CHAP 45 - GI

Question 1

• Normally obtained by the body through oral ingestion of fluid and by the water formed in the metabolic breakdownof food.
• It is lost from the body in urine and feces

Answer 1

FLUID

Question 2

3 FLUID IMBALANCES

Answer 2

1. ISOTONIC DEHYDRATION
2. HYPERTONIC D
3. HYPOTONIC D
4. OVERHYDRATION

Question 3

Occurs when a child’s body loses more water than it absorbs (as with diarrhea) or absorbs less fluid than it excretes (aswitnausea and vomiting)

Answer 3

ISOTONIC DEHYDRATION

Question 4

When water is lost in a greater proportion than electrolytes

Answer 4

HYPERTONIC DEHYDRATION

Question 5

There is a disproportionately high loss of electrolytes in diabetic proportion to fluid loss

Answer 5

HYPOTONIC D

Question 6

Excessive body fluid intake; generally occurs in children who are receiving IV fluid

Answer 6

OVERHYDRATION

Question 7

PH OF BLOOD

Answer 7

7.35-7.45

Question 8

• Results from diarrhea because a great deal of sodium is lost with stool
• This excessive loss of Na+ causes the body to conserve H+ ions in an attempt to keep the number of positive andnegativeionsin serum balanced

Answer 8

METABOLIC ACIDOSIS

Question 9

• With vomiting, a great deal of hydrochloric acid is lost. - Number of H+ ions becomes proportionately lower than the number of OH- ions present
• The serum HCO3 will invariably be high

Answer 9

METABOLLIC ALKALOSIS

Question 10

Most children with _________ are suffering from an acute episode of gastroenteritis (infection) due to a viral or bacterial
organism.

Answer 10

VOMITING

Question 11

is often associated with infectious, chronic illnesses, or malabsorption issues

Answer 11

DIARRHEA

Question 12

 Causative agent: one of the Salmonella bacteria.

 Incubation period: 6 to 72 hours for intraluminal type; 7 to 14 days for extraluminal type

 Period of communicability: while the organisms are being excreted (may be as long as 3 months)

 Mode of transmission: ingestion of contaminated food, especially chicken and uncooked eggs

Answer 12

SALMONELLOSIS

Question 13

Causative agent: Listeria monocytogenes.

 Incubation period: variable, ranging from 1 day to more than 3 weeks

 Mode of transmission: ingestion of unpasteurized milk or cheeses or vegetables grown in contaminated soil. Theinfectionis particularly important to avoid during pregnancy because infections during pregnancy can lead to miscarriageor stillbirth,prematurity, or infection of the newborn.

Answer 13

LISTERIOSIS

Question 14

 Causative agent: organisms of the genus Shigella
 Incubation period: 1 to 7 days
 Period of communicability: approximately 1 to 4 weeks
 Mode of transmission: contaminated food, water, or milk products

Answer 14

SHIGELLOSIS (DYSENTERY)

Question 15

 Causative agent: staphylococcal enterotoxin produced by some strains of Staphylococcus aureus
 Incubation period: 1 to 7 hours
 Period of communicability: carriers may contaminate food as long as they harbor the organism
 Mode of transmission: ingestion of contaminated food such as poultry, creamed foods (e.g., potato salad), andinadequatecooking

Answer 15

STAPHYLOCOCCAL FOOD POISONING

Question 16

a results in loose, watery stools. The Chief therapy for these is ORS. Childrenwhoarecultured with G. Lamblia may be prescribed metronidazole.

Answer 16

PROTOZOAN / VIRAL DIARRHEA

Question 17

COMMON DISORDERS OF THE STOMACH AND DUODENUM

Answer 17

 Inadequate function of the gastroesophageal valve
 Infections
 Gastroesophageal Reflux (GER)

Question 18

in infants occurs due to the imma-turity of the lower esophageal sphincter, which allows easyregurgitation of gastric contents into the esophagus. It is very common during infancy, with about 70% of infants affected, anditusually requires no treatment. It is more common in preterm infants. It usually starts within 1 week of birth and may beassociated with a hiatal hernia. The emesis occurs after eating, is effortless, and most often consists of 1 to 2 oz of undigestedmilk.

