Lecture 1 - GI disorders

The functions of the GI system includes:

1. Digestion which includes mechanical ways like _______ and peristalsis. It also includes chemical ways including the use of ____ and digestive secretions.

2. Absorption which mainly occurs in the _____ intestine and goes into the bloodstream.

3. Metabolism

4. Elimination which is evacuating via the ___ intestine and rectum.

Dysfunctions of GI system lead to:

1. Failure to _____, vomiting, constipation

2. Abdominal ____/distension, diarrhea, jaundice

3. Abnormal bowel ____ and fever

4. Hematochezia which are bloody ____

chewing; enzymes; small; large; thrive; pain; sounds; stools

For infants less than 6 months, they are recommended to be exclusively ______; however, they can also use commercial _____. It is important to supplement for deficiencies like Vitamin ____.

For infants 6-12 months, it is primarily breastfeed/formula but also ____ foods can be introduced. This is anything that is not breastmilk/formula such as ____ or yogurts. These infants should have good ____ control when sitting in a high chair. Other signs of readiness including a lack of a tongue ____ reflex to push things out of their mouth and good hand-eye ____.

Monitor for tolerance as signs of intolerance include ___ , diarrhea, rashes, bloody stools, etc.

Before their first year, these infants should not have raw ____ due to the risk for botulism.

Water can be introduced at about ___ months as it starts to affect sodium levels.

breastfed; formula; D; solid; purees; head; thrust; coordination; vomiting; honey; 6

For toddlers 1-2 years, the growth rate ____. It is still recommended to breastfeed but they should have 3 ____ and 2 snacks. They may eat smaller portions of ____ foods. Avoid any ___ hazards. They may also exhibit a normal dec in appetite which is called physiologic ____. This is due to the fact that they become more ____ of what foods to eat. They also will exhibit ___ or a sense of control/independence or wanting things to their liking.

For preschool kids 3-5 years, they may begin to eat ____ foods like those requireing the use of utensils. They will eat ____ of an adults portion and try to make these meals ____ dense. Increase the amount of ____ while decreasing hte amount of fat. They have strong taste _______. Limit fruit ____ and sugary drinks as this can affect their dental/overall health.

For 6-12 years, their calories needs diminist and they need more ______ in their foods. They eat similar to adult portion.

For 12-18 years, this is when ____ occurs which accelerates growth. They reach maxinmum bone mass and require ___ rich foods. It is important to balance diet with ____.

Challenges that school-aged and adolescents may face include convenience foods, ___ provided meals, and cultural influences like peers, body ____ , and the media.

slows; meals; finger; choking; anorexia; picky; ritualism; table; half; nutrient; protein; preferences; juices; variety; puberty; iron; activity; school; insecurities

When intake exceeds requirements/expenditure, this can lead to _____ or being overweight. This leads to a decreased life _____.

The 5-2-1-0 Approach states:

1. 5 Fruits and ____ servings per day

2. 2 hours or less of ___ time per day

3. 1 hour of physical ___ per day

4. 0 sugar-sweetened ____ per day

obesity; expectancy; vegetables; screen; activity; drinks

The inability to obtain or use calories leads to failure to ____ or a growth delay. There is persistent ____ from the expected growth curve. There is deceleration of weight ____. Diagnostic assessments can take a ____ time.

To treat this we must reverse the cause by correcting the defieciency, ensuring adequate ___ are being ingested and offer ____ on why to maintain the plan. The goal for catch up is to be 2 to ___ times the average rate of weight gain. For example, you can ____ them by mouth.

thrive; deviation; gain; long; calories; education; 3; feed

Celiac disease is an autoimmune and _____ syndrome which is triggered by ____. This substance damages and inflames the ____ intestine which recruits lymphotcytes to areas which releases more mediators which leads to epithelial damage and ____ atrophy. Damage to the villa decreases the ____ for absorption and leads to malabsorption. There are several ____ b/w ingestiona and symptom onset.

Symptoms include:

1. ____ or fatty stool due to malabsorption

2. General malnutrition and failure to ___

3. Abdominal _____ and pain

4. Secondary ___ deficiencies

5. Chronic diarriea

6. Aphthous or ____ sores due to vitamin defieicines needed for gum health

These symptoms will continue as long as ____ occurs.

Diagnostic testing includes blood tests for specific _____ and an upper GI ____ with a biopsy. Gluten should not be _____ until after these tests as it can make the tests inaccurate.

