GASTROINTESTINAL DISORDER

Question 1

GASTROESOPHAGEAL REFLUX

Answer 1

1. Facts
   - Called achalasiain infants
   - Cardiac sphincter & lower portion of the esophagus are lax and allow easy regurgitation
2. Causes
   - cerebral palsy & hiatal hernia
3. S/Sx
   - effortless vomiting
   - irritable
   - episodes of Apnea

Question 2

GASTROESOPHAGEAL REFLUX THERAPEUTIC MANAGEMENT

Answer 2

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. Ranitidine or omeprazole
3. Tightening of esophageal sphincter
4. Fundoplication
5. Do not lie down 2 hours after eating

Question 3

PYLORIC STENOSIS

Answer 3

1. Fact
   - Hypertrophy of the muscle surrounding the pyloric sphincter
2. S/Sx
   - Projectile vomiting immediately after feeding
   - sour, non bilous vomit
   - Dehydration lack of tears, dry mouth, sunken fontanels, fever, decreased urine output, poor skin turgor, weight loss
   - Alkalosis
   - Hypopnea (slowed respiration)
   - Olive shaped mass

Question 4

PYLORIC STENOSIS

Answer 4

1. Dx: Barrium swallow
2. Nsg Diagnosis w/ intervention
   - Risk for fluid volume deficit
   - Int: Monitor weight and urine output

Question 5

PYLORIC STENOSIS Management

Answer 5

1. Pyloromyotomy -electrolyte imbalance, dehydration & starvation must be corrected first
2. No oral feedings
3. Fredet Ramstedt procedure

Question 6

INTUSSUSCEPTION

Answer 6

Invagination of one intestine to another

Question 7

Causes of INTUSSUSCEPTION

Answer 7

• Meckel’s diverticulum
• polyp
• Hypertrophy of Peyer’s Patches
• Bowel Tumors

Question 8

INTUSSUSCEPTION S/Sx

Answer 8

• Vomiting with bile
• Currant jelly stool
• Abdominal distention
• Sausage shaped mass
• Sudden drawing up of legs & cry because of pain

Question 9

INTUSSUSCEPTION Management

Answer 9

Surgery, installation of water soluble solution, barium enema or air

Question 10

INTUSSUSCEPTION Nursing Diagnosis

Answer 10

-Pain
-Risk for fluid volume deficit

Question 11

VOLVULUS WITH MALROTATION

Answer 11

twisting of the intestine leads to obstruction of the passage of feces and compromise of blood supply to the loop of intestine involved

Question 12

VOLVULUS WITH MALROTATION S/Sx

Answer 12

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

Question 13

VOLVULUS WITH MALROTATION: Dx and Management

Answer 13

1. Dx
   - History Taking
   - Abdominal Examination
   - Ultrasound or lower Barium x-ray to check for obstruction
2. Management
   - Surgery

Question 14

MECKEL’S DIVERTICULUM

Answer 14

• 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.

Question 15

MECKEL’S DIVERTICULUM S/Sx

Answer 15

Infants: painless, tarry stools or grossly bloody stool

Question 16

MECKEL’S DIVERTICULUM Dx

Answer 16

History Taking

Question 17

MECKEL’S DIVERTICULUM Management

Answer 17

Laparoscopy exploration

Question 18

CELIAC DISEASE

Answer 18

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

Question 19

CELIAC DISEASE S/Sx

Answer 19

• Steatorrhea
• Vit. ADEK deficiency
• Malnutrition
• Rickets
• hypoprothrombinemia
• hypochromic anemia
• hypoalbuminemia

Question 20

CELIAC DISEASE NURSING DIAGNOSIS WITH INTERVENTIONS

Answer 20

Imbalanced nutrition, less than body requirements
- Record characteristics of stools
- Read food labels carefully
- Avoid spaghetti, hotdogs, cake, cookies

Question 21

CELIAC DISEASE Management

Answer 21

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

Question 22

HIRSCHPRUNG DISEASE

Answer 22

1. Facts
   - Absence of aganglionic innervation to the muscle of a section of the bowel
   - No peristaltic waves
2. S/Sx
   - chronic constipation
   - abdominal distention
   - ribbon like stools
   - failure to pass meconium by 24 hours

Question 23

HIRSCHPRUNG DISEASE NURSING DIAGNOSIS WITH INTERVENTIONS

Answer 23

1. Constipation r/t reduced bowel function
   - Normal saline for enemas: 2 tsp non- iodized salt with 1 quart water
2. Imbalanced nutrition: less than body requirements
   - no fried food & highly seasoned food
   - post-op: assess for bowel sounds & passage of flatus

Question 24

ULCERATIVE COLITIS

Answer 24

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

Question 25

CROHN’S DISEASE

Answer 25

- inflammation of segments of the intestine - may affect any part of the GI tract but most commonly involves terminal ILEUM. -

Question 26

ULCERATIVE COLITIS and CROHN’S DISEASE S/Sx and Dx

Answer 26

1. S/Sx - Diarrhea - Steatorrhea - Weight loss - Recurring fever 2. Dx - Colonoscopy - Barium Enema - Biopsy

Question 27

ULCERATIVE COLITIS and CROHN’S DISEASE THERAPEUTIC MANAGEMENT

Answer 27

1. Enteral or Total Parenteral Nutrition 2. Anti-inflammatory medications 3. SURGICAL MGT. - Bowel resection - Colectomy - Colostomy

Question 28

IRRITABLE BOWEL SYNDROME

Answer 28

- involves intermittent episodes of loose and normal stools or recurrent abdominal pain - cause is UKNOWN - Associated with low fat intake and excessive fluid intake.

Question 29

IRRITABLE BOWEL SYNDROME S/Sx

Answer 29

vague,episodes of diarrhea

Question 30

IRRITABLE BOWEL SYNDROME Management

Answer 30

- Encourage patient to eat regular diet - Psyllium bulk agents - Probiotics or food supplemented with lactic acid-producing bacteria