GI Disorders

GI Peds anatomy

- GI tract not fully developed until 2 yrs

- Mouth: Portal of entry for bacteria

- Weak lower esophageal sphincter

- Small stomach capacity

Liver size

Not fully mature, NO IBUPROFEN <6mo (unable to break down), HIGH risk for fluid loss, 5% body weight

Acid based imbalances

caused by vomiting and diarrhea

Normal ABG

Metabolic acidosis

low pH, low HCO3

caused by Diarrhea (lose bicarb)

Metabolic alkalosis

high pH, high HCO3

caused by Vomiting (lose HCL acid from stomach)

Severe diarrhea

metabolic acidosis, 10% weight loss, dehydration

Tx IV NS or 5

severe diarrhea tx

Rapid IV fluids for 3-6hrs

Do NOT ADD K+ until kidney function is VERIFIED! (child has voided)

Stool culture if diarrhea >24hr

Gastroesophageal reflux (GER)

Backflow of stomach contents into the esophagus

- lower esophageal sphincter is weak

- unable to keep down

GER symptoms

- Spitting up

- Feeding resistance

- Excessive crying, blood in stool

- Arching back

- heartburn if older

GER Tx

Thicken feeds to keep them down

- Small meals

- Keep upright for 1hr after feeds

DO NOT lay flat

GER meds

H2 antagonists, PPIs (omeprazole), OTC antacids

surgery for GER

- Nissen fundoplication (wrap fundus around sphincter)

- GT tube placement

Pyloric Stenosis

narrow pyloric sphincter = stomach cant empty

- Infants 2–8 weeks old

pyloric stenosis symptoms

- Projectile vomiting

- Hungry after vomiting

- Olive shaped mass in RUQ

Metabolic alkalosis

pyloric stenosis is treated with what surgery?

pyloromyotomy

Intussusception

Intestinal prolapse into another section of intestine

Intussusception Symptoms

- Draws legs up and cries, repeat every 15min

- Currant jelly stool

- Sausage-shaped mass in RUQ

Intussusception treatment

Air or contrast enema

Surgery if enema fails or perforation

Celiac Disease

gluten triggers autoimmune attack of villi in small intestine = malabsorption and malnutrition

no cure, strict gluten free diet

Celiac disease symptoms

- Fatty, foul stool

- Vitamin A,D,E,K deficiencies

- thin

- Abdominal distention

What foods to avoid in Celiac disease? (BROW)

barley, rice, oats, wheat

Hirschsprung disease (paralyzed colon)

Absent ganglionic nerve cells in colon → no peristalsis → fecal obstruction

- in newborns

- can perforate and cause sepsis

Hallmark of Hirschsprung disease?

No stool in first 48hrs of life

How is hirschsprung disease diagnosed?

Rectal biopsy

Anorectal manometry (balloon inserted in anus measures pressure)

Hirschsprung disease Tx

Surgery to remove aganglionic segment

Temporary colostomy needed