Education includes:

1. Sticking to a diet that is high in calorie/protien but ___ in fat.

2. Eat simple carbs like fruits/veggies

3. ____ sources like fillers and preservatives

malabsorption; gluten; small; villa; SA; months; steatorrhea; thrive; distension; vitamin; canker; ingestion; antibodies; endoscopy; excluded; low; hidden

Untreated/serious cases of celiac disease leads to celiac ___. This leads to profuse watery _____, vomiting, pain, and fluid/_____ imbalance. This is due to mucosal damage and _____.

Patietns should avoid foods high in ___ as it can reduce or worsen recovery.

Patients may be temporarily ____ intolerance due to mucosal damage.

Patients should be educated to avoid any triggers like gluten, infections, or anything that cuases ___ on the body.

Supplement defciencies usch as iron, folic acid, and ___ soluble vitamins.

If they eat gluten again after recovery, this will trigger a ___.

Nursing priorities include;

1. Stabilizing ____ and electrolyte imblance

2. Provide ____ support

3. Manage symptoms.

crisis; diarrhea; electrolyte; lesions; fiber; lactose; stress; fat; relapse; fluid; nutritional

A sudden infection of the stomach and intestines is called acute infectious ______. This can be from bacterial, viral, or _____causes.

This is a highly transmissable disorder can be obtained form the ______ - oral route or from ingesting contamined food or ___.

The main hallmark symptom would be ____ but may also be paired with N/V and fatigue. This is more concerning for children bc their intestinal _____ leads them to lose more electrolytes/fluids than adults.

It is often ____ ____ meaning the immune system should kick and fight in and you will be fine.

Chronic cases can lead to ____ and FTT. Acute cases may have little weight ____ but will bounce back

It is important to assess the bowel _____, fluid/hydration status, and take a ____ sample.

Admin meds based on cause.

For infection control it is important to be on ____ isolation, use universal precautions, and wear appropriate ____.

Prevention includes good ___ hygiene, good food preparation and ___ techniques and avoid contaminated water.

gastroenteritis; parasitic; fecal; water; diarrhea; permeability; self limited; malabsorption; loss; sounds; stool; contactl PPE: hand; storage

Inflammation of the appendix is called ___. This leads to inflammation in the _____ AKA McBurney’s point. Patients may also experience rebound ___ which is intense pain upon release of deep palpation.

Other symptoms include ___, N/V, and loss o fappetite. Patients may have ____ abnormalities based on how much they’ve been vomiting.

Diagnostic tests include a CT or ____. Labs will show elevation in ____ and white cell cound.

TXT is an ____ which is removal of the appendicitis and is usually done ____ but can also be done open.

Complications stem from _____ or rupture of the appendix if left untreated or undetected. This can lead to ____ or inflammation of peritoneum, an ____ being formed on the abdominal wall, or ____ if it enters into the bloodstream.

In pre-op, patients should be ___ for anesthesia, given IVF, antibiotics, monitor ___ for signs of rupture, and adequate pain control

In post-op, it is important to monitor for signs of infecition, a bowel obstection or an ____ which is absence of bowel activity. Monitor pain, monitor any _____ if there is an abscess or peritonitis, and encourage early ___ to prevent constipation and ileus. Patients will be on a ____ diet for a few hours and then advance as tolerated.

appendicitis; RLQ; tenderness; fever; electrolyte; ultrasound; CRP; appendectomy; laparoscopically; perforation; peritonitis; abscess; sepsis; NPO; VS; ileus; drains; ambulation; clear

Cleft lip and palate are most commonly found ____ but can be found separately as wekk.

It is a congenital defect in oral cavity formation that usually occurs in the _____ trimester.

Some factors that influence this development include:

1. Chromosome ____

2. ____ or things that can be harmful to embryo/fetus

3. ____ acid defieicnecy

It is important to educatae familes on what to expect and ensure that patients are eating enough ____.

Diagnosis is made at birth based on visualization and ____. Patients may also experience ____ difficulty due to abnormal function but usually ____ is not impaired.

TXT includes ____ repair which may occur in stages. This is usually done by a ____ surgeon.

As the soft palate is responsible for opening up the eustachian tube for drainage of middle ear, patients may expereince ____ loss. The soft palate is important for producing normal speech sounds which is why these patients may have ____ impairments. It is important to thus collaborate with speech therapy and an ____.

Due to inadequate calorie intake, these patients are at risk for ____.

For those with a cleft lip they can do breastfeeding or bottle feeding using a ____ based nipple and cheeck support.

