Pedia 2 Module 3B: Alterations in Nutrition, GI, Metabolism, and Endocrine

Colic

• paroxysmal abdominal pain or cramping manifested by loud crying and drawing the legs up to the abdomen

• infants that cry more than 3 hours a day, more than 3 days a week, for more than 3 weeks

Regurgitation

• return of undigested food from the stomach, usually accompanied by burping

Spitting up

• dribbling of unswallowed formula from the infant’s mouth immediately after a feeding

Trigger of colic

this disease can happen due to

• mothers who smoke

• allergy to formula milk

• growing digestive system and muscles spasm

• emotional stress or tension

Relieving Colic

treatment for this disease are the following:

• stimulate, change infant position, massage

• warm bottle at baby’s belly and warm bath

• swaddle and pacifier

• avoid caffeine, small feedings, burping

• change nipple, change cow’s milk to soy formula

• homeopathic drops for colic

Poisoning

• when a person is exposed to a substance that can damage their health or put their life in danger

signs and symptoms of poisoning

patients appear to have the following:

• vomiting/ stomach pains, fever

• drowsiness, burns, difficulty in breathing

• sleepiness and confusion

Management of poisoning

to relieve the symptoms of the disease:

• take away the substance

• rinse when skin contact

• flush inner corner of eye

• stimulate fresh air

• start CPR if without RR

cleft lip and palate

• are birth defects that occur when a baby’s lip or mouth do not form properly

causes of cleft lip and palate

predisposing factor

• genetics

• maternal hypoxia

• seasonal causes

• maternal diet and vitamin intake

• anticonvulsant drugs

• lack of folic acid

Unilateral incomplete cleft lip

Unilateral complete cleft lip

bilateral complete cleft lip

unilateral complete lip and palate

bilateral complete lip and cleft palate

complete cleft palate

incomplete cleft palate

diagnostic procedure for cleft lip and palate

1. ultrasonography

   • as early as 14 - 16 weeks of gestation

cheiloplasty

• surgical correction of cleft lip

• 2-3 months after birth

Palatoplasty

• surgical correction of cleft palate

• 6 - 12 months

Preoperative care Cleft lip

before surgery follow

1. elbow restraints

2. feeding infant in the manner to be postoperatively

3. medication

4. feed the child using ESSR

   • Enlarge the nipple with head elevated

   • Stimulate the sucking reflex

   • Swallow thoroughly

   • Rest as much as possible

Post operative care cleft lip

follow the procedure after operation

1. avoid prone position

2. side lying on the opposite side of the operative site

3. apply elbow restraint

4. NPO x 4h

5. clear liquids and soft diet (no spoon)

6. clean suture line

7. monitor bleeding

Imperforate anus

• a birth defect where the anus has no normal opening or is blocked

• the condition develops in utero during the 5th to 7th weeks of pregnancy

low lesion imperforate anus

the colon remains close to the skin

high lesion imperforate anus

the colon is the higher up in the pelvis

persistent cloaca

the rectum, vagina, and urinary tract are joined into a single large opening

causes of imperforate anus

1. sacrococcygeal teratoma

2. VACTERL anomalies

   • Vertebral defects

   • Anal atresia

   • Cardiac anomalies

   • Tracheal fistula

   • Esophageal atresia

   • Rena Abnormalities

   • Limb Abnormalities

signs and symptoms of imperforate anus

patients may appear to have the following:

• anal opening near to vagina

• missing or misplaced opening

• stool passes out of the genetalia or base of the genetalia

• no 1st stool within 24-48 hours

• swollen belly area

Diagnostic procedures for imperforate anus

to diagnose the condition, the following are the procedures

1. physical exam

   • absence of anal opening

   • flat perineum

   • no midline intergluteal groove

2. ultasonography

3. radiography

4. echocardiogram

5. CT scan

6. pelvic and esophageal MRI

7. fluoroscopy

8. IV pyelogram and cystourethrogram

surgical treatment for Imperforate anus

following are the surgical treatment for the disease

1. colostomy

2. anoplasty with pull through operation

3. anal dilatation

Intussusception

• invagination of one portion of the intestine - either the small intestine or colon slides into another part of the intestine

causes of intussusception

predisposing factors can be:

1. occurrence is between ages 5- 9 months

2. rotaavirus

3. anatomical factors

4. socioeconomic status

5. improper vaccination

6. currant jelly stool

7. sausage-shaped mass RLQ (dance sign)

8. dehydration

9. lethargy and crying spells

Diagnostic procedures to intussusception

procedures done to diagnose the disease

1. barium enema

2. abdominal radiograph

3. rectal examination

4. ultrasound

Therapeutic management to intussusception

procedures to manage the disease

1. hydrostatic reduction

2. non surgical treatment

3. reduction of affected part

   • laparoscopy

   • manual reduction

   • segmental resection with anastomosis

   • medications

complications of intussusception

can happen when the disease is not treated

1. perforation

2. wound infection

3. internal hernias

4. sepsis

5. intestinal hemorrhage

6. necrosis and bowel perforation

7. recurrence

Hirschsprung’s disease

• congenital ganglionic megacolon

clinical manifestation of Hirschsprung disease

disease can be observed by

1. failure to pass meconium

2. abdominal distention

3. green and brown vomitus

4. chronic constipation - “ribbon like, foul smelling stools”