Answer 18

GASTROESOPHAGEAL REFLUX

Question 19

When infants develop complications from reflux such as:
 Irritability
 Failure to thrive
 Esophagitis
 Aspiration pneumonia
 Wheezing
 Apnea
Children with cerebral palsy or other neurologic involvement are at particular risk
Reflux is occasionally due to cow’s milk intolerance`

Answer 19

GASTROESOPHAGEAL REFLUX DISEASE

Question 20

• The pyloric sphincter is the opening between the lower portion of the stomach and the beginning portion of the intestine(theduodenum). If hypertrophy or hyperplasia of the muscle surrounding the sphincter occurs, it is difficult for the stomachtoempty,a condition called pyloric stenosis. The incidence is high, approximately 1:150 in males and 1:750 in females. It tends tooccurmost frequently in first-born White male infants. The exact cause is unknown, but multifactorial inheritance is a presumedetiology.

Answer 20

PYLORIC STENOSIS

Question 21

a shallow excavation formed in the mucosal wall of the stomach, the pylorus, or the duodenum. Theyarerare,occurring in only 1% to 2% of children and more fre-quently in males than females.

Answer 21

PEPTIC ULCER DISEASE

Question 22

include both congenital disorders, such as obstruction or atresia of the biliary duct, and acquireddisor-ders,such as hepatitis or cirrhosis.

Answer 22

HEPATIC DISORDER

Question 23

(inflammation and infection of the liver) is caused by invasion of the A, B, C, D, or E virus

Answer 23

HEPATITIS

Question 24

 Causative agent: a picornavirus, A virus (HAV)
 Incubation period: 25 days on average
 Period of communicability: highest during 2 weeks preceding onset of symptoms
 Mode of transmission: in children, ingestion of fecal-contaminated water or shellfish; day care center spreadfromcontaminated changing tables

Answer 24

HEPA A

Question 25

 Causative agent: a hepadnavirus; B virus (HBV)  Incubation period: 120 days on average  Period of communicability: later part of incubation pe-riod and during the acute stage  Mode of transmission: transfusion of contaminated blood and plasma or semen; inoculation by a contami-natedsyringeorneedle through IV drug use; may be spread to fetus if birthing parent has infection in third trimester of pregnancy

Answer 25

HEPA B

Question 26

is a single-strand RNA virus. Transmission, as with HBV, is primarily by bloodor bloodproducts, IV drug use, maternal-fetal transfer, or sexual contact. The virus produces mild symptoms of disease, but thereisa high incidence of chronic infection with the virus

Answer 26

HEPATITS C

Question 27

is enterically transmitted simi-larly to hepatitis A (e.g., fecal-contaminated water). Diseasesymptoms from the E virus can range from asymptomatic to mild to chronic liver disease. Young children oftenhavenosymptoms, and most people recover fully from the disease (CDC, 2021b).

Answer 27

HEPA E

Question 27

when it persists for longer than 6 months. It is most likely the result of a hepatitis B, D, orCinfection. Abnormal liver enzyme levels and a liver biopsy establish the diagnosis and can predict the severity. Withchronichepatitis, fatty infiltration and bile duct dam-age can occur. The disease may progress to cirrhosis and even-tually liver failure.Therapy is supportive to compensate for decreased liver function (Lin & Kao, 2020).

Answer 27

CHRONIC HEPATITS

Question 28

or the delta form, is similar to HBV in transmission, although it apparently requires a coex-istingHBV infection to be activated. Disease symptoms are mild, but there is a high incidence of fulminant hepatitis after theinitial infection.

