Care of Children with Alterations in GI Tract

Question 1

GASTROESOPHAGEAL REFLUX a.k.a

Answer 1

ACHALASIA

Question 2

Cardiac sphincter & lower portion of the esophagus are lax and allow easy regurgitation

Answer 2

GASTROESOPHAGEAL REFLUX

Question 3

Causes of Gastroesophageal Reflux

Answer 3

cerebral palsy & hiatal hernia

Question 4

Signs and symptoms of Gastroesophageal Reflux

Answer 4

effortless vomiting, irritable especially after feeding, difficulties during feeding or refusal to eat, poor weight gain or failure to thrive, episodes of apnea

Question 5

GASTROESOPHAGEAL REFLUX
THERAPEUTIC MANAGEMENT

Answer 5

1. Formula thickened rice cereal - 1 tbsp cereal/1 oz formula or
   breast milk; feed in upright position & keep them upright for 1-2
   hours
2. Eat smaller, frequent meals/feedings – avoid large meals that can
   increase stomach pressure
3. Do not let the infant lie down 2 hours after feeding/eating
4. Ranitidine or omeprazole
5. Fundoplication

Question 6

is a surgical procedure used to treat gastroesophageal reflux disease (GERD) and conditions like achalasia.

Answer 6

Fundoplication

Question 7

It involves wrapping the upper part of the stomach (fundus) around the lower esophagus to reinforce the lower esophageal sphincter (LES), preventing acid reflux and improving swallowing function.

Answer 7

Fundoplication

Question 8

Hypertrophy of the muscle surrounding the pyloric sphincter

Answer 8

PYLORIC STENOSIS

Question 9

It is a condition where the pylorus (the muscle at the bottom of the stomach) becomes thickened, leading to obstruction of the passage between the stomach and the small intestine.

Answer 9

PYLORIC STENOSIS

Question 10

Signs and symptoms of Pyloric Stenosis

Answer 10

• Projectile vomiting immediately after feeding- sour, non-bilious
• Dehydration - lack of tears, dry mouth, sunken fontanels, fever, decreased
  urine output, poor skin turgor, weight loss
• Alkalosis - due to severe, persistent vomiting, leading to the loss of stomach
  acid (hydrochloric acid, HCl).
• Hypopnea - abnormally shallow or slowed respiration
• Olive shaped mass – on the upper right of the abdomen (enlarged pylorus)

Question 11

abnormally shallow or slowed respiration

Answer 11

Hypopnea

Question 12

(gold standard) shows thickened pyloric muscle

Answer 12

Ultrasound

Question 13

less common but can show delayed stomach emptying

Answer 13

Ultrasound

Question 14

Diagnosis PYLORIC STENOSIS

Answer 14

Ultrasound
Barium swallow X-ra

Question 15

PYLORIC STENOSIS
Management:

Answer 15

1. No oral feedings
2. Intravenous (IV) fluids are used to rehydrate the baby and correct any
   starvation and electrolyte imbalances
3. Pyloromyotomy (Fredet Ramstedt procedure)
4. Can resume feeding within 24-48 hours after the procedure and generally recover quickly

Question 16

In pyloric stenosis, you can resume feeding within ____________________ after the procedure and generally recover quickly

Answer 16

24-48 hours

Question 17

a small incision is made in the abdominal wall and carefully cuts the thickened pyloric muscle, which allows the stomach contents to pass into the small intestine more easily

Answer 17

Pyloromyotomy

Question 18

The procedure is often done laparoscopically, which is minimally invasive, requiring only small incisions.

Answer 18

Pyloromyotomy

Question 19

It is a serious condition in which part of the intestine slides into an adjacent part of the intestine.

Answer 19

INTUSSUSCEPTION

Question 20

INVAGINATION OF ONE INTESTINE TO ANOTHER

Answer 20

INTUSSUSCEPTION

Question 21

This telescoping action often blocks food or fluid from passing through. It also cuts off the blood supply to the part of the intestine that’s affected.