For those with a clept palate, they need more sat ____ to prevent nasal reflux, they need to have head aupposrt, and paused and ____ frequently due to them swallowing more air.

together; first; deletion; teratogens; folic; calories; palpation; feeding; swallowing; surgical; plastic; hearing; speech; ENT; FTT; wide; upright; burped

Post-op care for CL repair includes:

1. Protecting the operative site and monitor for ____.
   Carefully supervise any ____ or fingers in the mouth that can disrupt the surgical site

2. Monitor for excessive ___ which can be a sign of bleeding

3. Avoid ___ or objects in the mouth

For a CP repair:

1. Monitor for signs of airway _____ like stridor or croup

2. Monitor for difficulty _____ or swallowing

3. Monitor for hemorrhage or ______ spasm

4. Diet modifications include ___ liquid, liquid, and soft.

bleeding; objects; swallowing; suction; obstruction; breathing; laryngeal; clear

Obstruction/absence of the bile ducts is called ____ ____. This means waste cannot be drained from the ____ causing all electrolytes and liver enzymes to become abnormal. It leads to ____ issues due to circulating liver enzymes. It can cause ___ of the liver, cellular necrosis in the liver leading to cirrhosis and ____.

Systemic symptoms include portal vein ___, esophageal _____, and end stage liver failure.

If untreated, by age 2 ____ is iminent. Treatment includes a liver ____. There is also the ____ procedure or hepatoportoenterostomy in which they create a new bile duct from part of the ____ intestine.

The hallmark symptom is jaundice; however jaundice can be in the ___ or 2nd week, but other symptoms include:

1. Elevated _____

2. FTT and pale ____ like stools, steatorrhea

3. ____ colored urine

4. Abdominal distention or ____

5. Hepatomegaly, splenomegaly

6. Bruising and prolonged _____

7. _____ due to build up of bile salts

Definitive diagnosis is via _____ which can include a biopsy, a exploratory lapartomy, and a _____ which uses dye to visualize the bile ducts.

biliary atresia; liver; systemic; fibrosis; jaundice; HTN; varices; death; transplant; kasai; small; 1st; bilirubin; putty; tea; ascites; bleeding; pruritis; surgery; cholangiography

Nursing care for biliary atresia includes managing symptoms, optimizing nutrition, providing ____, monitoring ____ and I&O.

Medications taken include:

1. The use of ______ which binds bile acids to prevent reabsorption

2. _____ can be used for itchiness

3. _____ decreases cholesterol secretion from the liver

4. Vitamin ___ to help w clotting factors

5. Fat-soluble vitamins like ADEK, _____, and thiamine. Use ____-miscible forms

6. Minerals

7. For transplants, they will be on lifelone anti-rejection meds like ____ and immunosuppressants.

comfort; weight; cholestyramine; antihistamines; ursodiol; K; B12; water; steroids

When the bowel is exposed but in a membranous sac, this is called ______. It occurs usually at the ____ of the umbilical cord. It may include other organs and is ___ associated a genetic syndroms and cardiac defects. Prenatal diagnosis is via an _____ and potential risks includes sac ___, infection, and an ____ abdominal cavity.

To prevent injury to the sace, use a ________ dressing to maintain it. Position the patient to not put ____ on the exposed bowel. A ____ tube may be placed to decompress the abdominal cavity to give it as much room as possible. It is corrected via surgery which may be done in ____ for larger defects. While waiting for repairs, use _____ sulfadiazine to prevent infection. Also use ____ or elastic bandages. The surgeon may use the ____ abdominal wall as a skin flap. If the sac becomes disrupted this exposes the bowel, so use a ____ ____ to cover it. .

omphalocele; base; highly; ultrasound; rupture; underdeveloped; nonadherent; pressure; NG; stages; silver; compression; lateral; mesh silo

When the bowel is exposed but the peritoneum is broken, this is called ____ and it is more serious. This is usually occurs to the ____ of the umbilicus and usually only involves the intestines. It is ____ associated w genetic syndromes and a diagnosis is via an _____ which shows free-floating bowel loops. Postnatal risks includes risk of ______, inflammation, and dysfunction.

Use a mesh silo and if there are none, use a loose and ___ dressing.

A ____ tube play be placed for bowel decompression.

____ may occur if the opening is too tight and cuts off blood supply to the bowel. IT is important to ____ the hole out to prevent impaired blood flow.

Poor bowel function needs ____ support.

gastroschisis; right; rarely; ultrasound; dehydration; moist; NG; strangulation; stretch; nutritional

An absence of ganglion cells in the colon is called _____ disease. This is a disorder of ____. It leads to a mechanical obstruction as the internal ____ sphincter fails to relax. There can be _____ segments as well instead of continuous.