Answer 28

HEPA D

Question 29

is present when acute, massive necrosis or sudden, severe impairment of liver function oc-curs, leading to liver failure and hepatic encephalopathy. It can be due to infection or toxicity. Acetaminophen overdoseis alikelyetiology. Hepatic encephalopathy, or invasion of brain cells by ammonia, occurs because of the inability of the liver todetoxifythe ammonia being constantly produced by the intestine in the process of digestion (Brumbaugh et al., 2020)

Answer 29

FULMINANT HEPATIC FAILURE

Question 30

generally occurs from congenital biliary atresia, stenosis, or absence of theduct. Italsocan occur from the plugging of biliary secretions, although this is rare. When the bile duct is obstructed, bile, unabletoentertheintestinal tract, accumulates in the liver. Bile pigments (direct bilirubin) enter the bloodstream and jaundice occurs, increasinginintensity daily.

Answer 30

OBSTRUCTION OF THE BILE DUCT

Question 31

s (distended veins in the esophagus) are a frequent complication of liver disorders such as cirrhosis. Theygenerally form at the distal end of the esophagus near the stomach because of back pressure on the veins resulting fromincreased portal circulation blood pressure. Varices may bleed if the child coughs vigorously or strains to pass stool. Gastricreflux into the distal esophagus may irritate and erode the fine covering of the distended vessels, causing rupture

Answer 31

ESOPHAGEAL VARICES

Question 31

is the accumula-tion of fatty deposits in the liver and is usually associated with obesity. As obesity is increasing in school-agedchildren and adolescents, this condition is also increasing in incidence (Brumbaugh et al., 2020). NAFLD can progress tocirrhosisin rare cases.

Answer 31

NON-ALCHOLIC FATTY LIVER DISEASE (NAFLD)

Question 31

Is fibrotic scarring of the liver. ___________ means "yellow," or the typical color of hepatic scar tissue. It rarely occurs inchildren, although it may be seen as a result of congenital biliary atresia or as a complication of chronic ill-nesses such as protractedhepatitis, sickle cell anemia, or cystic fibrosis.

Answer 31

Cirrhosis

Question 32

the surgical replacement of a mal-functioning liver by a donor liver. Child-size donor livers are not readily available, sothewaiting time for surgery may be months. Adult livers can be reduced in size for transplantation or a lobe of a liver fromalivingdonor can be used. Often, the child is extremely ill with ascites, GI bleeding, extreme pruritus, hepatic encephalopathy, orrenaldysfunction before the surgery. This makes nursing care after liver transplantation in a child complex as it involves takingcareofa child who has had major surgery and who normally would be too ill to undergo surgery.

Answer 32

LIVER TRANSPLANTATION

Question 33

The invagination of one portion of the intestine into another, most frequently occurs in the second half of the first year of life(Mandeville, Chien, Willyerd, et al., 2012) with 90% of cases occurring by 2 years of age. About 75% of intussusceptionoccursforidiopathic reasons where there is no clear cause. In other cases, a “lead point” on the intestine likely cues the invagination. Sucha point might be a Meckel’s diverticulum, a polyp, hypertrophy of Peyer patches (lymphatic tissue of the bowel that increasesinsize with viral diseases), or bowel tumors. The point of the invagination is generally at the juncture of the distal ileumandproximal colon

Answer 33

INTUSSUSCEPTION

Question 34

is the twisting of the intestine, which blocks stool passage and cuts off blood supply to the affected area. It oftenresultsfrom intestinal malrotation, a condition where the intestines do not rotate and attach properly during fetal development, usually between the 6th and 10th week of pregnancy. This incomplete rotation leads to an unstable mesentery, makingtwistingmore likely.

Answer 34

VOLVOLUS WITH MALNUTRITION

Question 35

There is a lower incidence of the condition in infants who are fed breast milk than in those who are formula fed becauseintestinal organisms grow more profusely with cow’s milk than breast milk (cow’s milk lacks antibodies). A responsetotheforeign protein in cow’s milk may also be a mechanism that starts the necrotic process. Therefore, encouraging breastfeedingmay help prevent this disorder (Underwood, 2013) Signs of NEC usually appear in the first week of life. The infant’s abdomenbecomes distended and tense.

