GI disorders

s/s: failure to thrive, abdominal pain, vomiting, hematochezia, constipation, jaundice, diarrhea, abdominal distention, fever, and abnormal bowel sounds

manifestations of GI dysfunction

bloody stools, usually from lower GI tract - may be frank red blood or black tarry stools (digested blood/hemolyzed)

hematochezia

Exclusive Breastfeeding - Vit. D, Vit. B12, Fluoride, & Iron ~ AND / OR ~ Commercial Formula Fortified - Vit. D & Iron

less than 6 mo

breastmilk/formula and “solid” foods, Look for tolerance of new foods (allergic or not), Water can be introduced sporadically at 6 mo but should be getting enough fluids from breastmilk/formula, no raw honey

6-12 mo

Babies should have good head control for this, Babies should have a lessened tongue thrust reflex - when you see this going away could be a sign

solid foods

risk for botulism, GI system can handle after 1 yr but not sooner

raw honey

can throw off sodium in their blood if introduced too soon - can be introduced sporadically at 6 mo

water

No upper limit to when —- stops being beneficial

breastfeeding

Growth Rate Slows, Continue Breastfeeding, Three Meals + Two Snacks (can be in addition to breastfeeding): Small Portions, “Finger Foods”, Avoid Choking Hazards, Physiologic Anorexia, Ritualism - these two normal for the most part during this phase (ages 1-2)

toddler nutrition

toddler nutrition: more picky, stronger taste preferences, want to be more in control with what they’re eating and how they’re eating - Should not cause failure to thrive

physiologic anorexia

toddler nutrition: control element, thrive on predictability - want milk in green cup not blue cup, orderly and precise in how they imagine food intake

ritualism

“Table foods” - look more similar to adult foods (adult portions halved), Learning to use utensils, May still be some physiologic anorexia/ritualism lingering, Good variety is important, Limit sugary drinks/fruit juices for dental hygiene, increased protein, decreased fat, strong taste preferences (ages 3-5)

preschool nutrition

complications can begin in childhood if child is - heart disease, DMT2

obesity

Calorie Needs Diminish, More Variety, Similar to Adult Portions, ages 6-12

school age nutrition

Puberty: Accelerated Growth, Maximum Bone Mass, Iron-Rich Foods, Balance Diet + Activity, 12-18 years

adolescent nutrition

Convenience Foods, School-Provided Meals, Cultural Influences: Peers, Body Insecurities, Media

school age/adolescent nutrition challenges

5-2-1-0 approach to healthy living:

5 servings of fruits/vegetables, 2 hrs or less screen time, 1 hr exercise, 0 sugar-sweetened drinks per day

Inability to Obtain or Use Calories, “Growth Delay”, Persistent Deviation, could be absorption problem, enzyme problem, or a physical intake issue, if chronic issue can affect height too, can have good prognosis through adequate treatment

failure to thrive

2 - 3 x Average Rate of Weight Gain - used as treatment for failure to thrive

goal for catch up

reversing cause of failure to thrive:

correct deficiency, adequate calories, education

Chronic, Auto-Immune, Gluten Ingestion, Several Months between Ingestion & Symptom Onset, Damaged Mucosa in Small Intestine - Villous Atrophy - Reduced Surface Area for Absorption, Lymphocyte Infiltration, could be hidden sources of gluten - some oat is cross contaminated with gluten

celiac disease

Steatorrhea - excessive fat in stool, General Malnutrition, Abdominal Distention & Pain, Secondary Vitamin Deficiencies, failure to thrive, Chronic Diarrhea, Muscle Wasting/Atrophy, Aphthous Ulcers (“Canker Sores”), Fatigue

celiac

gluten should not be excluded from diet until:

blood tests, upper GI endoscopy with biopsy

diet: High Calorie, High Protein, Low Fat, Simple Carbs (Fruits / Vegetables)

celiac

for celiac: Acute, Severe - Profuse Watery Diarrhea & Vomiting, Pain, Avoid High Fiber, Lactose Intolerant  - Improves as Mucosa Heals

mucosal damage and lesions

triggers: Gluten Ingestion, Infections, Prolonged fluid and electrolyte depletion, Emotional Disturbance/Stress

celiac

deficiencies common in celiac:

iron, folic acid, fat soluble vitamins

people with celiac often relax diet when symptom free and that can cause a —-

relapse

If child is 10th percentile across multiple ages it’s okay because they are—- in that

consistent

most commonly viral (fecal oral route), also contaminated food/water, primary symptom is diarrhea - hand hygiene important prevention

acute infectious gastroenteritis

Highly Variable - Often “self-limited” - immune system kicks in and eliminates on its own, Acute: loose bowels/diarrhea, nausea/vomiting, abdominal pain, bloating and weight loss, Chronic: Malabsorption & Failure to thrive (FTT), If symptom is not N/V/D - may not be this and due to something else

gastroenteritis

need to check labs for —— because kids are going to get worse quicker than adults because of less surface area for the same amount of V/D

fluid/electrolytes

kids with gastroenteritis should be on —— precautions

contact

tests for ova, cysts, and parasites in stool - certain parasitic infections will have normal labs ex: Giardia

