Disorders of Motility

disorders of motility

gastroesophageal reflux GER, diarrhea, hirschesprung disease

gastroesophageal reflux GER

weak lower esophageal sphincter, peaks at 4 months and resolves by 12 months old

GER risk factors

overweight, tight clothing, sedentary lifestyle

GER infant s/s 

spitting up, regurgitation, vomiting, excessive crying, irritability, arching of back, stiffening, poor weight gain, cough, wheezing, stridor, gagging, choking, refuse to eat

GER children s/s

heartburn, abdominal pain, chronic cough, hoarse voice, dysphagia, asthma, vomiting 

GER diagnostics 

24 hour pH test, hx and physical 

GER treatment

remain upright for 1 hour after eating, don’t eat before sleeping, small frequent meals, thicken liquids to honey/nectar consistency, exercise, avoid spicy acidic and carbonated foods, non restrictive clothes

GER pharmacology

PPI and H2

PPI education

ends in zole, don’t crush or chew, take within 30 min of eating

H2 suffix

dine

GER care management 

carry extra clothes, they are fine if they are gaining weight and eating

acute diarrhea

less than 14 days

chronic diarrhea

more than 14 days

diarrhea etiology

spread through fecal, oral, person to person, rotivirus

diarrhea hx questions

frequency, when it began, characteristics, antibiotic use, diet, fever, travel, urine output 

s/s of mild dehydration

increased thirst, slightly dried mucous membranes

treatment for mild dehydration

oral hydration within 4 hours, continue to breastfeed and formula feeding if tolerated 

moderate dehydration s/s

loss of skin turgor, dry mucous membranes, sunken eyes and fontanels 

moderate dehydration treatment

oral hydration, regular diet

severe dehydration s/s

tachypnea, cyanosis, tachycardia, lethargy, coma

severe dehydration treatment

NPO, IV fluids and hydration

diarrhea education

small frequent fluid intake, no antidiarrheal meds, monitor number of wet diapers and voiding, high stool output when resuming regular diet 

diarrhea prevention 

wash hands, use correct water source when traveling

hirchsprung disease pathophysiology

congenital, portion of colon has no ganglion cells

ganglion cells

helps with motility of the bowels to excrete waste

hirchsprung disease newborn s/s

no meconium, refuse to eat, bilious vomiting, abdominal distention

hirchsprung disease infancy s/s

failure to thrive, constipation, abdominal distention, vomiting, diarrhea, entercolitis 

entercolitis s/s from hirchsprung disease

explosive watery diarrhea, fever, appears significantly ill

hirchsprung disease children s/s

constipation, ribbon like foul smelling stool, abdominald istention, easily palpable fecal mass, visible peristalsis, undernourished, anemic appearance 

hirchsprung disease diagnostics

colon biopsy, absence of ganglion cells

hirchsprung disease treatment and goals

surgery to remove part of colon, excrete waste as normally as possible 

hirchsprung preop treatment

low fiber and high protein/calories diet, enemas, measure abdominal circumference, monitor for distention 

hirchsprung postop treatment 

listen to bowel sounds, possible colostomy