Answer 21

INTUSSUSCEPTION

Question 22

Causes of INTUSSUSCEPTION

Answer 22

Meckel’s diverticulum, polyp, hypertrophy of Peyer’s Patches, bowel tumors

Question 23

Signs and symptoms of INTUSSUSCEPTION

Answer 23

Vomiting with bile
Currant jelly stool (mix of blood and mucus)
Abdominal distention
Sausage shaped mass
Sudden drawing up of legs & cry because of pain

Question 24

Management of INTUSSUSCEPTION

Answer 24

◦ Surgery (open or laparoscopic)
◦ Installation of water soluble solution
◦ Enema Procedure: doctors use an air or contrast enema, similar to a
lower GI series, to push the telescoped intestine back into its normal
position
◦ Contrast (Barium) enema
◦ Air Enema: a soft tube is inserted into the rectum, and air is passed
through it.

Question 25

is a twisting of the intestine.

Answer 25

Volvulus

Question 26

Signs and symptoms of VOLVULUS WITH MALROTATION

Answer 26

Intestinal obstruction Intense crying Pain Pulling up the legs Abdominal distention Vomiting

Question 27

Diagnosis VOLVULUS WITH MALROTATION

Answer 27

History Taking Abdominal Examination - mass Ultrasound or lower Barium-Xray – obstruction

Question 28

Management VOLVULUS WITH MALROTATION

Answer 28

Surgery

Question 29

It is the most common congenital abnormality of the small intestine that results from incomplete closure of the vitelline (omphalo-mesenteric) duct. Some misplaced gastric mucosa, which secretes gastric acids that flow into the intestine and irritate the bowel wall.

Answer 29

MECKEL’S DIVERTICULUM

Question 30

cause of MECKEL’S DIVERTICULUM

Answer 30

It's a remnant of the vitelline duct, which connects the yolk sac to the midgut of the developing fetus during the first few weeks of pregnancy.

Question 31

location of MECKEL’S DIVERTICULUM

Answer 31

It's typically found in the distal ileum, the lower part of the small intestine, and is usually located within 90 cm of the ileocecal valve.

Question 32

Signs and symptoms of MECKEL’S DIVERTICULUM

Answer 32

painless tarry stools grossly bloody stool

Question 33

Diagnosis of MECKEL’S DIVERTICULUM

Answer 33

History Taking (s/sx)

Question 34

Management of MECKEL’S DIVERTICULUM

Answer 34

Laparoscopy exploration; involves surgical removal (resection) of the diverticulum, either through an open or laparoscopic approach

Question 35

MALABSORPTION SYNDROME; GLUTEN-INDUCED ENTEROPATHY

Answer 35

CELIAC DISEASE

Question 36

It is a change in the ability of the intestinal villi to absorb nutrients.

Answer 36

CELIAC DISEASE

Question 37

Sensitivity or abnormal immunologic response to gluten found in wheat, rye, oats & barley.

Answer 37

CELIAC DISEASE

Question 38

CELIAC DISEASE Signs and symptoms:

Answer 38

Steatorrhea Abdominal distention Vitamin ADEK deficiency Malnutrition Rickets (lack Vitamin D), hypoprothrombinemia (vitamin K deficiency), hypochromic anemia (lack of iron) & hypoalbuminemia (protein deficiency) may occur

Question 39

CELIAC DISEASE Nursing Interventions

Answer 39

- Record characteristics of stools - Read food labels carefully - Avoid spaghetti, hotdogs, cake, cookies

Question 40

ManagementCELIAC DISEASE

Answer 40

GLUTEN-free diet for life, water soluble forms of Vit. A & D, Fe & folate

Question 41

AGANGLIONIC MEGACOLON

Answer 41

HIRSCHSPRUNG DISEASE

Question 42

Absence of ganglionic innervation in the terminal section of the bowel of varying lengths.

Answer 42

HIRSCHSPRUNG DISEASE

Question 43

It is a congenital disorder characterized by missing nerve cells (ganglion cells) in the colon, leading to difficulties with bowel movements and potential blockages.

Answer 43

HIRSCHSPRUNG DISEASE

Question 44

No peristaltic waves

Answer 44

HIRSCHSPRUNG DISEASE

Question 45

Signs and symptoms of

Answer 45

chronic constipation abdominal distention ribbon like stools failure to pass meconium by 24 hours

Question 46

HIRSCHSPRUNG DISEASE Management:

Answer 46

Pull-through procedure Ostomy surgery

Question 47

this involves removing the section of the colon lacking nerve cells and pulling the healthy portion down to the anus. It can be done minimally invasively (laparoscopically).