OCP stool study

RLQ; large intestine, pain at mcburney’s point with rebound tenderness, fever, N/V - may have electrolyte imbalances based on how much they’ve been vomiting, loss of appetite, may need open surgery in the case of perforation (rupture)

appendicitis

complications from appendicitis perforation:

peritonitis, abscesses, sepsis

appendicitis post op complications:

infection, bowel obstruction, paralytic ileus

pre op appendicitis care:

NPO, IV fluids, antibiotics, VS

post op appendicitis care:

pain, ambulation, advance diet, NG tube, drains, antibiotics, labs, VS

deep palpation is going to hurt more when you release pressure - common in appendicitis

rebound tenderness

Most breastfeeding mothers are ——deficient - good to supplement baby with extra —, Most babies will be supplemented through formula

vitamin D

most commonly seen together (L/P), occurs in the first trimester (sometimes before women even know they’re pregnant), Most common congenital deformity in the US, swallowing is not usually impaired in either of these, both are at risk for failure to thrive because of feeding impairments, can also causing hearing problems (Eustachian tubes) when together or just P problem

cleft lip/palate

usually can still breastfeed because nipple is pliable, bottle nipple may be harder because those are less pliable - may need special bottle - speech is good for determining what they need, this by itself probably won’t effect hearing

cleft lip

needs more feeding support and modifications because the pressure is off in their oral cavity, Sometimes the only way to diagnose is sweeping a finger along the palate, can sometimes still breastfeed depending on severity, Upright, Head Support; Pause & Burp Frequently

cleft palate

Will typically have surgery at 3-6 mo - age when they like to put things in their mouth so have to be mindful of that and incision sites - bleeding may just be swallowed so look for excessive swallowing, Family needs to know how to feed baby while waiting for surgery

cleft lip/palate

post op nursing care: Protect Operative Site & Monitor Bleeding, Careful Supervision - Objects / Fingers in Mouth, Excessive Swallowing (potential bleeding), Avoid Suction or Objects in Mouth

cleft lip repair

post op nursing care: Airway Obstruction, Hemorrhage, Laryngeal Spasm (spontaneous closing of vocal chords that obstructs airway), Stridor, Croup, Difficulty Breathing/Swallowing, Diet Modifications - Clear Liquid, Liquid, & Soft

cleft palate repair

obstruction/absence of bile ducts, disrupted hepatobiliary system, needs liver transplant, death by 2 if not treated, jaundice lasting more than a week or two after birth

biliary atresia

assessment findings: jaundice, FTT, Elevated bilirubin, Pale, Putty-like Stools, Steatorrhea - fat in stool, Tea-colored Urine, Abdominal Distention / Ascites, Hepatomegaly, Splenomegaly, Bruising, Prolonged Bleeding (b/c vit K deficit), Pruritus (from build up of bile salts under skin)

biliary atresia

Definitive diagnosis of —- is usually surgery, Usually in same surgery will do liver biopsy, All kind of encapsulated in exploratory lap, cholangiography - special X-ray to view bile ducts

biliary atresia

“Bridge” to Transplant for biliary atresia, make a bile duct from the small intestine, performed when baby is 6 wk-2 mo, 20-30% success rate

kasai procedure

bile acid sequestrant that helps lower blood cholesterol and treat severe itching caused by liver disease, binds to bile acids to be excreted in the feces, tx for biliary atresia

cholestyramine

Antihistamines for —- in biliary atresia

pruritus

decreases secretion of cholesterol from liver - promotes bile flow, med for biliary atresia

ursodiol

Anytime invasive procedure - going to get —- shot to prevent bleeding

vitamin K

exposed bowel, starts in utero (congenital), intake peritoneum over exposed bowel, Want to be careful with positioning - don’t want to put additional pressure on exposed area, Baby has to grow a little more before surgery for there to be more space to fit in the bowel because they’ve developed without that extra room in utero

