    • olive-shaped mass in the epigastrium area
    • be palpated/US
  82. How do we treat HPS?
    • replace fluid and electorlytes
    • NGT
    • pyloromyotomy
  83. Which obstruction is the most common cause of intestinal obstruction in children between the ages of 3 months to 3 years?
    Intussusception
  84. What is intussusception?
    telescoping or invagination of one portion of intestine into another
  85. 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
  86. 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
  87. How will we know if the intussesception has been solved?
    passage of normal bowel
  88. Define volvulus?
    occurs when intestine is twisted around itself and compromises blood supply
  89. What types of complications will malrotation and volvulus cause?
    • intestinal perforation
    • peritonitis
    • necrosis
    • death
  90. Define malrotation?
    due to abnormal rotation around the superior mesenteric artery during embryonic development
  91. What characterizes malabsorption syndromes?
    • chronic diarrhea
    • malabsorption of nutrients
  92. What types of things may occur from malabsorption syndromes?
    • failure to thrive
    • digestive defects
    • absorptive defects
    • anatomic defects
  93. 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
  94. How do we treat celiac disease?
    • remove gluten foods from diet
    • (wheat, barley, oats)
  95. what are symptoms of celiac disease?
    • anemia
    • muscle wastings
    • steatorrhea
    • malnutrition
    • anorexia
    • abdominal distention
  96. What is the cause of short bowel syndrome?
    results of decreased mucosal surface area, usually due to extensive resection of small intestine
  97. what's the first thing nutritional wise we will give a patient with SBS?
    TPN
  98. WHats the second phase of treating SBS?
    enternal feedings asap after surgery
  99. What is the priority of the nurse for a patient after  surgery of SBS?
    monitor TPN
  100. If a patient is vomiting coffee grounds or vomiting blood which area might they have a GI bleed?
    upper GI bleed
  101. If a patient has bright red rectal bleeding and tarry stools
  102. what is considered acute diarrhea?
    less than 14 weeks
  103. what is considered chronic diarrhea?
    longer than 2 weeks
  104. what is the most concerning complication with acute diarrhea?
    dehydration
  105. What is the most concerning complication with chronic diarrhea?
    • inflammatory bowel disease
    • food allergies
    • celiac disease
  106. 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
  107. 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
  108. will you see a cleft lip with or with out a cleft palate?
    may be separately or together
  109. which age group is likely to develop a cleft palate?
    12 to 18 months of age
  110. what causes cleft lip/cleft palate?
    failure of the maxillary process to fuse during the 6 week of gestation
  111. whats the best approach to treating cleft lip/cleft palate?
    muti-team approach
  112. what are some complications with cleft lip/cleft palate?
    • sucking problems
    • speech developments
  113. can a baby with cleft lip/cleft palate still breastfeed?
    yes

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Author:
 bpayton
ID:
 247672
Filename:
 PED GI disorders
Updated:
2013-11-19 05:52:11
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theory
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