class 7. GI GU Flashcards
a. Omphalocele
b. Gastroschisis
c. Anorectal Malformations
d. Hernias
i. Diaphragmatic
ii. Umbilical
e. Short bowel syndrome
f. Biliary atresia
define these GI issues
a. Enuresis
b. Encopresis
c. Acute Glomerulonephritis
d. Phimosis
e. Cryptorchidism
f. Inguinal hernia
g. Hydrocele
h. Testicular Torsion
Define these GU issues
Changes in children
-Coordinated suck and swallow ability develop by 34 wks gest
-Coordinated oral pharyngeal movements to allow solids develop after 2 months
-Abd distention can cause resp distress in young children because the accessory muscles of respirations are less developed and more dependent on the diaphragm as primary muscle of respiration
-Stomach capacity increases from 10-20 ml in early infancy to up to 3 L by late adolescence
-lactase levels are low in preterm neonates, peak in infancy, and gradually decline after early childhood
-infants and young child may have palpable liver edge 1-2 cm below the right costal margin
-pancreatic amylase secretion at 4-6 months
-pancreatic lipase levels are low and then increase
-intestines are highly permeable = allows uptake of protective immunoglobulin from human milk
-stool frequency is highest in infancy and decreases to adult frequency at 4 years
-defecation is involuntary in infancy (under reflex control), voluntary control is at 18months-4years
Most congenital issues occur before 8 wks because it is a highly sensitive period of growth
common sites of action of teratogens:
-ASD, VSD, truncus arteriosus
-Amelia, meromelia
-cleft lip, palate
-lowset ears
-cataracts, glaucoma
-masculinization of female genitalia
Cleft
lip is more common than palate
failure of maxilla closure by 6 wks gest
union of upper lip - 7-8th wk
soft and hard palate dev 7-12th wk
can be unilateral or bilateral and involve soft or hard or both
Causes:
Genetic and environmental (multifactorial)
-responsible gene unknown
-associated w/ chromosomal abnormalities
-Drugs (phenytoin, valproic acid, thalidomide)
-Pesticides (dioxin)
-folic acid deficiency
-alcohol and smoking
Dx:
-by ultrasound at 14-16 wks
(highlighted) Tx:
-cleft lip repair at 2-3 months
lips sutured together with stabilizing device to prevent tension on suture line
**need to minimize crying
-cleft palate repair at 6-12 months
early repair protects formation of taste buds and normal dev of speech
Long-term problems:
-higher risk for ear infections, needs ear tubes
-speech and language
-teeth malformed/positioned
Pre-Op care
RISK FOR ASPIRATION:
-assess resp status and VS q2h
-suction nose and mouth prn
-position upright for feedings, hold there for 30 after feeding
-burp frequently q15-30 mL
IMBALANCED NUTRITION: LESS THAN BODY REQUIREMENTS
-may use special bottles (Haberman feeder)
-NG feeds prn
-BFing is possible but may be difficult with cleft palate
-monitor weight
RISK FOR COMPROMISED PARENT COPING:
-help parents see whole child, not just defects
Post Op Care
IMPAIRED TISSUE INTEGRITY
-position supine
-avoid straws, hard utensils, or pacifiers
-use elbow restraints (soft)
-maintain metal bar or steri-strips over lip repair
-clean suture line with water or NS after each feed (infection interferes with healing)
-minimize crying
RISK FOR FEEDING DIFFICULTIES OR ASPIRATION:
-sit semi-upright for feeding
-position to prevent airway obstruction
IMBALANCED NUTRITION LESS THAN BODY REQUIREMENTS:
-modify feeding technique w appliances prn
-frequent burping
ACUTE PAIN:
-pain management. may use sedation but remember sedation does not mean analgesia
-cuddling, tactile stimulation
KNOWLEDGE DEFICIT:
-teach feeding techniques
-S&S infection
INTERRUPTED FAMILY PROCESSES:
-refer to support groups prn
-care of suture line
-preparation of siblings
Esophageal Atresia (EA) &
Tracheoesophageal Fistula (TEF)
-failure of esophagus to dev as a continuous tube during 4-5 wk gst
-failure of trachea and esophagus to separate into 2 distinct structures
MANIFESTATIONS:
-frothy saliva in mouth, nose
-drooling
-choking, coughing, sneezing
(highlighted) RISK OF ASPIRATION-cyanosis, apnea
-caught in hours to days
causes:
-polyhydramnios- too much fluid in utero
associated anomalies:
-congenital heart defects, GI or urinary tract, musculoskeletal
-most common is when trachea enters stomach and lungs. food comes back up esophagus
-blind pouch
Pre Op Care
-surgical emergecy. ASAP w. Gtube
-HOB raised slightly to reduce aspiration
-maintain patent airway, suction prn
-continuous flow/low intermittent suction to blind puch (Replogle tube)
-NPO. Iv fluids, prophylactic abx
Post Op Care
Pain management
IV fluids, abx
TPN until oral or Gtube feeds tolerated. Go slow
Monitor weight
Complications:
-GE reflux,
-aspiration
-strictures
DISCHARGE TEACHING:
-need to suction
-signs of resp distress (many have some degree of tracheomalacia - softening of tracheal cartilage = can collapse)
-signs of constriction of esophagus (poor feeding dysphagia, drooling, regurgitating undigested food)
-risk for infection
Hypertrophic Pyloric Stenosis
(highlighted) def: obstruction of circular muscle of pyloric canal
(tight and doesn’t allow food to pass pyloric sphincter into stomach, maybe just a bit of milk)
-unknown cause
Most distinct common symptoms:
-projectile vomit
-always hungry, irritable
-no weight gain
-visible peristalsis
-few, small stools
Good prognosis w surgery
(highlighted) Assessment:
-visible peristaltic waves
-hyperactive bowel sounds
-olive-shaped mass in upper quadrant
-hydration status
-monitor vomiting
Nursing Care:
MEET FLUID NEEDS
-NPO, IV, accurate I&O
MINIMIZE WEIGHT LOSS
-daily weight
-small, frequent feedings q4-6 hours post-op
PROMOTE REST AND COMFORT
-pre-op cuddling, swaddling, pacifier
-post-op pain management
PREVENT INFECTION
-incision clean, dry, temp
SUPPORTIVE CARE
-explanations for parents
DISCHARGE TEACHING
-S&S of infection of incision
-fold diaper away from incision
-occasional vomiting may occur first 24-48 hrs post-op
Gastroesophageal Reflux
Def: transfer of gastric contents back into esophagus
-common cause: transient relaxation of LES
-lower esophageal sphincter should remain
tonically contracted at rest
-GER vs GERD
GER =normal, no medical intervention
vs
GERD ++severe needs tx. peaks at 4
months, resolves by 1 yr
-risk of uRTI because of aspiration.
