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MCN 02 > CHAPTER 5:4 > Flashcards

CHAPTER 5:4 Flashcards

GASTROINTESTINAL DISORDERS

1
Q

STRUCTURAL DISORDERS of GASTROINTESTINAL DISORDER

A

A. CLEFT LIP (HARELIP)/CLEFT PALATE
B. ESOPHAGEAL ATRESIA with TRACHEOESOPHAGEAL FISTULA
C. OMPHALOCELE/GASTROSCHISIS

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2
Q

Distinct facial defects that occurs singly or in combination

A

CLEFT LIP (HARELIP)/CLEFT PALATE

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3
Q

Malformation of the face that may occur individually or together

A

CLEFT LIP (HARELIP)/CLEFT PALATE

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4
Q

CLEFT LIP (HARELIP)/CLEFT PALATE:
→ Merging of the upper lip is completed between _____ wk AOG
→ Fusion of the palate is completed between _____ wk AOG

A
  • 7-8th wk AOG
  • 7-12th wk AOG
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5
Q

failure of the maxillary and median nasal processes to fuse

A

Cleft Lip

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6
Q

Incomplete fusion of the palate which results in communication between the mouth and the nose

A

Cleft Palate

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7
Q

Incidence of:
- Cleft Lip
- Cleft Palate

A
  • 1:800 live births
  • Males
    ———————
  • 1:2000 live births
  • Females
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8
Q

Associated with deformed
dental structures

A

Cleft Lip

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9
Q

Difficulty feeding =infant is unable to generate a negative pressure and create suction in the oral cavity

A

Cleft Palate

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10
Q

Types of Cleft Lip

A
  1. Complete
  2. Incomplete
  3. Unilateral
  4. Bilateral
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11
Q

Type of Cleft Lip that extends into the base of the nose and even the gums in which upper teeth are set may also be deformed

A

Complete

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12
Q

Prone to recurrent otitis media→fluid can get in the middle ear →tympanic membrane scarring →hearing loss

A

Cleft Palate

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13
Q

Type of Cleft Lip that is a small notch; maybe a little more than a notching of the vermillion border of the lip and may extend to the nostril

A

Incomplete

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14
Q

Type of Cleft Lip that is generally below the center of one nostril

A

Unilateral

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15
Q

Type of Cleft Lip that is beneath both nostril

A

Bilateral

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16
Q

Cause of CLEFT LIP (HARELIP)/CLEFT PALATE related to chromosomal abnormalities; associated with other defects (omphalocele; TEF); inherited – evidenced by increase incidence in relatives

A

Genetics

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17
Q

Cause of CLEFT LIP (HARELIP)/CLEFT PALATE related to teratogens (maternal smoking accounts for 11-12% of cases, viral infection, folic acid deficiency/avitaminosis)

A

Environmental

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18
Q

CL is apparent at birth – detected with what instrument while in Utero

A

Sonogram

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19
Q

surgical modification for Cleft Lip

A

CHEILOPLASTY

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20
Q

surgical modification for Cleft Palate

A

URANOPLASTY

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21
Q

Date of repair for CHEILOPLASTY

A

6-12 weeks (precedes CP)

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22
Q

Date of repair for URANOPLASTY

A

12-18 months

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23
Q

Surgical modification:
* early repair avoids oral deprivation, prevents trauma and difficulty for the parents
* its difficult to bond with an infant with deformed face

A

CHEILOPLASTY

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24
Q

surgical modification to take advantage of palatal changes that take place with normal growth and before child develops faulty speech

A

URANOPLASTY

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25
Q

surgical modification in anticipation of speech development, it is done before the child develops faulty speech habits

A

URANOPLASTY

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26
Q

what position is to facilitate swallowing and discourage aspiration to pediatrics with CLEFT LIP (HARELIP)/CLEFT PALATE

A

Upright position

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27
Q

What is done because more air is swallowed which can cause regurgitation/vomiting

A

Burp frequently

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28
Q

widely used as part of a cleft lip management to maintain postoperative apposition and to avoid excessive strain after cheiloplasty for a cleft lip

A

Logan’s bow/butterfly adhesive

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29
Q

At what condition are these done to Avoid trauma to the operative site:
▪ Elbow restraint
▪ Jacket restraint for older children to prevent rubbing of site

A

CL

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30
Q

In cleft palate, up to how many weeks are needed for the use of elbow restraint until palate is healed to avoid trauma to the operative site?