Answer 47

Pull-through procedure

Question 48

Colon and rectum are involved, with the distal COLON and RECTUM most severely affected, and inflammation involves continuous segments.

Answer 48

INFLAMMATORY BOWEL DISEASE ULCERATIVE COLITIS

Question 49

It is an inflammation of segments of the intestine; it may affect any part of the GI tract but most commonly involves terminal ILEUM.

Answer 49

INFLAMMATORY BOWEL DISEASE CROHN’S DISEASE

Question 50

Signs and symptoms of INFLAMMATORY BOWEL DISEASE

Answer 50

Diarrhea Steatorrhea Weight loss Recurring fever

Question 51

Diagnosis INFLAMMATORY BOWEL DISEASE

Answer 51

Colonoscopy Barium Enema Biopsy

Question 52

INFLAMMATORY BOWEL DISEASE THERAPEUTIC MANAGEMENT

Answer 52

- Enteral (NGT) or Total Parenteral Nutrition - Antiinflammatory medications

Question 53

INFLAMMATORY BOWEL DISEASE Surgical Management

Answer 53

◦ Bowel resection (Colectomy) – a surgery to remove part or all of the colon ◦ Colostomy - is a surgical procedure that creates an opening (stoma) in the abdomen to allow waste to exit

Question 54

a surgery to remove part or all of the colon

Answer 54

Bowel resection (Colectomy)

Question 55

is a surgical procedure that creates an opening (stoma) in the abdomen to allow waste to exit

Answer 55

Colostomy

Question 56

It involves intermittent episodes of loose and normal stools or recurrent abdominal pain.

Answer 56

IRRITABLE BOWEL SYNDROME (CHRONIC NONSPECIFIC DIARRHEA)

Question 57

In IRRITABLE BOWEL SYNDROME (CHRONIC NONSPECIFIC DIARRHEA), the cause is ___________. Associated with _______________________________________

Answer 57

UKNOWN; low fat intake and excessive fluid intake

Question 58

IRRITABLE BOWEL SYNDROME (CHRONIC NONSPECIFIC DIARRHEA) Signs and symptoms:

Answer 58

vague, episodes of diarrhea

Question 59

IRRITABLE BOWEL SYNDROME (CHRONIC NONSPECIFIC DIARRHEA) Management:

Answer 59

Encourage patient to eat regular diet Fiber rich food or psyllium bulk agents Antispasmodics Probiotics or food supplemented with lactic acid-producing bacteria

Question 60

Refers to deficiencies or excesses in nutrient intake, imbalance of essential nutrients or impaired nutrient utilization. The double burden of malnutrition consists of both undernutrition and overweight and obesity, as well as dietrelated noncommunicable diseases

Answer 60

ALTERATION IN NUTRITION: MALNUTRITION

Question 61

Low weight for height, indicating recent and severe weight loss

Answer 61

Wasting

Question 62

Low height for age, reflecting long-term nutrient deficiencies

Answer 62

Stunting

Question 63

Low weight for age, indicating both acute and chronic malnutrition.

Answer 63

Underweight

Question 64

Lack of essential vitamins and minerals.

Answer 64

Micronutrient deficiencies

Question 65

- Overweight/Obesity - Excess body weight, often due to overconsumption of calories and certain nutrients - Diet-related noncommunicable diseases - Conditions like heart disease, stroke, and diabetes, linked to unhealthy diets

Answer 65

Overnutrition

Question 66

is a severe form of malnutrition characterized by extreme weight loss and muscle wasting, often due to a lack of calories.

Answer 66

Marasmus

Question 67

is a form of malnutrition caused by a severe protein deficiency, leading to edema (swelling) in the extremities and other symptoms.

Answer 67

Kwashiorkor

Question 68

ALTERATION IN NUTRITION: MALNUTRITION - MANAGEMENT

Answer 68

- dietary interventions: increased calorie and nutrient intake, encourage smaller, more frequent meals, provide food supplements, nutrient-dense foods, and fortified foods - addressing underlying medical conditions - provide micronutrient supplements, with specialized care for severe cases.