Unit 3: Gastrointestinal (GI) Disorders

What are key pediatric differences in the GI system?

Infants have smaller stomachs, higher peristalsis, relaxed cardiac sphincter (spitting up), immature enzyme activity until 4–6 months, and immature liver function for the first year.

What is the maximum feeding volume for an infant?

8 oz (240 mL) per feeding.

By what age are digestive processes complete in children?

By age 2 years, with the stomach able to handle 3 meals and 2 snacks per day.

What causes cleft lip and/or palate?

Failure of the maxillary processes to close or fuse between the 5th–12th week of gestation.

When can cleft lip and palate be detected?

Prenatally via ultrasound as early as 13 weeks of gestation.

List possible risk factors for cleft lip/palate.

Maternal tobacco/alcohol use, anticonvulsant or steroid use, genetics, and lack of folic acid during pregnancy.

When is cleft lip typically repaired?

At 3–5 months of age to promote feeding and speech development.

When is cleft palate typically repaired?

Between 9–12 months to allow for normal speech and protect tooth buds.

What are key nursing assessments for cleft lip/palate preoperatively?

Assess airway, weight, feeding ability, and provide family emotional support and education.

What are important feeding techniques for infants with cleft lip/palate?

Feed upright, use special nurser bottles, burp every 15–30 mL, and keep a bulb syringe nearby for secretions.

What postoperative interventions protect the cleft lip/palate repair?

Position infant on back, apply soft elbow immobilizers, keep suture line clean, and avoid pacifiers, straws, or utensils.

Why is antibiotic ointment sometimes used after cleft lip repair?

To prevent infection and promote healing of the suture line.

How is pain managed post–cleft surgery?

Pain assessed every 4 hours and treated per order; infant kept comfortable and swaddled (note: AAP recommends swaddling only up to 2 months to reduce SIDS risk).

What is pyloric stenosis?

Hypertrophy and thickening of the pyloric muscle between the stomach and duodenum, leading to obstruction and projectile vomiting.

What age is pyloric stenosis most common?

Between 3–5 weeks of age.

What are hallmark signs of pyloric stenosis?

Projectile vomiting after feeds, constant hunger, poor weight gain, dehydration, and a palpable olive-sized mass in the right upper quadrant.

What acid-base imbalance occurs in pyloric stenosis?

Metabolic alkalosis due to loss of gastric acid from vomiting.

How is pyloric stenosis diagnosed?

Abdominal ultrasound.

What is the surgical treatment for pyloric stenosis?

Pyloromyotomy — splitting of the pyloric muscle (usually laparoscopic).

What are key preoperative nursing actions for pyloric stenosis?

NPO, insert NG tube for decompression, monitor I&O, maintain IV fluids, correct electrolyte imbalance, and provide family support.

What are key postoperative nursing interventions for pyloromyotomy?

Assess wound, pain, and hydration; start small clear liquids per surgeon order, then advance diet as tolerated; decrease feeding amount if vomiting occurs.

What is gastroesophageal reflux (GER)?

Relaxation of the lower esophageal sphincter allowing stomach contents to flow back into the esophagus; common in infants and usually resolves by 12 months.

What are clinical features of GER?

Spitting up after feeding, normal growth, no distress — “happy spitter.”

How is GER managed?

Smaller frequent feeds, thicken feeds, frequent burping, hold upright after feeding, avoid car seats, and monitor weight.

What is gastroesophageal reflux disease (GERD)?

Chronic or pathologic reflux causing poor weight gain, irritability, feeding refusal, and respiratory symptoms.

What medications are used to treat GERD?

H2 blockers (famotidine, ranitidine) and proton pump inhibitors (omeprazole, lansoprazole) to reduce acid secretion.

What surgical procedure may be needed for severe GERD?

Nissen fundoplication — wrapping the fundus of the stomach around the distal esophagus to prevent reflux.

What is the nurse’s role preoperatively for Nissen fundoplication?

NPO, maintain IV hydration, reinforce education, and monitor for aspiration.

What is the nurse’s role postoperatively for Nissen fundoplication?

Monitor VS, I&O, pain, and wound; begin clear liquids, advance diet per order, and encourage upright activity.

What is intussusception?

Portion of intestine prolapsing into another section (telescoping), causing obstruction and inflammation.

What are classic symptoms of intussusception?

Sudden intermittent abdominal pain, vomiting, red “currant jelly” stools (blood and mucus), and a palpable RUQ mass.

What is the primary diagnostic and therapeutic treatment for intussusception?

Contrast air or barium enema — may reduce the telescoping and resolve obstruction.

What is Hirschsprung disease?

Congenital absence of ganglion cells in the colon, preventing peristalsis and causing intestinal obstruction.

What are key symptoms of Hirschsprung disease in newborns?

Failure to pass meconium within 48 hours, abdominal distention, and bilious vomiting.

How is Hirschsprung disease diagnosed?

Rectal biopsy confirming absence of ganglion cells.

What is the treatment for Hirschsprung disease?

Surgical removal of affected bowel segment; may require temporary colostomy followed by reanastomosis.

What is appendicitis?

Inflammation and obstruction of the appendix, which may lead to rupture and peritonitis.

What are common symptoms of appendicitis?

Periumbilical pain shifting to RLQ, tenderness at McBurney’s point, fever, nausea, anorexia, and guarding.

What finding suggests appendiceal perforation?

Decreased or absent bowel sounds and sudden relief of pain followed by worsening symptoms.

What preoperative care is provided for appendectomy?

NPO, IV fluids, pain management, monitor VS, and provide education.

What postoperative care is required after appendectomy?

Assess wound and VS q4h, encourage ambulation, manage pain, monitor bowel sounds, and use incentive spirometer.

What additional care is needed if appendix perforated?

NG tube to low intermittent suction, Foley catheter, and IV antibiotics for 1–2 days.

What is Crohn’s disease?

Chronic inflammatory bowel disease affecting any part of the GI tract (most commonly ileum, colon, rectum).

What are symptoms of Crohn’s disease?

Abdominal pain, diarrhea, fever, anorexia, growth failure, joint pain, and malaise.

How is Crohn’s disease diagnosed?

Endoscopy and colonoscopy with biopsy to determine inflammation extent and severity.

What medications are used to treat Crohn’s disease?

Antibiotics, corticosteroids, immunosuppressants, and biologic agents (anti–TNF therapy).

What nutritional support is recommended for Crohn’s disease?

Small, high-calorie meals; limit fiber, whole grains, and nuts; use liquid supplements.

What is gastroenteritis?

Inflammation of the stomach and intestines, usually viral (commonly rotavirus).

What are key symptoms of gastroenteritis?

Fever, vomiting, diarrhea, irritability, poor intake, and dehydration.

What lab tests may be ordered for gastroenteritis?

Stool culture, ova and parasite test, and serum electrolytes.

What are the primary treatments for gastroenteritis?

Rehydration (oral or IV), correcting electrolyte imbalance, and preventing dehydration.

What are key nursing interventions for gastroenteritis?

Monitor I&O, daily weight, describe stool output, assess VS, practice strict handwashing, and educate parents on hydration.

Why are juice and sugary drinks avoided during diarrhea?

Simple sugars worsen diarrhea by increasing osmotic load.

What vital sign changes indicate dehydration in gastroenteritis?

Increased heart rate and respiratory rate due to hypovolemia; fever increases metabolic rate and worsens dehydration.