Exam 3: GI/GU Disorders

Question 1

Hypertrophic Pyloric Stenosis (HPS)

Answer 1

Hypertrophy of pyloric muscle
Results in constriction of pyloric sphincter and obstruction of gastric outlet
Occurs more commonly in males and children < 3 months
Cause unknown

Question 2

Risk factors of HPS

Answer 2

Overproduction of gastric secretions in infant may be caused by stress factors in mother/maternal smoking
Down syndrome
Hx of parent or close relative with pyloric stenosis
1st born children

Question 3

Assessment and diagnosis of HPS

Answer 3

Projectile vomiting

Signs of dehydration:
Sunken/depressed fontanelle
Weight (daily weight)
Pulse
Lethargy vs. irritability
Urine output
Mucous membranes

Vomiting nonbilious

Diagnosis: Ultrasound, radiography with barium swallow

Question 4

RN care for HPS

Answer 4

Immediate intervention: Correct dehydration
Fix fluid/electrolyte imbalance
First: BOLUS of isotonic solution (20 ml/kg of lactated ringers or 0.9% NSS)
Post op: Feeds restarted 4-8 hours after recovery from anesthesia

Question 5

Signs of intussusception

Answer 5

30 minutes after feed note:
PT continuously cries
Difficult to console
Knees to chest position
Abdomen tender
Pain intermittent, cyclical
Currant jelly stool
Vomiting

Question 6

Intussusception

Answer 6

Telescoping or invagination of one portion of intestine into another
Most common: ileum telescopes inside cecum
Common in children <1 year and more common in males

Surgery to repair, NG inserted to decompress bowel

Question 7

Intussusception risk factors

Answer 7

Male
Meckel diverticulum (outpouching on intestinal wall)
Polyps, hemangiomas, tumors
CF
Celiac, Crohn’s