The Child with a Gastrointestinal Disorder

Objectives

• Anatomy and Physiology Comparison

  • Identify differences between pediatric and adult gastrointestinal (GI) anatomy and physiology.

• Medications and Treatments

  • Discuss common medications and treatments for managing pediatric GI disorders.

• Nursing Assessments and Interventions

  • Identify assessments and interventions for children with GI illnesses.

• Common GI Illnesses

  • Distinguish between cleft lip and palate, dehydration, hypertrophic pyloric stenosis, intussusception, gastroesophageal reflux, appendicitis, Hirschsprung disease, and celiac disease.

Variations in Pediatric Anatomy & Physiology

• Mouth

• Lower Esophageal Sphincter

• Esophagus

• Stomach

• Intestines

Nursing Assessment

Health History

• Evaluate growth patterns.

• Address dietary concerns.

• Review toilet training and bowel patterns.

• Collect patient history and family history.

Diagnostic Testing

• Esophageal pH probe

• Ultrasound (abdominal)

• KUB

• Barium studies

• Stool studies

Nursing Assessment Physical Exam

• Inspection & Observation

• Assess abdominal size and shape.

• Auscultation

• Percussion

• Palpation

Dehydration

• Occurs more readily in infants and young children due to:

  • Greater proportion of body water (up to 2 years of age).

  • Infants have higher insensible fluid losses and a higher body surface area (BSA) to body mass ratio.

  • The renal system of infants does not concentrate urine like adults.

• Goal: Restore fluid volume and prevent hypovolemia.

Signs and Symptoms of Dehydration

• Physical Signs

  • Sunken eyes.

  • Reduced level of consciousness.

  • Dry mucous membranes and tissue turgor.

  • Tachypnea and tachycardia.

  • Oliguria and hypotension.

  • Sudden weight loss.

  • Reduced capillary refill time.

Fluid Replacement

• Mild to Moderate Dehydration:

  • Oral rehydration: 50-100 mL/kg with solutions like Pedialyte.

• Severe Dehydration:

  • IV fluid management: 20 mL/kg with Lactated Ringer or Normal Saline.

Cleft Lip and Palate

Nursing Assessment

• Risk Factors

• Health history and physical exam.

• Family education.

Post-Op Nursing Care for Cleft Lip

• C: Calming techniques

• L: Lie on back

• E: Evaluate airway

• F: Feeding techniques

• T: Teaching

• L: Lip protection (Logan bow)

• I: Infection

• P: Parent bonding

Post-Op Nursing Care for Cleft Palate

• P: Pain management

• A: Airway management

• L: Liquid diet

• A: Avoid hard foods and objects in the mouth

• T: Avoid hot, spicy, and citrusy foods.

• E: Educate parents on infection signs, use of arm restraints, and diet advancement.

Hypertrophic Pyloric Stenosis

Pathophysiology

• Pylorus becomes hypertrophied leading to obstruction.

Nursing Assessment

• Health History & Symptoms

  • Non-bilious emesis 30-60 minutes after feeding.

  • Signs of hunger despite feeding.

• Physical Exam:

  • “Olive shaped” mass in the upper abdomen.

  • Progressive dehydration.

Nursing Management

• Manage fluid and electrolyte levels.

• Provide parental education.

• Administer pre and post-operative care.

• Resume feedings post-op.

Intussusception

Pathophysiology

• Bowel telescopes into a distal segment, leading to edema, impaired blood circulation, and obstruction.

Nursing Assessment

• Health History & Symptoms

  • Sudden onset of intermittent abdominal pain.

  • Bilious emesis and “currant jelly” stools.

• Physical Exam:

  • Lethargy and “sausage”-shaped abdominal mass.

Nursing Management

• Barium or air enema.

• Surgical repair if necessary.

• Pre and post-operative care.

Appendicitis

Pathophysiology

• Obstruction leads to increased appendix pressure, edema, bacterial overgrowth, and potential perforation.

Nursing Assessment

• Health History

  • Right lower quadrant pain, nausea, vomiting, fever.

• Assessment Techniques

  • McBurney’s Point and rebound tenderness.

• Labs:

  • CT scan or ultrasound.

Management for Appendicitis

• Perforated (Complicated):

  • Appendectomy, peritoneal drainage, IV antibiotics.

• Non-Perforated (Uncomplicated):

  • Appendectomy with pre-op antibiotics and fluids.

Alternative Options

• Studied: Antibiotics only (provider preference).

Gastroesophageal Reflux Disease (GERD)

Health History and Symptoms

• Failure to thrive, respiratory problems, irritability, “wet burps” or vomiting

  • Specific symptoms in infants and older children.

Nursing Management

1. Alter feeding techniques:

   • Small, frequent feedings; upright positioning; thickened formula.

2. Medications:

   • Histamine 2 blockers, proton pump inhibitors, prokinetics.

3. Consider Nissen fundoplication.

Hirschsprung Disease

Pathophysiology

• Lack of ganglionic cells in the bowel resulting in inadequate motility.

Risk Factors

• Not passing meconium within the first 24 hours, male.

Symptoms

• Abdominal distension, pain, constipation, vomiting, slow growth.

Treatment

• Surgical resection of bowel with reanastomosis; "pull-through" procedure.

Celiac Disease

Pathophysiology

• Autoimmune disorder impairing the ability to digest gluten, leading to villous damage in the small intestine.

Medical Management

• Implement a strict gluten-free diet.

Nursing Assessment

• Health history and symptoms indicating malnutrition: anemia, steatorrhea, poor weight gain.

Diagnosis of Celiac Disease

• Screening:

  • Blood test for Tissue Transglutaminase Antibodies (tTG-IgA) yields positive results in most cases.

• Definitive Diagnosis:

  • Small bowel biopsy showing villi atrophy.

• Genetic Testing:

  • Testing for HLA-DQ2 and HLA-DQ8 genes.