↑↓ GI

Diarrhea

Viral (rotavirus), bacterial (samonella), parasites, antibiotics, toxins → ↑ frequency and watery stool due to abnormal water/electrolyte transport → Dehydration, electrolyte imbalance, metabolic acidosis, shock.

Classification:

◦ Acute- < 14 days

◦ Chronic - > 14 days

Rotavirus

vomiting then watery diarrhea 5-7 days.

Most common cause of hospital associated diarrhea in children spread

assessment: Hydration (fontanel, turgor, mucous membranes), I&O, daily weight.

tx. Oral rehydration therapy (ORS); continue breastfeeding; IV if severe.

  • diet: Avoid juice/soda/BRAT (diet low in lytes and protein); resume normal diet early.

prevention: Hand hygiene, safe food, vaccines.

Rule of Thumb for Daily Maintenance Fluid Requirements:

1-10kg= 100ml/kg

11-20kg= 1000ml + 50ml/kg for each kg >10kg

>20kg= 1500ml + 20ml/kg for each kg >20kg

mild: Thirst, dry mucosa → ORS 50 mL/kg.

moderate: Sunken eyes, poor turgor → ORS 100 mL/kg.

severe: Lethargy, weak pulse → IV fluids (LR bolus).

Constipation

Low fiber, withholding, stress, meds → Infrequent/difficult stools; hard stools.

Constipation newborn red flag

Failure to pass meconium → initial presentations of cystic fibrosis → Hirschsprung, hypothyroidism

child: idiopathic (unknown cause) or functional constipation r/t diet

tx. Fiber, fluids, exercise, bowel routine.

meds: PEG (MiraLax), lactulose, stool softeners, laxatives.

types of lax:

(PEG) 3350 without electrolytes (MiraLax): a chemically inert polymer

Bulk – absorb water – Metamucil, Fibercon

Surfactant – detergent – Surfak, Colace

Stimulant – stimulate peristalsis – Bisacodyl, Senna, Cascara,

Osmotic – retains water (volume) – MOM, Phosphosoda, Epsom salts

vomiting

Infection, obstruction, ↑ICP, toxins → Forceful gastric emptying controlled by medulla

Bilious vomiting: Green → bowel obstruction (EMERGENCY).

Projectile vomiting → Pyloric stenosis.

nursing care: Upright positioning, prevent aspiration, small frequent fluids.

Gastroesophageal Reflux (GER)

GER normal reflux vs GERD causes damage and symptoms 9 may occur w/o regurgitation); life threatening associated w/ respiratory disorder

infants: Common, resolves by age 1.

complications: FTT, anemia, respiratory issues.

GERD meds:

H2 blockers: cimetidine [Tagamet] or famotidine [Pepcid])

PPIs: esomeprazole [Nexium], lansoprazole [Prevacid], omeprazole [Prilosec])

Surgical intervention: Nissen fundoplication

GERD nursing care: Upright feeding, frequent burping, avoid overfeeding, thickened feeds: 1 tsp.-1 tbsp. rice cereal per ounce of formula

Appendicitis: peak 12-18 years old M

obstruction of lumen usually due to fecal material (fecalith), virus, parasite → inflammation of vermiform appendix

Early sign: Periumbilical pain

Progression: RLQ pain, nausea, vomiting, fever, guarding.

Complication: Perforation → peritonitis → shock.

sign of peritonitis: sudden relief from pain → increase in pain diffuses and rigid guarding; tachycardia; rapid, shallow breathing, pallor; chills; irritability; and

restlessness

safety: NO enemas/laxatives bc inc risk for Perforation

tx. Appendectomy, antibiotics, IV fluids. if ruptured Open Appendectomy

hernia

Umbilical: Common in newborn; fusion of the umbilical ring is incomplete where umbilical vessels exit the abdominal wall.

  • resolves by 3 to 5 years old

inguinal: occurs when abdominal tissue (bowel) protrudes through a weak spot in lower abdominal muscles → painful bulge in the groin / scrotum

(ME) Incarcerated Hernia= the hernia is constricted and cannot be reduced manually

Strangulated Hernia= loss of blood supply to bowel

trx. surgery

Pyloric stenosis: Hypertrophy of pyloric muscle

key sign: Projectile NON-bilious vomiting.

  • Olive mass RUQ, hungry after vomiting.

complication: Metabolic alkalosis, dehydration.

tx. Pyloromyotomy after rehydration.

duodenal atresia: complete blockage of duodenum green (bilious) vomiting (ME)

Intussusception: Bowel telescopes into itself → edema, iscemia, venous engorgement → leakage into lumen → peritonitis

s/s. Sudden pain, knees to chest, currant red jelly stool

assessment: Sausage mass, lethargy between episodes. Empty lower right quadrant (Dance sign)

treatment: Air (pneumatic) enema or surgery.

Monitor stool after procedure:

◦ Passage of a normal brown stool usually indicates that the intussusception has reduced itself.

◦ Contraindication for rotavirus vaccine in the future

Malrotation: Abnormal intestinal rotation.

Volvulus: Intestine twists → cuts blood supply → ischemia/death. most serous type of intestinal twisting

s/s. Bilious vomiting.

tx. Emergency surgery.

Nursing Care Management: IV fluids, NG decompression, and systemic antibiotics

Biliary atresia: Bile duct obstruction → Liver failure

s/s. Jaundice, dark urine, pale stools, hepatomegaly.

tx. Kasai procedure or transplant.

vitamin (ADEK)

TPN: enteral solution should be low in sodium.

Phenobarbital: stimulate bile flow

Ursodeoxycholic acid: ↓ cholestasis and the intense pruritus from jaundice.

Celiac disease: Autoimmune gluten intolerance → villi damage.

s/s. Diarrhea, steatorrhea, distention, FTT, anemia.

dx. Antibodies + intestinal biopsy.

tx. Gluten-free diet.

IBD:

Ulcerative colitis (UC): colon and rectum; bloody diarrhea.

  • common severe diarrhea no pain

Crohn’s disease (CD)

  • uncommon moderate diarrhea, sever pain and weight loss Transmural; skip lesions; fistulas common.

Inflammatory bowel disease unspecified (IBDU): terminal ileum.

IBD Therapy Goals

  • ↓ inflammation → ↓ symptoms

  • Induce + maintain remission

Treatment: Steroids, immunosuppressants, biologics, nutrition support.

Nutrition: Correct deficiencies, ↑ calories/protein

Surgery (UC): If meds fail → colectomy + ileostomy

Nursing

  • Diet + stress management

  • Educate on flares/remission

  • Prep for possible surgery

Short bowel syndrome:

Loss of intestine surface area → Malabsorption → need TPN to Promote growth and adaptation.

dx. fecal fat in stool

tx. surgery (prevere as much of the bowel as possible)

Progress from TPN → enteral → oral as bowel adapts

Hirschsprung disease: No ganglion cells → no peristalsis.

newborn sign: No meconium in 24-48 hrs.

s/s. Constipation, distention, explosive diarrhea.

tx. Surgical removal.

Abd wall defects:

Omphalocele: Bowel covered by sac.

Gastroschisis: Bowel exposed outside abdomen.

priority: Cover bowel, prevent heat/fluid loss.

Foreign body ingestion risk: Airway obstruction, perforation, burns (batteries).

Foreign body intervention: Seek care immediately if symptoms or dangerous object.