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GI Flashcards

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1
Q

GERD sx

A 
Vomiting and regurgitation - non-bilious
Crying
Irritable - esophagitis
Refusal to eat
Failure to thrive
Apnea, aspiration
URI
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2
Q

GERD diagnosis

A

Esophageal probe study with a pH probe (apple juice)

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3
Q

GERD tx

A 
Dietary modifications
Small frequent feedings
Thickening formula w/ cereal or oatmeal
Prone position
Elevate HOB
Meds: antacids, prokinetics and acid suppression
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4
Q

Opening through which food passes from the stomach to the intestines

A

Pylorus

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5
Q

Pyloric stenosis

A

Sphincter hypertrophies and leads to a narrowed opening and obstruction to the flow of food into the intestines

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6
Q

Pyloric stenosis sx

A 
Projectile vomiting
No bile
Hungry infant and wants to eat
Dehydration
Weight loss
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7
Q

Pyloric stenosis diagnosis

A

Palpate the hypertrophied pylorus (olive shaped mass)

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8
Q

Difference btwn GERD and pyloric stenosis

A

GERD:
oozing vomit, don’t want to eat, aspiration pneumonia, UGI, rice cereal/antacids
PYLORIC:
projectile vomit, want to eat, palpate mass/U.S.,

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9
Q

Pyloric stenosis tx

A

Pylormyotomy

Begin feeds slowly

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10
Q

Pyloric stenosis pre op mgmt

A 
Correct dehydration
Daily wt on same scale
NPO- pacifier
I & O - specific gravity
Weigh diapers
NG prep
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11
Q

When to begin feedings with Pyloric stenosis

A

As soon as bowel sounds present

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12
Q

Segment of bowel telescoped into an adjacent intestine

A

Intussusception

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13
Q

Intussusception occurrence

A

3-9 months

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14
Q

Intussusception sx

A 
Colic
Abd. pain
Vomiting
Currant jelly like stools
Big baby- obstructed stomach
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15
Q

Intussusception diagnosis

A

U.S.

Barium enema - perforation

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16
Q

Intussusception tx

A

Barium enema
Air enema
Surgery
NPO w/ NG tube

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17
Q

Absence of parasympathetic ganglion in the large intestine

A

Hirschsprung’s disease

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18
Q

What does Hirschsprung’s cause?

A

Prevents peristalsis and causes feces to accumulate proximal to the defect and leads to a bowel obstruction

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19
Q

Where is the section w/out ganglion located?

A

Recto sigmoid area

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20
Q

Hirschsprung’s sx

A 
Failure to pass meconium w/in 24 - 48 hr p birth
Abd. distention
Bile stained vomit
Refusal to sat
Intestinal obstruction
Enterocolitis
Colon->rupture->sepsis->death
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21
Q

Hirschsprung’s diagnosis

A

Commonly found around 1 year of age bc the signs and symptoms aren’t as bad; put off

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22
Q

Hirschsprung’s tx

A

Surgical, w/in 2 stages

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23
Q

Hirschsprung’s tx stage 1

A

Temporary colostomy of the normal bowel allows bowel to rest and child to gain wt

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24
Q

Hirschsprung’s tx stage 2

A

Affected area is resected/removed and the normal bowel is reanastomosed to the rectum. Colostomy is closed