A

4-6 weeks

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31
Q

failure of the esophagus to develop a continuous passage, and esophagus ends in a blind pouch with no entry to the stomach

A

Esophageal atresia (EA)

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32
Q

abnormal connection between the esophagus and the trachea

A

Tracheoesophageal fistula (TEF)

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33
Q

3 C’s of TEF

A

choking, coughing, cyanosis

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34
Q

used to determine exact type of anomaly (radiopaque catheter then chest films are taken)

A

Radiography

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35
Q

Management for gastric decompression (placement of a feeding tube, left open to drain by gravity to keep stomach empty of secretion and prevent reflux into lung) and jejunosotomy feeding

A

Gastrostomy

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36
Q

an alternative to gastrostomy if the 2nd step surgery will be much later

A

Cervical esophagostomy

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37
Q

in post-op ESOPHAGEAL ATRESIA with TRACHEOESOPHAGEAL FISTULA, what is the best position to prevent gastric juice from flowing to the fistula

A

Semi-Fowler’s position or right side

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38
Q

Protrusion of intraabdominal contents into the base of umbilicus which is covered by a
translucent sac (peritoneum without skin)→rupture→evisceration

A

OMPHALOCELE

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39
Q

Protrusion of intraabdominal contents through defect in abdominal wall lateral to umbilical ring which is never with a peritoneal sac

A

GASTROSCHISIS

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40
Q

WHAT ARE THE DISORDERS OF MOTILITY IN GASTROINTESTINAL DISORDERS

A

A. GASTROESOPHAGEAL REFLUX
B. HIRSCHPRUNG’S DISEASE
C. COLIC

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41
Q

OBSTRUCTIVE DISORDERS IN GASTROINTESTINAL DISORDERS

A

A. INTUSSUSCEPTION
B. HYPERTROPHIC PYLORIC STENOSIS

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42
Q

MALABSORPTION SYNDROME IN GASTROINTESTINAL DISORDERS

A

CELIAC DISEASE

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43
Q

It is the Return of gastric contents into the esophagus / Backward movement of gastric content

A

GASTROESOPHAGEAL REFLUX

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44
Q

Neuromuscular disturbance in which the cardiac sphincter and lower portion of the esophagus are lax.

A

GASTROESOPHAGEAL REFLUX

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45
Q

What diagnosis for GASTROESOPHAGEAL REFLUX is used to establish presence of reflux

A

Barium swallow (esophagography)

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46
Q

What diagnosis for GASTROESOPHAGEAL REFLUX is used where pH determined at distal esophagus (insertion of small catheter into esophagus through nose)→ to determine the number of reflux episodes

A

24 hour pH probe study

sees number of reflex episodes

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47
Q

What diagnosis for GASTROESOPHAGEAL REFLUX is used with radionuclide scanning for evaluation of gastric emptying (after feeding a radioactive compound)

A

Scintigraphy

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48
Q

What management is For children with severe complications (recurrent aspiration pneumonia, apnea, severe esophagitis, failure to thrive, failure to respond to medical therapy)

A

surgery

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49
Q

What kind of surgery uses Valve mechanism by 360o wrap of the fundus (greater curvature of the
stomach) around the esophagus. A gastrostomy tube is usually inserted during the procedure

A

NISSEN FUNDOPLICATION

50
Q

a management Alternative for children with neurologic impairment who are continuously tube fed

A

NON-SURGICAL PERCUTANEOUS GASTROJEJUNOSTOMY and placement of jejunostomy tube

51
Q

what position is best for those with GASTROESOPHAGEAL REFLUX, after feeding and at night

A

PRONE (head elevated/flat)

NOT SUPINE/INFANT SEAT-worsens GER→↑intraabdominal pressure

30’ prone 60’ supine - both until 6 weeks

52
Q

other name for HIRSCHPRUNG’S DISEASE:

A

Congenital Aganglionic Megacolon

53
Q

_____=without nerve tissue in the colon/rectum
_____=dilated action of colon

A
  • Aganglionic
  • Megacolon
54
Q

It is a Mechanical obstruction due to inadequate motility of the intestines

A

HIRSCHPRUNG’S DISEASE

55
Q

Babies with this birth defect (HIRSCHPRUNG’S DISEASE) are born without intestinal nerve cells called __________

A

ganglion cells

56
Q

leading cause of death in children with Hirschprung’s disease=inflammation of small bowel and colon; s/s=fever, explosive watery diarrhea, dehydration, severe prostrationseptic shock

A

Enterocolitis

57
Q

what occurs when there is vomiting, refusal to suck

A

Dehydration

58
Q

what diagnosis uses - biopsy samples of the inside of the large intestine, near the anus

A

Rectal biopsy

59
Q

This procedure can be done without making an incision on the abdomen. Instead, small laparoscopic (telescopic) instruments are used and the operation is done through the anus.

A

PERINEAL ONE STAGE OPERATION PULL THROUGH PROCEDURE (POOP procedure )

60
Q

What procedure is the Removal of aganglionic segment and temporary colostomy made with the part of the bowel with normal nerve transmission to allow this part to rest and let child gain weight

A

Staged repair

61
Q

closure of the colostomy and reanastomosis of working part of colon to point near anus

A

Corrective

62
Q

recurrent episodes of unexplained crying inability to be consoled

A

COLIC

63
Q

Colic occurs around what weeks of age; subsides spontaneously by how many weeks

A
  • 1-2 weeks of age
  • 16 weeks
64
Q

sharp, visceral pain resulting from torsion, obstruction, or smooth muscle spasm of a hallow or tubular organ, such as a ureter or the intestines

A

COLIC

65
Q

An invagination or telescoping of one portion of intestines into another

A

INTUSSUSCEPTION

66
Q

Invagination of the cecum in colon producing obstruction of the intestines

A

INTUSSUSCEPTION

67
Q

one of the most frequent causes of intestinal obstruction between 3 months to 5 years of age;
50% below 1 year (3-12 months )of age

A

INTUSSUSCEPTION

68
Q

TYPES of INTUSSUSCEPTION (according to location)

A
  1. Ileocolic
  2. Cecocolic
  3. Ileoileal
69
Q

TYPE of INTUSSUSCEPTION which is the most common; ileum invaginates into cecum and ascending colon

A

Ileocolic

69
Q

types of Non-surgical management for INTUSSUSCEPTION

A

a. HYDROSTATIC REDUCTION (by barium enema)
b. PNEUMATIC INSUFFLATION (AIR ENEMA)

70
Q

TYPE of INTUSSUSCEPTION which ileum invaginates into another portion of the ileum

A

Ileoileal

70
Q

complications of INTUSSUSCEPTION include:

A
  • Perforation
  • Peritonitis
  • Sepsis
70
Q

Non-surgical management for INTUSSUSCEPTION Done at the time of diagnostic testing

A

HYDROSTATIC REDUCTION (by barium enema)

70
Q

TYPE of INTUSSUSCEPTION which cecum invaginates into colon

A

Cecocolic

71
Q

What is used to detect intraperitoneal air from a bowel perforation

A

Abdominal radiograph

71
Q

what is used for the obstruction of the flow of barium

A

Barium enema

72
Q

Non-surgical management for INTUSSUSCEPTION where The force exerted by the flowing barium is usually sufficient to push the invaginated portion (80-90% of cases)

A

HYDROSTATIC REDUCTION (by barium enema)

73
Q

Non-surgical management for INTUSSUSCEPTION with No risk of peritonitis and is More rapid

A

PNEUMATIC INSUFFLATION (AIR ENEMA)

74
Q

management for INTUSSUSCEPTION which is a manual reduction of invagination and resection of nonviable intestine when necessary

