GI, GU, and dermatology

signs of fluid loss in children?

• skin turgor

• dry mucous membranes

• lack of tears

• always investigate weight loss

what viruses affect the GI the most?

Hepatitis A and Rotavirus *

what physiological reason leads infants to infants losing more fluids?

immature kidneys (do not concentrate urine well)

fluid requirement per 24 hours* for a child up to 10kg

1,000mL + 50mL/kg for each additional kilogram over 10kg

fluid requirement per 24 hours* for a child whose 11-20kg

1,500mL + 20mL/kg for each additional kilogram over 20kg

fluid requirement per 24 hours* for a child over 20kg

100mL/kg

emesis

usually caused by acute gastroenteritis; could also be due to: obstruction, increased ICP, cyclic ______ syndrome (from migraines), motion sickness, post-tussive

leads to dehydration and electrolyte imbalance

needs clear fluid maintanence

management of dehydration

• oral rehydration fluid like water or diluted juice in small amounts

  • avoid high sugar

• avoid greasy, fried, and spicy foods

• give lean proteins, fruits, vegetables, complex carbs

  • are NOT limited to BRAT diet

• increase breastfeeding/formula in infants

monitor for:

• 1+ wet diapers in a 6hr period

• tears, skin turgor, mucous membranes

• consider antiemetic

  • with caution (body’s way of getting rid of issue)

• consider IV fluids

diarrhea

2-10 loose, watery stools/day (can be green, explosive)

S+S: fever, anorexia, irritable

interventions:

• infection control like wearing gloves when changing diapers or at daycare

• rehydration

• fever management

  • not ibuprofen

• if longer than 24hrs → stool culture

• avoid dairy

symptoms of severe diarrhea in infants

• fever of 103-104ºF

• weak pulse and RR

• depressed fontanelle

• sunken eyes

• poor skin turgor

• elevated Hg, Hct, and serum protein

• metabolic acidosis

mild dehydration % **

2.5-5% of body weight

severe dehydration % **

5-15% of body weight

above 10% - needs immediate treatment

acute gastroenteritis

can be viral or bacterial; can be foodborne from salmonellosis or staph

hand hygiene is biggest prophylactic measure

oral rehydration often sufficient for treatment

educate on:

• washing hands and surfaces often

• separating foods (do not cross contaminate)

• chill foods properly

• cook food to proper temperatures

GERD

regurgitation of stomach secretions into esophagus through the lower esophageal sphincter

occurs 70% in infants due to immature lover esophageal sphincter (following a feeding); higher incidence in cerebral palsy, down syndrome, obesity, and cystic fibrosis

educate on:

• small frequent feedings

• thickened cereals

• upright for 30 minutes post-feed

• no exposure to smoke

• avoid acidic/fatty foods

• healthy BMI

should disappear by 6 months

pyloric stenosis (Landon had this)

hypertrophy or hyperplasia of the muscle surrounding the pyloric sphincter, making stomach emptying difficult

more common in white male infants

manifestations:

• sour-smelling emesis at 6 weeks (breastfed) or 4 weeks (formula)

• dehydration

• starvation

• alkalosis

• hypopnea

• olive sized lump/gastric peristalsis waves while drinking

• projectile vomiting

needs surgery

intussusceptions

the invagination of one part of the intestine into another (turned inside out or folded back on itself to form a cavity or pouch)

most common at 6-12 months

can lead to tumor, polyps, or diverticulitis

will have:

• peristaltic waves of cramping and abd. pain

• vomiting bile

• blood in stool described as “red currant jelly”

• fever

• pain

• guarding

surgical emergency

appendicitis

inflammation of the appendix

most common cause of abd. surgery in children

fecal matter accumulates → inflammation, edema, necrosis → rupture

RLQ pain is a late sign (can diffuse to shoulder); might also have anorexia, N/V, fever, rebound tenderness

use ultrasound or CT to diagnose

celiac disease

immune-mediated abnormal response to gluten (protein in wheat) and related proteins in rye, barley, and oats

villi in the intestines flatten → unable to absorb food, especially fats

develops steatorrhea - bulky, fatty, foul-smelling stool

risk factors: european descent, T1D, down syndrome

need gluten free diet

Hirschsprung disease aka Aganglionic Megacolon

absence of ganglionic innervation to the muscle of a section of the bowel - usually the lower portion of the sigmoid colon above the anus = no peristaltic waves to move feces

leads to chronic constipation, ribbonlike stools, and a distended abdomen

patient can be thin and malnourished

is a surgical emergency

cleft lip/palate

varying degrees of structural abnormalities

more

can be caused by genetic, low folic acid, or intrauterine conditions

affects feeding, growth, and speech

needs surgical repair

patent urachus

fistula between the bladder and the umbilicus

exstrophy of the bladder

bladder lies on the surface of the abd. wall

epispadias/hypospadias

opening of the urinary meatus on the dorsal/ventral aspect of the penis

UTIs

more common in females due to their shorter urethras

children present with different symptoms - often a fever and nothing else, maybe abd. pain, nocturnal enuresis

if severe: high fever, flank pain, malaise, vomiting

do a urine culture (clean catch or catheterization)

treat with broad spectrum antibiotics

gold standard for diagnosing UTI in children

suprapubic aspiration

acute glomerulonephritis

inflammation of the glomeruli of the kidneys

occurs after untreated strep, commonly in males in the winter and spring

manifestations:

• sudden onset of hematuria and proteinuria

• tea colored, red smoky urine

• oliguria

• fever

• edema

• cardiac enlargement

• HTN

• abd. pain

treat symptoms, antibiotics for strep

takes 2 months for full return of kidney function

nephrotic syndrome

altered glomeruli permeability cause by autoimmune process that leads to hyperlipidemia

more common in males around 3yro

manifestations:

• lower extremity edema

• growing out of clothes in the waist → ascites

• significant proteinuria

treatment: long term steroid therapy, diuretics

nephroblastoma (Wilms Tumor)

malignant tumor on the upper part of the kidney

can metastasize to lungs, lymph nodes, and brain

identified at 6mo to 5 years

usually a hard mass in abdomen that can be misdiagnosed as constipation

has rapid progression

eczema

chronic, itchy, inflammatory skin condition; triggered by allergens, irritants, heat, sweat

extremely common in infants and children

nursing tips:

• promote moisturizing (2-3 times a day)

• educate on appropriate topical steroid use

• avoid known triggers like wool, soaps, dust mites

care for diaper dermatitis

• frequent diaper changes

• barrier creams (zinc oxide)

• nystatin or antifungal creams

where does tinea vesicolor usually start?

in the hair

scarlet fever

looks like a sandpaper rash all over the body

is a systemic illness

treatments for acne

benzol peroxide, retinoids, topical antibiotics