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25
What should be questioned with Hirschsprung's?
Chronic constipation
26
Hirschsprung's mgmt
Colostomy care | NPO w/ NG tube
27
Absence of anal opening
Imperforate anus
28
What is Imperforate anus associated with?
Defects of the urinary tract, esophagus and intestines
29
Imperforate anus sx
Obvious at birth Stool coming from vagina due to a fistula Unable to take rectal temp
30
Imperforate anus diagnosis
Baby held upside down to allow air to ride into anal area
31
Imperforate anus tx
Depends on extent.. Anal stenosis: dilation of anus anoplasty High malformations: colostomy and reanastomsis
32
Imperforate anus mgmt
Assess patency by taking rectal temp on newborn Note failure to pass meconium first 24-48 hr Observe rectal dimple Record stools/meconium
33
Who is at high risk post op due to urine and feces?
Imperforate anus pt
34
Gluten sensitive enteropathy
Celiac disease
35
BROW
Intolerance gluten and the protein to barley, rye, oats and wheat for celiac disease
36
Celiac sx
``` Anorexia Abd. distention Diarrhea Irritability Listlessness Large amt of unabsorbed fat in stools Stools are bulky, foul, smelling and float Wt loss ```
37
What does a celiac biopsy of the small bowel show?
Atrophy of the villi
38
Cereal/ flours
Gluten free: Buckwheat, rice flour, corn, tapioca, soya | Gluten: wheat, bran, barely, rye, semolina, barley, pearl barley
39
Dairy products and eggs
Gluten free: Eggs, milk, cheese, butter, cream, curd cheese | Gluten: yogurts, cheese spreads
40
Beverages
Gluten free: coffee, tea, herb tea, cocoa, alc. | Gluten: malted drinks
41
Fruits and vegetables
Gluten free: All
42
Nuts and seeds, beans
Gluten free: All except certain baked beans
43
Preserves
Gluten free: Jams, syrup, marmalade
44
Miscellaneous
Gluten free: salt, pepper, vinegar, herbs, tamari, yeast | Gluten: soy
45
Extrusion of abd. contents, large and small intestine w/out umbilical cord
Gastroischesis
46
Gastroischesis appearance
To the right of the umbilical cord | No protective sac covering intestines
47
Extrusion of abd. contents and umbilical cord
Oomphalocele
48
Oomphalocele appearance
Centrally located with a sac
49
Gastroischesis / Oomphalocele sx
Obvious at birth | Detected during U.S. before birth - c/section
50
Gastroischesis / Oomphalocele tx
Depends on size Silo to slowly force contents back in Done over 7-10 days
51
Gastroischesis / Oomphalocele mgmt
Temperature Prevent infection Maintain tissue perfusion
52
Allow intestines to protrude through umbilical ring defect during crying/straining
Umbilical hernia
53
Umbilical hernia tx
May spontaneously close by 3-4 yrs | Surgery
54
When does a hernia need to be reported immediately?
With excessive crying and discoloration of the hernia
55
Herniation of the abd. contents through a defect in the diaphragm into the chest
Diaphragmatic hernia
56
Diaphragmatic hernia location
Left side
57
Diaphragmatic hernia incidence
8 weeks of gestation
58
Diaphragmatic hernia sx
``` Severe resp. distress Cyanosis Tachypnea Absent breath sounds of affected side Barrel chest Shifted heart sounds Bowel sounds in chest Flat abd. ```
59
Necrosis of the mucosa of the small and large intestine
Necrotizing enterocolitis
60
Necrotizing enterocolitis incidence
Affects both sexes and races equally
61
What causes Necrotizing enterocolitis?
Intestinal ischemia, bacterial coloniation or formula thas hypertonic
62
What does Necrotizing enterocolitis lead to?
Decreased bl. flow to the bowel-> ischemia of intestinal mucosa. Distended/ swollen bowel-> sepsis-> perforation of bowel
63
Necrotizing enterocolitis sx
``` Abd. tenderness Distention Bloody stools Decreased bowel sounds Increased gastric residuals Shock-> apnea-> brady ```
64
Necrotizing enterocolitis tx
``` Stop oral feedings NG tube O2/vent. Surgery Resect necrotic bowel - colostomy ->short bowel syndrome w/malabsorption ```
65
Necrotizing enterocolitis mgmt
Check stools for blood Abd. girths (mark w/ pen) Check feeing residuals before feeds Assess bowel sounds
66
Absence or obstruction of the bile ducts outside the liver preventing flow of the bile from the liver to the intestines
Biliary atresia
67
Most frequent reason for liver transplant in children
Biliary atresia
68
Biliary atresia sx
``` Newborn asymptomatic ^ becomes jaundiced w/in 2 weeks-2 mos. Urine is tea Stools are light in color Hepatomegaly Failure to thrive / malnutrition ```
69
Why is the urine tea colored with Biliary atresia?
Excretion of bilirubin
70
Why are the stools light in color with Biliary atresia?
Absence of bile pigments
71
Biliary atresia labs
``` ^ bili ^ AST ^ ALP ^ ammonia Prolonged PT ```
72
Biliary atresia tx
``` Surgery for obstruction Kasai procedure (not a cure; die waiting) ```

exam 3 (6 decks)

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