GI Dysfunction Flashcards
(49 cards)
1
Q
assessment
A
- abdomen (inspection, auscultation, palpitation)
- nutrition
- stool (consistency, colour, smell, pattern, continence, seepage, changes)
- family hx
2
Q
diagnostic procedures for GI dysfunction
A
- abdominal ultrasound
- barium/contrast enema (make sure barium is passed can = obstruction)
- CT of abdomen (metformin)
- endoscopy
- GI series
- Intraesophageal pH probe
- abdominal radiographs
3
Q
why cant you take metformin with CT contrast
A
- contrast induced nephropathy
- can decrease kidney function and cause metformin buildup
4
Q
lab tests for GI dysfunction (7)
A
- CBC
- bilirubin
- electrolytes
- liver enzymes
- stool for occult blood
- stool for ova/parasites
- CRP (inflammation)
5
Q
gastroesophageal reflux
A
- 50% of infants 0-3 months
- painful regurgitation that increases in frequency
- linked to ALTE (apparent life threatening events
- apnea from reflux
- most grow out of it and dont progress to GERD
- overfeeding is big cause
- less likely with breastfed
6
Q
gastroesophageal reflux treatment
A
- dependent on severity (give time to work ~1 wk)
- nutrition changes
- position changes
- movement
- mothers nutrition
- air bubbles
- overfeeding
- PPIs if other changes dont work
7
Q
pyloric stenosis
A
- pylorus is narrow or won’t open
- males more than females
- 2-4 wk after birth
- projectile vomiting due to increased intake
- child looks hungry, failure to gain weight because cant absorb
8
Q
pylorus
A
- opening between stomach and small intestine
9
Q
pylorotomy
A
- surgery for pyloric stenosis where pylorus is cut open
10
Q
diagnosis of pyloric stenosis
A
- ultrasound
- can sometimes feel olive like structures in stomach
11
Q
intussesception
A
- bowel telescopes upon itself = two layers of bowel touching
- unknown cause
- more in males than females
- abrupt pain and onset
- red and jelly stools
12
Q
diagnosis of intussesecption
A
- hx
- ultrasound
- barium enema
13
Q
treatment for intussesception
A
- barium enema sometimes works as weight can pull it back down
- if that doesn’t work then surgery
14
Q
Hirschprung disease
A
- segment of bowel is missing nerve endings to stool is harder to pass through that section
- congenital
- constipation, no wight gain, ribbon stools
15
Q
diagnosis of Hirschprungs disease
A
- biopsy
16
Q
treatment of Hirschprungs disease
A
- bowel resection
17
Q
encopresis
A
- constipation + soiling
- 3-5yrs
18
Q
encopresis treatment
A
- behaviour management
- diet (increased fibre, fruits, probiotics)
- Medical management with lactulose (usually doesn’t work) or PEG to clear them out
19
Q
appendicitis
A
- inflammation of the appendix
- caused by obstruction (stool) in the appendices lumen
- may lead to perforation (fluid into preineum)
- school aged/teens
20
Q
manifestations of appendcitis
A
- periumbilical cramps, abdominal tenderness, fever
- pain in rt lower quad becomes constant (McBurneys point)
- progression of symptoms: nausea, vomiting, rebound tenderness
21
Q
manifestations of appendix rupture
A
- sudden relief of pain
- usually causes diarrhea incontinence
22
Q
diagnosis of appendicitis
A
- fever + elevated WBC
- ultrasound
- CT (most reliable but want to avoid as radiation)
- may see elevated CRP
23
Q
management of appendicitis
A
- immediate surgical removal (laparoscopic)
- NPO, IV antibiotics/fluids, pain management
- discharge home next day
- DB & C and ambulation
24
Q
management of ruptured appendix
A
- treat rupture first to avoid increase fluid in peritoneal cavity
- prolonged antibiotic use, pain management
- open appendectomy
- drain, irrigation, packing
- usually back with access if not treated long enough
25
gastroenteritis
- inflammation of stomach or intestines
- may be accompanied by vomiting and diarrhea
- bowel absorption decreased due to inflammation
- common cause is rotovirus and norwak virus
- dehydration & electrolyte balance
26
common age for gastroenteritis
- under 5 yrs
| - because they are putting everything in their mouth
27
manifestations of gastroenteritis
- mild to sever diarrhea
28
gastroenteritis assessment
- onset, frequency, & consistency of stools
- frequency & amount of vomiting
- vitals
- weight management
- voiding, diet, other ppl sick around them
29
diagnosis of gastroenteritis
- hx, physical exam
- lab findings
- dehydration
30
bloodwork for gastroenteritis
- electrolyte concern
- most worried about K+
- kidney function must be confirmed before adding K+ to IV
31
management of gastroenteritis
- dependent on severity of dehydration & electrolyte imbalance
- monitor ins/outs
- isolation (contact)
- slowly reintroduce foods (bland, avoid sugar)
32
electrolyte bloodwork for peds
- capillary lytes
- can get falsely high K+ amount from squeezing capillary
- causes lysis of hemoglobin and release of K+
33
can gravol be given for gastroenteritis?
- not given because sedation results in less fluid intake
| - ondansetron (Zofran) can be given
34
can Imodium be given for gastroenteritis?
- not given due to risk of obstruction
35
oral rehydration
- treatment of choice for dehydration caused by diarrhea
- no fruit juice/sports drink as increased sugar = increase diarrhea
- milk products ok
- increase intake slowly by small amounts
36
parenteral rehydration phase 1
- expand extracellular volume
- isotonic fluids (NS)
- 20-40ml/kg over 2hrs
37
parenteral rehydration phase 2
- replace losses
- determine % of dehydration
- 1.5x maintenance
- may add K+ here
38
parenteral rehydration phase 3
- return to normal
| - slow down IV and drink
39
daily fluid requirements
- 100ml/kg for frist 10 kg
- 50ml/kg for next 10kg
- 20ml/kg for remainder
40
inflammatory bowel disease
- ulcerative colitis
| - Crohn's disease
41
ulcerative colitis
- inflammation and ulceration of rectum and colon
- 15-25 peak then 50-70
- affects only mucosa and submucosa
- bleeding, diarrhea, abdominal pain
42
diagnosis of ulcerative colitis
- scope
- colonoscopy
- blood work (WBC, CRP)
43
management of ulcerative colitis
- nutritional management (no residue diet - bland, no seeds, no raw veggies, nothing hard to digest)
- medications
- surgery
- NPO or blood transfusion if severe
44
medications for ulcerative colitis
- antimicrobial - prevent secondary infection
- 5-ASA - decrease inflmmation
- corticosteroids - decrease inflammation
- immunosuppressants - suppress immune response
45
Crohn's disease
- any part of GI tract from mouth to anus
- peak at 15-30
- most common in terminal ileum and colon
- non bloody diarrhea and abdominal pain
- transmural inflammation
- skip lesions, granulomas, fistulas, cobblestone appearance
- extra intestinal symptoms sometimes before GI
46
diagnosis of Crohn's disease
- scope (upper GI)
| - colonoscopy
47
management of Crohn's disease
- diet therapy
- medications
- TPN
- elemental diet (predigested nutrients)
- surgery
48
medications for Crohn's disease and why
- antimicrobial - prevent secondary infection
- corticosteroids - decrease inflammation
- immunosuppressants - suppress immune response
- immune modulators (humera, remicaid) —> tumor necrosis factor inhibitors, tumour necrosis factors may be attacking body
49
examples of immunomodulators
- remicade
| - Humira