A

Surgical

75
Q

other name for HYPERTROPHIC PYLORIC STENOSIS

A

INFANTILE HYPERTROPHIC PYLORIC STENOSIS

76
Q

A hypertrophic obstruction of the circular muscle of the pyloric canal

A

HYPERTROPHIC PYLORIC STENOSIS

77
Q

one of the most common conditions requiring surgery in infants, and is seen at the First few weeks of life (1-10 weeks)

A

HYPERTROPHIC PYLORIC STENOSIS

78
Q

standard treatment, which Longitudinal incision through the circular muscle fibers of the pylorus down to, but not including the submucosa

A

PYLOROMYTOMY (FREDET-RAMSTEDT PROCEDURE)

79
Q

other names for CELIAC DISEASE

A
  • Gluten –induced enteropathy
  • Gluten-sensitive enteropathy
  • Celiac sprue
80
Q

Inherited Autoimmune disease of the proximal intestine characterized by abnormal mucosa and permanent intolerance to gluten

A

CELIAC DISEASE

causes: genetics, gluten exposure, GUT microbiome, medical conditions, environmental factors

81
Q

Secondary to CF as a cause of malabsorption in children

A

CELIAC DISEASE

82
Q
  • Chronic, insidious, noted after introduction of gluten-containing grains in the diet, typically
    between 1-5 y/o
  • 1st signs=failure to thrive, diarrhea
A

CELIAC DISEASE

83
Q

what is an excessively large, pale, oily, frothy stools called

A

Steatorrhea

84
Q

screening test for presence of antigliadin; and antireticulin and antiendomysial Ig A and Ig G antibodies (antibodies to connective tissue)

A

Blood test

85
Q

Often follows screening test Demonstrates changes in mucusa and positive clinical response to a gluten-free diet

A

Jejunal biopsy

86
Q

in CLEFT LIP (HARELIP)/CLEFT PALATE, Merging of the upper lip is completed at what week AOG

A

between 7-8th wk AOG

87
Q

in CLEFT LIP (HARELIP)/CLEFT PALATE, Fusion of the palate is completed at what week AOG

A

between 7-12th wk AOG

88
Q

Stomach capacity in mL for:
* NB
* 1 week
* 2-3 weeks
* 1 month
* 3 months
* 1 year
* 2 years

A
  • NB - 10-20mL
  • 1 week - 30-90mL
  • 2-3 weeks - 75-100mL
  • 1 month - 90-150mL
  • 3 months -150-200mL
  • 1 year - 210-360mL
  • 2 years - 500mL
89
Q

6 Postoperative care nursing care for those with CLEFT LIP (HARELIP)/CLEFT PALATE

A
  1. Maintain airway patency
  2. Observe for bleeding
  3. Avoid trauma to the operative site
  4. Minimize pain
  5. Optimum nutrition
89
Q

Causes of CLEFT LIP (HARELIP)/CLEFT PALATE:

A
  1. Genetics
  2. Environmental
  3. Exposure to certain drugs during pregnancy
  4. Nutritiona deficiencies
  5. Certain medical conditions
89
Q

what are the ESSR according to Richard 1991

A

▪ Enlarge the nipple (long, soft)
▪ Stimulate the suck reflex
▪ Swallow fluid appropriately
▪ Rest

89
Q

what position is best for those with CLEFT LIP (HARELIP) to maintain airway patency

A

upright/infant seat position

89
Q

what position is best for those with CLEFT PALATE to maintain airway patency

A

lie on abdomen

89
Q

At what condition is “Rubber tipped syringe on the side of the mouth” used to provide optimum nutrition?

A

CL

90
Q

At what condition is “Paper cup/large hole nipple” used to provide optimum nutrition?

A

CP

91
Q

at what week is the development of larynx, trachea, beginning lung tissue, and esophageal lumen

A

4-6th week

91
Q

What are the 5 types of ESOPHAGEAL ATRESIA with TRACHEOESOPHAGEAL FISTULA

A
  1. Simple esophageal atresia with no fistula (Isolated EA) - A 2
  2. EA with proximal TEF - B4
  3. EA with distal TEF - C1
  4. EA with double TEF - D4
  5. Isolated TEF - E3
92
Q

Type of ESOPHAGEAL ATRESIA with TRACHEOESOPHAGEAL FISTULA: where Upper and lower ends of esophagus are blind, no
connection to the trachea