omphalocele

tx: non adherent dressing to reduce pressure to site, NG tube for gastric/bowel decompression, Staged Reduction for Large Defect ~ 12 mo.: Silver Sulfadiazine (Silvadene), Compressio /Elastic Bandage, Abd. Skin Flaps - Lateral Abd. Wall, if the peritoneal sac/membranous sac ruptures you need a mesh silo to cover the bowel

omphalocele

exposed bowel but broken through peritoneum so doesn’t have protective sack - Bowel has been exposed to amniotic fluid > could be paralytic ileus and hypomotility, Thickening & Shortening of Bowel, Will have chronic hypomotility/absorption issues

gastroschisis

tx: mesh silo or loose, moist dressing to cover bowel, Hole where bowel is coming through might be smaller than actual size of bowel so will have to stretch so there is no strangulation of bowel, NG tube for bowel decompression, nutritional support

gastroschisis

risks with abdominal wall defects:

peritonitis, vena cava compression, short bowel syndrome

at the base of the umbilical cord, covered by a membrane, May include intestines, liver, and other organs, High association with genetic syndromes and cardiac defects, prenatal: Ultrasound shows herniated organs within a sac, Risk of sac rupture, infection, and underdeveloped abdominal cavity, May require staged repair for large defects, Prognosis: Depends on associated anomalies; may face developmental challenges

omphalocele

right of umbilicus, no membrane coverage, usually only intestines involved, Rarely associated with genetic syndromes; more GI complications, prenatal: Ultrasound shows free-floating bowel loops, risk of dehydration, inflammation, and intestinal dysfunction, Immediate protection of exposed bowel (silo); Often staged repair, prognosis: Generally good if isolated; may require prolonged nutritional support

gastroschisis

Colon does not have ganglion cells so it gets bigger, Aganglionic cells - everything proximal to that will be backed up (Sigmoid Colon, Internal Sphincter, Rectum), Delayed meconium (48hrs) is one of the first signs, causes mechanical obstruction > failure of rectal sphincter to relax and inadequate motility (Accumulation of Stool + Distention), can cause enterocolitis (inflammation of colon) which can be deadly to newborns

hirschsprung

diagnostics: X-ray + Barium Enema, Anorectal Manometry - measures strength of rectum, Rectal Biopsy (to see if there are ganglion cells), tx: colectomy + colostomy creation (Hartmans)

Hirschsprung

congenital, Muscle is just too tight around the sphincter - causes projective vomiting 5-10 mins after (NOT typical spit up), Babies are rapidly increasing how much they are feeding - that’s why you don’t see the symptoms as soon as the baby is born - more intake = more vomiting, causes chronic hunger and FTT

pyloric stenosis

3 - 6 Weeks after Birth, Dehydration, Metabolic Alkalosis, Decreased Stools, Palpable “Olive” Shaped Mass, Visible Peristaltic Waves, u/s will measure sphincter - if certain size then will be diagnoses

pyloric stenosis

cut muscle of sphincter so that food can move through in pyloric stenosis - very easy surgery 

pyloromyotomy

intestines telescope into themselves (one part slides into another part), Compression of everything in the intestines - if not resolved > perforation, necrosis, sepsis, death, Males more prone under 1 year, is usually in ileocecal valve but could be anywhere in bowel, More at risk for recurrence so family needs to educated on signs, can have cooccurrence with cystic fibrosis and celiac

intussusception

s/s: Blood mixed with mucus in bowels > currant jelly stools, pain is sudden, severe, and intermittent, Sausage-Shaped Mass, Bilious Vomiting

intussusception

Diagnosis - barium enema sometimes just injecting it will straighten out the bowel so they won’t even see it, risk for peritonitis with surgery - give abx

intussusception

chronic malabsorption because bowel is too short/damaged: Crohns, trauma, gastroschesis, hirsch - anything that affects how much bowel the body can use can lead to this, decreased interstitial surface area, need to rely on parental nutrition, high mortality within 5 years if untreated, risk for bowel atrophy

short bowel syndrome

nutrition: Vitamins: A, D, E, K, Trace Minerals: Iron, Selenium, Zinc, Reduce Losses: H2 Blocker, PPI, Octreotide, Cholestyramine, High Fat, Low Carb Diet

short bowel syndrome

occurs as an end stage of many chronic liver diseases, including biliary atresia and chronic hepatitis. Infectious, autoimmune, or toxic factors and chronic diseases such as hemophilia and cystic fibrosis can cause severe liver damage. A — liver is irreversibly damaged

cirrhosis

General signs of —— include colicky abdominal pain, nausea and vomiting, abdominal distention, and decreased stool output

obstruction

is one of the most common causes of intestinal obstruction during infancy

intussusception