Answer 35

NECROTIZING ENTEROCOLITIS (NEC)

Question 36

is an absorptive disorder in which there is not sufficient bowel surface area in the small intestine for proper nutrient absorption.The condition has several causes, including surgery for NEC, volvulus, and GI tract trauma, which resulted in a largeportionofthe intestine being removed.

Answer 36

SHORT BOWEL/SHORT GUT SYNDROME

Question 37

(INFLAMMATION OF THE APPENDIX) is the most common cause of abdominal surgery in children. It occurs most frequently in school-age children and adolescents, although it can occur in preschoolers and even in newborns (Ladd, Neff, Becher, et al., 2012).

Answer 37

APPENDICITIS

Question 38

During embryonic life, the intestine is connected to the umbilicus by the omphalomesenteric (vitelline) duct, whichtypicallyregresses by term. In about 2–3% of infants, a portion remains as Meckel’s diverticulum—located near the ileum. It maycontaingastric mucosa that secretes acid, causing intestinal irritation, ulcers, and painless, bloody or tarry stools. It can alsoleadtointussusception or bowel obstruction due to fibrous bands. Diagnosis is suggested by history and confirmed with a Meckel’sscan.Treatment involves laparoscopic removal.

Answer 38

MECKEL'S DIVERTICULUM

Question 39

is an immune reaction to gluten found in wheat, rye, barley, and possibly oats, in genetically predisposedindividuals.

Answer 39

CELIAC DISEASE

Question 40

is a common childhood issue, often starting in the first year of life, and occurs without an underlyingmedical condition. It’s usually defined as two or fewer painful bowel movements per week. Stools are hard, large, andpainful, sometimes causing anal fissures. This pain leads to stool holding, which worsens the problem as the rectumstretches andreduces the urge to defecate.

Answer 40

CONSTIPATION

Question 41

is a protrusion of a section of the bowel into the inguinal ring. It usually occurs in boys (9:1) because, as the testes descendfromthe abdominal cavity into the scrotum late in fetal life, a fold of parietal peritoneum also descends, forming a tube fromtheabdomen to the scrotum (García-Hernández, Carvajal-Figueroa, Suarez- Gutiérrez, et al., 2012). In most infants, this tubeclosescompletely.

Answer 41

INGUINAL HERNIA

Question 42

(instillation of carbon dioxide into the perineal cavity) during surgery may be performed to reveal thepresence of an enlarged inguinal ring on the opposite side

Answer 42

PNEUMOPERITONEUM

Question 43

is an absence of ganglionic innervation to the muscle of a section of the bowel—in most instances, the lower portionof thesigmoid colon just above the anus

Answer 43

AGANGLIONIC MEGACOLON

Question 44

develop crampy abdominal pain, urgency, tenesmus, and frequent bloody stools. Anemia and hypoalbuminemia due to losses in the stool may be present.

Answer 44

ULCERATIVE COLITIS

Question 45

Common signs include abdominal pain, diarrhea (with or without blood), and weight loss. Inflammation may cause bowel narrowing (strictures) and, if untreated, bowelobstruction. Fistulae—abnormal tunnels between the bowel and other organs or skin—often affect the perianal area

Answer 45

CROHN DISEASE

Question 46

is a functional bowel disorder marked by abdominal pain and altered bowel habits without anidentifiable organic cause

Answer 46

IRRITABLE BOWEL SYNDROME

Question 47

The pain can be constant or come and go, usually centered around the belly button, with no link to meals or bowel habits.Physical exams often show no signs of tenderness or swelling, but stress-related issues like sleep problems or family tensionmaybe present. Though the pain is real, treatment focuses on symptom management through dietary changes (like addingfiberorprobiotics), medications, and therapies such as cognitive behavioral therapy, hypnosis, and parental support

Answer 47

RECURRENT ABDOMINAL PAIN

Question 48

a severe protein deficiency disease

Answer 48

KWASHIORKOR

Question 49

a severe form of malnutrition caused by a deficiency of all food groups, essentially a state of starvation.

Answer 49

NUTRITIONAL MARASMUS