Children prone to dev GER:
-BPD, TEF or EA repairs, preterm, neuro disorders, CF cystic fibrosis, CP cerebral palsy
MANIFESTATIONS:
-hungry, irritable
-weight loss
-hx of vomiting, URTI
-apnea
-hematemesis
-gagging, choking after feeding
Passive regurgitation (vomit while holding)
Dx:
-hx
-upper GI series
24 hr pH probe monitoring
-endoscopy w/ biopsy
Tx:
-depends on severity
-mild:
-modify feeding habits (ex. thicken feeds,
avoid foods that aggravate)
-medications: H2 receptor antagonists,
proton pump inhibitors
-upright position 30 min after feeds
-severe: surgery w/ Gtube for 6 wks
(surgery: Nissen fundoplication- sutures passing thru esophageal musculature)
Nursing Care:
-daily weight
-signs of resp distress
-adequate nutrition small frequent feeds, raise upper body 30 degrees after feeds, Gtube care
Ileocolic Intussusception
def: invagination/telescoping of one portion of intestine into another
(the colon goes inside the small intestine)
cause:
-common with viral illness, gastroenteritis
-results in obstruction -> inflammation, edema, decreased blood flow -> ischemia, perforation, peritonitis, shock
MEDICAL EMERGENCY
MANIFESTATIONS:
-sudden onset crampy (colicky) abd pain
-distention, firm abd
-inconsolable crying, knees drawn up
-may dev bilious emesis and lethargy
-red currant jelly stools
-palpable sausage-shaped mass in RUQ
-sometimes it can right itself and pop out BUT risk of going back in
-if it doesn’t, the section can lose blood supply and it needs to be resectioned surgically
Hirschsprung Disease
(congential Aganglionic Megacolon)
(highlighted) def: absence of autonomic parasympathetic ganglion cells in one or more segments of colon
cause:
-congenital - colon doesn’t form properly, didn’t get the nerves
-lack of innervation produces absence of peristalsis which causes accumulation of intestinal contents, bowel distension proximal to defect (megacolon)
-results in mechanical obstruction
-also no absorption in that section
MANIFESTATIONS:
-failure to pass meconium within 24-48 hrs (noticed early)
-bilious vomiting
-abd distension
-FTT - failure to thrive
-constipation
-visible peristalsis
-palpable fecal mass
definitions to know for GI
Anorectal Malformations:
-anomalies of the rectum and distal anus, the urinary tract, and the genital tract
-associated with other abnormalities (VACTERL)
-common: imperforate anus
Biliary atresia:
-when the extrahepatic bile ducts fail to develop or are closed.
-Absence or blockage of the extrahepatic bile ducts results in blocked bile flow from the liver to the duodenum. This altered bile flow soon causes inflammation and fibrotic changes in the liver.
-Lack of bile acids also interferes with digestion of fat and absorption of fat-soluble vitamins A, D, E, and K, resulting in steatorrhea and nutritional deficiencies. Without treatment the disease is fatal by 2 years of age
Gastroschisis:
-abd wall structural defect 1.0
-is a congenital defect of the ventral abdominal wall, characterized by protrusion of bowel through a defect in the abdominal wall to the side (most often to the right) of the umbilicus. —Unlike the omphalocele, no membrane covers the organs
Hernias:
-the protrusion or projection of an organ or a part of an organ through the muscle wall of the cavity that normally contains it
Diaphragmatic:
-congenital
-abdominal contents protrude into the
thoracic cavity through an opening in
the diaphragm.
Umbilical:
-Omentum and small intestine
herniate or protrude through the
opening with coughing, crying, or
straining during a bowel movement
-results from imperfect closure or
weakness of the umbilical ring
Omphalocele:
-abd wall structural defect 2.0
-is a congenital malformation in which intra-abdominal contents herniate through the umbilical cord
-results when the intestines fail to return to the abdomen when the abdominal wall begins to close by 10 wk gest
Short bowel syndrome:
-Disorders of malabsorption include celiac disease, lactose intolerance, and short bowel syndrome
-a decreased ability to absorb and digest a regular diet due to a shortened intestine. Loss of intestine may result from extensive bowel resection for treatment of necrotizing enterocolitis or inflammatory disorders or from a congenital bowel anomaly such as intestinal malrotation, gastroschisis, or atresia