A

Simple esophageal atresia
with no fistula (Isolated EA) - A2

93
Q

Type of ESOPHAGEAL ATRESIA with TRACHEOESOPHAGEAL FISTULA: where Upper end of the esophagus ends into the
trachea

A

EA with proximal TEF - B4

94
Q

Type of ESOPHAGEAL ATRESIA with TRACHEOESOPHAGEAL FISTULA: where Upper end of esophagus is blind, lower end
connects into the trachea=most common

A

EA with distal TEF - C1

94
Q

Type of ESOPHAGEAL ATRESIA with TRACHEOESOPHAGEAL FISTULA: where Both upper and lower ends of esophagus open
into the trachea by a fistula

A

EA with double TEF - D4

95
Q

Type of ESOPHAGEAL ATRESIA with TRACHEOESOPHAGEAL FISTULA: where No Esophageal atresia but with fistula between
normal esophagus and trachea

A

Isolated TEF - E3

96
Q

At what days is Gastrostomy tube feedings applicable to Provide optimum nutrition for those with ESOPHAGEAL ATRESIA with TRACHEOESOPHAGEAL FISTULA

A

5th-7th day-post-op feedings

97
Q

At what days is Oral feeding when anastomosis site healed applicable to Provide optimum nutrition for those with ESOPHAGEAL ATRESIA with TRACHEOESOPHAGEAL FISTULA

A

10th day-2nd week

98
Q

How do you Protect sac from trauma and infection as a NURSING CARE for those with OMPHALOCELE/GASTROSCHISIS

A
  • Monitor sac and make sure that it is covered with sterile gauze soaked in NSS
  • Place dried sterile gauze over sterile moist gauze and cover with plastic wrap
99
Q

what is a neuromuscular disturbance in which the gastroesophageal (cardiac) sphincter and lower portion of esophagus are lax and therefore allow easy regurgitation of gastric contents into esophagus

A

GASTROESOPHAGEAL REFLUX DISEASE (GERD)

Causes: Relaxed cardiac sphincter, delayed gastric emptying, increased abdominal pressure

100
Q

Pharmacologic management for those with GASTROESOPHAGEAL REFLUX

A

a. H2 antagonists
b. Proton pump inhibitor
c. Prokinetc agents

101
Q

What pharmacologic management for those with GASTROESOPHAGEAL REFLUX: Reduce amount of acid in the gastric contents and prevent esophagitis

A

H2 antagonists

Cimetidine (tagamet), famotidine (Pepcid), Ranitidine (Zantac)

102
Q

What pharmacologic management for those with GASTROESOPHAGEAL REFLUX: Block acid production

A

Proton pump inhibitor

Omeprazole (Prilosec), lansoprazole (prevacid)

103
Q

What pharmacologic management for those with GASTROESOPHAGEAL REFLUX: Increase resting LES pressure mildly and increase the rate of gastric emptying)

→ BUT S/e-restlessness, drowsiness, extrapyramidal reactions and in some,
increase number of reflux episodes

A

Prokinetc agents

Metochlopromide HCl

104
Q

COMPLICATIONS OF SURGERY for those with GASTROESOPHAGEAL REFLUX

A

small bowel obstruction, retching, gas-bloat syndrome, Dumping syndrome

105
Q

what are considered in Feeding for those with GASTROESOPHAGEAL REFLUX

A

▪ Thickened (1 tsp-1 tbsp of rice cereal/oz of formula)
▪ Small frequent feeding
▪ Frequent burping

106
Q

What is done to keep stool small and soft so that they can be easily evacuated

A

Low residue diet

107
Q

What is done to prevent impaction until child is toilet trained; use volume appropriate to weight of the child

A

Isotonic irrigations

Not tap water-water intoxication | Not soap suds

108
Q

What is the significance of Keeping in upright position during feeding for those with colic

A

to prevent aspiration

109
Q

What is done to decrease self stimulation by jerky or sudden movements for those with colic

A

Swaddle

110
Q

what is the telescoping of bowel into itself called

A

INTUSSUSCEPTION

MCN 02 (6 decks)

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