Pediatrics Gastrointestinal

mature, small capacity, increased motility, relaxed pyloric sphincter, deficient enzymes, and a immature liver

pediatric differences in GI

6 weeks of age

when can you voluntary control swallowing

frequently regurgitate small amounts of feedings

Relaxed pyloric sphincter allows for

cleft lip + Palate

May occur singly or in combination but is a structural defect

cleft lip

failure of maxillary process to fuse in gestation

cleft palate

failure of tongue to move down at correct time (prevents palate from fusing)

feeding issues, AOM, speech, hearing, and dental issues

issues seen with cleft lip and palate

first 6 months of life

how long is lip usually impaired for with cleft lip

18 months

when is a cleft palate usually fixed

Nasoalveolar Molding

label appliance

aspiration precaution, keep suction at bedside, position upright with feeds + 30 min after, feed slowly with adaptive equipment, burp often

nursing management of these kids before they get it fixed

elbow immobilizers, prevent prolonged crying, special feeding devices, wound care

post op management of these kiddos with cleft lip/palate

vomit containing large amounts of bile -suggestsbowel obstruction

bilious vomit is

esophageal atresia

It causes the esophagus to end in ablind-ended pouch rather than connecting normally to the stomach

Tracheoesophageal Fistula (TEF)

an abnormal connection (fistula) between the esophagus and the trachea

• 90% of those with esophageal atresia also have a TEF

3 C: cyanosis choking + coughing, and lots of drooling, difficult to feed

s/s of those born with esophageal fistula + TEF

pneumonia

TED + fistula are at risk for

immediate identification, prevent complications, resp + nutritional support

Esophageal Atresia and TEF:Management

confirmed by attempting to pass a nasogastric or orogastric tube into the stomach and it meets resistance or unable to retrieve stomach contents

diagnosis of Esophageal Atresia and TEF

suction, elevate HOB, NPO, IV fluids

Esophageal Atresia and TEF: Nursing Management

gastrostomy tube (GT)

what may be put in place with Esophageal Atresia and TEF

Pyloric Stenosis

Hypertrophic obstruction of the circular muscle of the pyloric canal

PROJECTILE VOMIT >3 feet and hungry after meals! (nonbilious emesis), irritable, FFT, small stools, dehydrated

what it seen with pyloric stenosis

peristaltic waves across the abdomen and an olive-sized mass in the upper right quadrant

what is seen on exam with pyloric stenosis

abd ultrasound

diagnosis of pyloric stenosis

Gastroesophageal Reflux (GER)

Relaxation of lower esophageal sphincter = return of gastric contents into esophagus

50% of infants have some degree of GER

Lower esophageal relaxations

• Incompetent lower esophageal sphincter

• Anatomic disruption of esophagogastric junction

Three mechanisms allow reflux to occur

pitting up or vomiting, Hungry and irritable, refusal of feedings, poor weight gain,sleep disturbance, respiratory symptoms (coughing, choking, wheezing),arching of back during feedings

Symptoms with GERD

aspiration (resp comp)

GERD are at risk for

Upper endoscopy with esophageal biopsy - assess damage and R/Oother conditions

diagnosis of GERD

Thickened feeds

Slow-feed nipple

Smaller volume feedings

Positioning upright 20-30 minutes after feeding

Feeding modification for GERD

H2 blockers: Zantac + pepcid and PPI prevacid + prilosec (take on empty stomach)

meds for GERD

Umbilical Hernia

Weak or imperfectly closed umbilical ring = soft swelling covered by skin

easily reduced by pushing bowel back through ring, resolved by 1 year or may need surgery

what else with umbilical hernia

Intussusception

inversion of one portion of the intestine within another.• The telescoping of the intestine obstructs passage of stool

Abrupt onset!

•Abdominal pain

•Vomiting (bilious)

•Red/currant jelly

•Intermittent crying that becomes worse

S/S of intussusception

air contrast edema

management of intussusception

Hirschsprung disease (congenital aganglionic megacolon)

inadequate motility causes mechanical obstruction of the intestine

failure to pass meconium in 24/48 hr, abd distension, bilious vomiting, failure to gain weight + severe constipation

Hirschsprung Disease :Clinical Manifestations

Surgically remove the aganglionic bowel portion; may need temporary colostomy

Hirschsprung Disease: Management

Celiac Disease

Chronic malabsorption syndrome, intolerance for gluten

• Damages villi - impairs absorption in small intestine

solid foods containing gluten are introduced (6months to 2 years)

symptoms occur with celiac when

gluten free

treatment of celiac

Chronic diarrhea, abdominal distention, growth impairment, poor appetite, lack of energy, muscle wasting with hypotonia

s/s of celiac

periumbilical cramp, abd tenderness, anorexia, nausea, fever, pain,

Appendicitis: Clinical Manifestations

mcburney's point

Pain in RLQ with appendicitis

NPO, pain, + hydration/antibiotic

pre op appendicitis

NPO, suction to wall, wound care, antibiotics + hydration

post op care

Appendectomy

surgical removal of the appendix

Acute Viral Gastroenteritis

Inflammation of stomach and intestines = vomiting and diarrhea

dehydration

Infants and small children at risk for

loose or watery stools, irritability, anorexia,nausea, vomiting

s/s of Acute Viral Gastroenteritis

tenting of skin, sunken fontanelle, sluggish cap refill,

dehydration manifestations

sodium can go any direction, hypokalemia, elevated BUN, low bicarb

labs seen with dehydration

• Oral rehydration solution (Pedialyte) in frequent, small amounts

• After hydration continue breastfeeding or resume age-appropriate diet

If not improving after 4 hours or worsens seek re-evaluation

mild to moderate dehydration. management

isotonic IV fluids

management of severe cases

normal diet

For all categories: once hydration achieved resume