PED GI

GI Pediatric Differences

Immature at birth; stomach capacity small and peristalsis rapid.

Infants prone to dehydration

Higher extracellular fluid percentage and faster metabolic rate → more fluid loss.

Infants regurgitate easily

Lower esophageal sphincter is weak until about 1 month of age.

Cleft Lip and Palate Causes

Failure of facial structures to fuse during embryonic development (weeks 5-12).

Cleft Lip and Palate Risk Factors

Genetics, maternal smoking, folate deficiency, anticonvulsant use.

Pre-op care for cleft lip/palate

Encourage feeding (special nipple), prevent aspiration, promote bonding, upright feeding, burp frequently.

Post-op care for cleft lip repair

Protect incision (use Logan bar/arm restraints), clean suture line, avoid sucking (no pacifiers), side-lying position.

Post-op care for cleft palate repair

Avoid hard foods, objects in mouth, or straws; rinse mouth after feedings; soft diet.

Nursing management overall for cleft lip/palate

Support nutrition, airway maintenance, infection prevention, and parental support.

Tracheoesophageal Fistula (TEF)

Congenital malformation where the esophagus fails to form a continuous tube, connecting abnormally to the trachea.

Signs and symptoms of TEF

Frothy saliva, choking, coughing, cyanosis, drooling, respiratory distress during feeding.

Nursing management of TEF

NPO, elevate head 30°, maintain airway, suction secretions, NG to continuous suction, prepare for surgical repair, IV fluids.

Gastroesophageal Reflux (GER)

Backflow of stomach contents into the esophagus due to immature lower esophageal sphincter.

Clinical manifestations of GER

Spitting up, irritability, poor weight gain, arching after feeding, apnea.

Diagnosis of GER

pH probe study, barium swallow, history and physical.

Management of GER

Small frequent feedings, thicken formula, keep upright 30 mins after meals, avoid overfeeding.

Medications for GER

H₂ blockers (famotidine), PPIs (omeprazole).

Intussusception Etiology/Pathophysiology

Telescoping of one bowel segment into another → obstruction and ischemia.

Telescoping

Telescoping of one bowel segment into another → obstruction and ischemia.

Clinical manifestations of Telescoping

Sudden cramping pain, drawing knees to chest, vomiting, currant jelly stools (blood + mucus), sausage-shaped mass in RUQ.

Diagnosis of Telescoping

Ultrasound (shows target sign).

Management of Telescoping

Air or barium enema (diagnostic & therapeutic), IV fluids, NPO, possible surgery if unresolved.

Hirschsprung's Disease Etiology

Congenital absence of ganglion cells in colon → no peristalsis → bowel obstruction.

Clinical manifestations of Hirschsprung's Disease

Newborn: no meconium in 24-48 hrs, bilious vomiting, abdominal distention. Child: chronic constipation, ribbon-like stools, failure to thrive.

Diagnosis of Hirschsprung's Disease

Rectal biopsy (absence of ganglion cells).

Management of Hirschsprung's Disease

Surgical resection of aganglionic bowel, possible temporary colostomy, bowel prep, monitor for enterocolitis post-op.

Pyloric Stenosis Etiology

Hypertrophy of pyloric muscle → obstruction between stomach and duodenum.

Clinical manifestations of Pyloric Stenosis

Projectile vomiting (non-bilious), hungry after vomiting, olive-shaped mass in RUQ, dehydration, weight loss.

Diagnosis of Pyloric Stenosis

Ultrasound of abdomen (shows thickened pylorus).

Management of Pyloric Stenosis

Surgical pyloromyotomy after fluid/electrolyte correction. Post-op: begin small frequent feedings, monitor for vomiting.

Common causes of diarrhea in children

Viral (rotavirus), bacterial (E. coli, Salmonella), antibiotic use, contaminated food/water.

Symptoms of diarrhea

Loose watery stools, dehydration signs (sunken fontanel, dry mucosa), irritability.

Management of diarrhea

Oral rehydration therapy (Pedialyte), continue feeding (BRAT diet not recommended), avoid sugary drinks, skin care.

Categories of dehydration

Isotonic: Equal fluid & electrolyte loss. Hypotonic: Electrolyte loss > water loss. Hypertonic: Water loss > electrolyte loss.

Severity of dehydration

Mild: 3-5% body weight loss. Moderate: 6-9%. Severe: ≥10%.

Clinical findings by severity of dehydration

Mild: Slight thirst, normal VS. Moderate: Tachycardia, dry mucosa, decreased tears, delayed cap refill. Severe: Very dry mucosa, sunken eyes/fontanel, lethargy, rapid thready pulse, low BP, oliguria.

Complications of dehydration

Hypovolemic shock, electrolyte imbalance, metabolic acidosis.

Management of dehydration

Mild/moderate: Oral rehydration therapy. Severe: IV fluids (0.9% NS or LR bolus).