The first symptom is delayed _____ which should be passed within 24-48hrs. A common complication is _____ which is infection of the intestine and this is an ____ in newborns.

This mostly affects the _____ colon, the internal sphincter, and the rectum.

Diagnostic tests include:

1. The definitive one which is a rectal _____ to test for ganglionic cells

2. A ____ enema and x-ray can be used to suggest it. It shows where the _____ aganglionic bowel meets the dilated bowel.

3. An anorectal _____ measures how the rectum n anal sphincter respond to stimulation

This is resolved via ____ to remove the diseased portions and ____ the healthy portions. If there is little diseased bowel, it can be done in 1 stage, but if large/skipped it will be done in ____ stages. This is called the ____ ____ procedure. Those with multiple stages may require a temporary _____ to collect the stool.

hirschsprung; motility; anal; skipped; meconium; enterocolitis; emergency; sigmoir; biopsy; barium; narrow; manometry; surgery; reconnect; 2; pull through; colostomy

Pyloric stenosis is an ____ disorder in which the pyloric smooth muscle is abnormally _____ around the sphincter which prevents it from relaxing.

This is congenital and will lead to projectile ____ that worsens. The children will eat fine and have a great _____ but will spew everything up. This leads to ___ hunger and FTT.

Symptoms occur 3 to ____ weeks after birth and can include:

1. Vomiting which leads to dehydration and metabolic _____. Common signs include fewer ___ diapers, dry membranes, skin turgor, etc.

2. Decreased amount of ____

3. A palpable ____ shaped mass which is the pyloric muscle

4. Visible _____ waves as the stomach tries to push the milk out.

Diagnosis is via an abdominal _____. TXT includes a ____ to slice through the pyloric muscle, correction of ____ and alkalosis.

Pre-Op interventions include making the patient ____, placing a ___ tube for decompression, and giving IVF and electrolutes.

Post-OP interventions includes I&O, managing pain, IVF, ____ resuming feeds, and upright position.

obstructive; thickened; vomiting; appetite; chronic; 6; alkalosis; wet; stool; olive; peristaltic; ultrasound; pyloromyotomy; electrolytes; NPO; NG; slowly

When part of the intestines telescopes into itself, this is called ____. This is an ____ disorder in which the blood vessels and intraluminal space becomes compressed.

Risk factors include being under ____ year, celiac disease, cystic fibrosis, and being the gender of ____.

The hallmark sign is ____ that is sudden, severe, and intermittent. Other symptoms include bloody stools that are described as currant _____, a ____ shaped mass where the telescope has happened, and bilious _____.

Diagnosis includes an x-ray, ultrasound, or an air/barium ____. The last one is the main one and can act as a _____ is injecting barium may straighten it out.

Sometimes a complication of peritonitis can happen in which surgery and IV ____ is needed.

Educate the patients that ____ can happen and tell them S/S that would show that.

intussusception; obstructive; 1; male; pain; jelly; sausage; vomiting; enema; resolution; antibiotics; recurrence

Short bowel syndrom is when there is decreased intestinal ____ which causes the patient to rely on _____ nutrition. Any disease can cause this such as ____ of small intestine due to NEC, Crohns, trauma, etc. OR _____ which is the protruding the bowel through the wall.

There is high ____ within 5 years.

The phases include:

1. Initial which is parenteral nutrtion used long term and infused at ____.

2. Second which is ____ nutrition ASAP postop. Use continuous and ___ formulas as they are easier to absorb.

3. Third is advance to ____ feedings as tolerated. Some children may exhibit oral ____ as they reject oral feedings due to heavy reliance on tube feedings

4. Final is ____ growth

Nutritional support includes:

1. Vitamins like _____

2. Trace minerals like ___, selenium, and zinc

3. Medications to reduce intestinal losses like H2 blocker, ____, octreonide, and cholestyramine.

4. A diet that is high in ___ and low in carb

Complications include:

1. Chronic ____ and bowel atrophy

2. Infection/sepsis due to increased _____ to bacteria and ____ ____ line infections

3. cholestasis

4. Bacterial ____

Surgical interventions include intestinal ____, lengthening, and transplants

SA; parenteral; resection; gastrochisis; mortality; home; enteral; elemental; oral; aversion; sustained; ADEK; iron; PPI; fat; diarrhea; permeability; central venous; overgrowth; valves