Obstructive and Inflammatory Disorders

obstructive disorders

pyloric stenosis, intussusception

appendicitis

inflammation of the appendix

pyloric stenosis

narrow or complete occlusion of the pyloric sphincter, seen in the first few weeks of life

pyloric stenosis s/s

projectile vomiting, hungry cry, palpable olive shaped mass, dehydration, weight loss, upper abdominal distention 

diagnostics for obstructive and inflammatory disorders

ultrasound

pyloric stenosis treatment 

NPO, IV fluids, hydrate then surgery within 24 hours

pyloric stenosis care management

feedings start around 24-48 hours, oral hydration solution, advance diet as tolerated, vomiting is expected after surgery 

what age group does intussusception most likely occur

5-10 year olds

what can intussusception lead to

bowel necrosis

intussusception s/s

jelly like stool, sudden onset of abdominal pain, tender distended abdomen, palpable sausage shaped mass in RUQ, knees drawn to chest, empty RLQ, vomiting, diarrhea, weight loss 

intussusception treatment

air or saline enema, surgery, IV fluids, NG decompression, antibiotics

when is surgery needed for intussusception

enema doesn’t work

intussusception care management

passage of normal stool before surgery means no surgery needed

appendicitis s/s

pain start at the umbilicus then migrated to the RLQ, decrease/absent bowel sounds, vomiting, constipation, diarrhea, anorexia, stooped posture, rebound tenderness 

rupture appendix s/s

rigid and hot abdomen, lethargy, tachycardia, rapid shallow breathing

appendicitis treatment

NPO, IV fluids, IV prophylactic antibiotics, appendectomy

appendectomy post op

assess bowel sounds and function, respiration status, monitor for infection, NG decompression, NPO and advance as tolerated

appendicitis complicaiton

peritonitis

peritonitis s/s

rigid abdomen, progressive distention, tachypnea, tachycardia, pallor, chills, irritability, restlessness