5. fecal impaction

6. watery diarrhea

7. jaundice

8. poor feeding and failure to thrive

diagnostic procedure for Hirschsprung disease

this procedure can help diagnose the disease

1. abdominal x-ray

2. anal manometry

3. barium enema

4. rectal biopsy

5. rectal exam

6. palpate loops of bowel in the swollen belly

treatment of Hirschsprung disease

the following are needed to manage the disease

1. serial rectal irrigation

2. colostomy

3. resectioning

complication of Hirschsprung disease

the following can happen if the disease is disregarded

• enterocolitis

• perforation ad rupture of intestine

• short bowel syndrome

Failure to thrive

• growth failure, feeding disorder, poor feeding, faltering weight

Endogenous failure to thrive (Organic)

• failure to thrive cause by inborn error of metabolism

Exogeneous failure to thrive (Non Organic)

• failure to thrive cause by caregiver’s actions

Clinical manifestation of FTT

can be manifested by

• poor hair texture and amount, nails, hygiene, and rashes

• protruding abdomen

• irritability and excessive crying

• easily fatigability

• avoid eye contact

• lethargy

• constipation, inappropriate weight gain

• slowed growth and delayed motor development

Diagnostic procedures for FTT

disease can be diagnose by the following

• screening test

• radiologic studies

• laboratory exams

treatment for FTT

to treat the disease

1. provide sufficient calories

2. correct vitamins and minerals

3. identify complications

Diabetes mellitus

• a chronic disorder of metabolism characterized by a partial or complete deficiency or insulin because the body does not produce enough insulin

• fasting blood sugar is 126 mg/dL or higher

Type 1 DM

• can develop any time during childhood, even during infancy, but usually begins between ages 6 - 13 years

• insulin-dependent DM

Type 2 DM

• occurs mainly in adolescent but is becoming increasingly common among overweight or obese children

• non-insulin-dependent DM

clinical manifestation of DM

symptoms of the disease are:

1. polyphagia, polydipsia, polyuria, pruritis, paresthesia

2. weight loss

3. irritability

4. fatigue

5. blurred vision

6. headache

7. enuresis or nocturia, flushed skin

8. short attention span

9. poor wound healing

10. frequent infection

diagnostic procedure of DM

to identify the disease the following procedures can be done

1. 8-hour fasting blood glucose level (more than 126 mg/dL)

2. random blood glucose (200 mg/dL or higher)

3. oral glucose tolerance test (140 - 200 mg/dL impaired glucose tolerance)

4. postprandial blood glucose

Insulin therapy

• a hormone released by the pancreas

• the goal is to maintain near-normal blood glucose values while avoiding too frequent episodes of hypoglycemia

rapid acting insulin

• used as a bolus dosage

• starts to lower blood glucose levels 10 - 15 mins after injection

• peak actions in 30 - 90 minutes last as as long as 5 hours

• Lispro - human insulin used in injection replacing the insulin produced by the body

short acting insulin

• work 30 min - 1 hr after injection

• peaks after 2-3 hrs but remians active 4-6 hrs

• clear insulin

• regular, humulin - R; semilente. crystalline zinc, actrapid

intermediate acting insulin

• cloudy insulin

• works 2-4 hours after injection, peaks after 6-12 hours

• NPH, Lente, Humilin - N, Monotard

long acting insulin

• cloudy insulin

• slow onset of action 6-8 hrs relatively small peak effect 12-16 hrs

• last for 20-30 hrs

• usually given around bedtime

• Ultralente insulin, PZI

therapeutic management of DM

recommended management for the disease

1. insulin therapy

2. diet

3. exercise

Obesity

• is a medical condition in which excess body fat has accumulated

• more than 20% over their ideal weight

• BMI of 30 and above

causes of obesity

this disease can be caused by the following:

1. sedentary lifestyle

2. imbalance between calorie intake and energy expenditure

3. slow metabolism

4. psychiatric illness

5. insufficient sleep

6. endocrine disruptors

7. genetics

8. used of medications

9. hormones

Diagnostic procedure for obesity

the following diagnostic test can help assess the disease

1. waist-hip ratio

2. waist circumference

3. body mass index

4. underwater weighing

5. Dual-energy X-ray absorptiometry

6. skin calipers

waist circumference

estimate the amount of a person’s abdominal fat

body mass index

classifies obesity according to height and weight

underwater weighing

calculate lean body mass and body fat

Dual-energy X-ray absorptiometry

• used to measure bone density

• determine percentage of body fat and where and how much fat is located in the body

skin calipers

used to calculate the percentage of body fat

management for obesity

to manage the disease here are the following procedures

1. physical activity and exercise

2. anti-obesity drugs

3. surgery

   • gastric balloon

   • bariatric surgery

Anorexia Nervosa

• intense fear of becoming obese

• an eating disorder characterized by:

  • immoderate food restriction

  • inappropriate eating habits

  • obsession with having a thin figure

  • an irrational fear of weight gain

  • a distorted body self-perception

Restricting type Anorexia

• individuals does not utilize binge eating nor displays purging behaviors as their main strategy for weight loss. instead, the individual uses restricting food intake, fasting, diet pills, and/or exercise as a means for losing weight

Binge-eating Anorexia

• individuals utilizes binge eating or displays purging behavior as a means for losing weight (eating a lot of food and then trying to get rid of the calories by forcing themselves to vomit, using laxatives, or exercising excessively, or some combination of these).

Bulimia Nervosa

• is a binge eating combined with inappropriate ways of stopping eating such as self-induced vomiting, abuse of laxatives and diuretics, or excessive exercise

• it can occur in a normal body weight person

Binge Eating Disorder

• similar to anorexia and bulimia because a person binges regularly on food. but, unlike the other eating disorders, does not try to compensate by purging the food

causes of Anorexia Nervosa

predisposing factors of the diseases are

1. cultural pressures

2. family environment

3. psychological issues

4. food rituals