GI 2

inflammatory bowel disease (IBD): ulcerative colitis vs crohn’s disease

colon and rectum, inflammation in continuous segments; any part of GI tract (mouth to anus), skip lesions (normal and abnormal areas), thickening/hypertrophy of GI muscle, fistulas/fissures

ulcerative colitis symptoms

diarrhea with hematochezia (fresh bloody stool)

crohn’s disease symptoms

diarrhea, abdominal pain, fever, weight loss, strictures (narrowing), extraintestinal manifestations (ulcers, peripheral arthritis, digital clubbing, renal/gal stones)

inflammatory bowel disease (IBD) treatment

steroids, nutritional support (parenteral/enteral), surgical options (remove colon/sections)

hypertrophic pyloric stenosis (HPS)

thickening of the pyloric sphincter→ bowel obstruction

hypertrophic pyloric stenosis (HPS) symptoms

olive-shaped mass in RUQ*, projectile nonbilious vomiting after meals, chronic hunger

hypertrophic pyloric stenosis (HPS) surgical management

pyloromyotomy (remove thickening)

most common cause of intestinal obstruction from 3-6 months

intussusception

intussusception

ileocecal valve invagination→ obstruction to flow of intestinal contents, edema/inflammation decrease blood flow→ ischemia, perforation, peritonitis, shock

intussusception symptoms

jelly-like stools and sausage-like mass in RUQ palpable*, sudden acute abdominal pain, screaming with drawing up of legs, distended abdomen, pain on palpation, bullseye appearance on US

intussusception: treatment? pre/postop?

barium enema; IVF, NG decompression, abx

malrotation vs volvulus

congenital defect, abnormal intestinal rotation→ superior mesenteric artery obstruction; intestine twists on itself→ compromised perfusion

short bowel syndrome: pathophysiology? cause?

decreased mucosal surface area due to bowel resection→ decreased absorption; liver failure, decreased fluid absorption

short bowel syndrome treatment & nursing considerations

nutritional support, long-term TPN, elemental formulas (proteins broken down to digest easier), transitioned to PO feedings, ostomy/skin care, risk for infection, prolonged hospitalization, teach about enteral feeding tube

biliary atresia

progressive inflammatory process→ bile duct fibrosis→ obstruction, cirrhosis, unknown cause (maybe immune-mediated gestational response)

biliary atresia: symptoms? diagnosis?

jaundice (>2 weeks old), dark urine, gray stools (absence of bowel pigment), hepatomegaly, liver firm on palpation; lab work, nuclear scan (HIDA radioactive dye), liver biopsy*

biliary atresia treatment

hepatic portoenterostomy/Kasai procedure (SI connected to liver)*, phenobarbital (stimulates bile flow), ursodiol (decreases cholestasis)

biliary atresia nursing considerations

supportive nutrition (special formula with medium chain triglycerides/MCT/essential fatty acids), fat soluble vitamin supplements, prurtiris from jaundice (oatmeal baths, trim fingernails, meds)

tracheoesophageal fistula & or atresia

failure of trachea/esophagus to separate/develop as separate entities at 4-5 weeks gestation

tracheoesophageal fistula & or atresia symptoms

3 C’s- coughing, choking, cyanosis*, stomach distention (air), can lead to polyhydramnios (baby unable to swallow amniotic fluid), gastric contents in lungs

tracheoesophageal fistula & or atresia: diagnosis & treatment

radiographic studies; surgery, G-button

tracheoesophageal fistula & or atresia nursing implications

NPO with IVF, NG to low INT suction (salem sump), abx, positioning, TPN then GT, prioritize respiratory, contrast study/esophagram before PO feedings, repeated esophageal dilation PRN, prone to strictures/tracheal malaise (weak/floppy tracheal cartilage)

omphalocele vs gastroschisis

abdominal contents herniate through umbilical ring; bowel herniates through abdominal wall with no peritoneal sac present, typically to the right of the umbilical cord

omphalocele & gastroschisis treatment

moist/covered (omphalocele defect with nonadherent dressing/plastic bad), IVF, abx, surgery, NG to low INT suction (salem sump), NPO, temp management, (losing heat from exposed viscera/burning glucose), radiant warmer

omphalocele & gastroschisis nursing implications

make opening bigger at bedside (release tension), primary closure not possible→ Silo reduction in gastroschisis (decrease fluid loss), postop- respiratory support (ventilator), pain management (morphine, fentanyl)

cleft lip vs palate

incomplete fusion of oral cavity (normally fused at 6 weeks gestation*), repaired at 2-3 months, adequate blood flow; incomplete fusion of soft/hard palate (normally fused at 7-12 weeks*), repaired at 6-12 months, poor blood flow

cleft lip & palate treatment & nursing considerations

z-plasty (improves scar appearance), prevented with folic acid supplements pre-pregnancy), impaired feeding, plastic surgeon, ENT, speech therapist, orthodontist, frequent OM (may need PE tubes), special needs feeder (haberman), burp frequently

cleft lip & palate postop

elbow restraints, supine/upright, avoid straws/rigid utensils/sippy cup/hard pacifiers/suction catheters, IVF then clear liquid diet, change positions frequently for drainage/breathing, excessive swallowing = bleeding