GI Dysfunction

Question 1

chemical digestion

Answer 1

enzymes
hormones
hydrochloric acid
mucus
water / electrolytes

Question 2

consequences of GI dysfunction

Answer 2

malabsorption
fluid / electrolyte imbalance
malnutrition
poor growth

Question 3

diarrhea

Answer 3

abnormal intestinal water / electrolyte transport
acute = infectious / related to other illness
chronic = 14+ days

cause = fecal oral route by contamination
rotavirus = #1 cause of diarrhea related to mortality in kids

Question 4

intractable diarrhea

Answer 4

first few months of life / more than 2 weeks with no recognized pathogens
refractory to treatment

Question 5

diarrhea treatment

Answer 5

replace fluids / electrolytes
rehydrate
- oral rehydrate: safer, cheaper, less painful, and more effective than IV
reintroduce adequate diet

Question 6

mild
moderate
severe

Answer 6

5-6%
7-9%
>9%

Question 7

vomiting

Answer 7

forceful expulsion of stomach contents
assess hydration / prevent complications
replace hydration
meds = zofran

Question 8

s/s of ingestion of foreign substance

Answer 8

vigorous coughing, excessive drooling, poor feeding, vomit, gagging, anorexia, neck pain, sensation of object in throat

intervene when: severe distress, unable to swallow, multiple magnets, sharp objects, toxic

Question 9

newborn constipation

Answer 9

meconium shouldd pass within 24-36 hours 
if not:
- Hirschsprung disease
-hypothyroidism
-cystic fibrosis (meconium ilieus)

Question 10

infant constipation

Answer 10

related to diet
most have 1-4 bowel movements / day
breastfed may not BM everyday bc high absorption rate of breast milk

Question 11

childhood constipation

Answer 11

environmental changes, stress, moving to a new home or new school
management
- debulking of stool
-diet / hydration / exercise
bowel regimen (try to go every so often, same time of day)
-may require months to get back to normal

Question 12

Hirschsprung disease

Answer 12

mechanical obstruction from inadequate motility of intestine
more common = males / Down syndrome
absence of ganglion cells in colon = lack of enteric nervous system stimulation / lack of sphincter ability to relax

Question 13

S/S of Hirschsprung disease

Answer 13

accumulation of stool w/ ab distention
failure to pass meconium first 48 hours
feeding intolerance with bilious vomiting

Question 14

treatment of Hirschsprung

Answer 14

surgery
less extent = one surgery w/o colostomy
more extensive = 2 surgies

Question 15

gastroesophageal reflux (GER)

Answer 15

transfer of gastric contents into esophagus
- occurs in everyone, what makes it pathological is that it is persistent

pathological when: FTT, respiratory problems, dysphagia
meds = ranitidine / famotidine

feed upright, burp often, avoid overfeeding, frequent small meals

Question 16

IBS

Answer 16

alteration of constipation / diarrhea

Question 17

acute appendicitis

Answer 17

pain at mcburneys point, referred pain
obstruction of lumen of appendix by fecal material
surgery; If ruptured will also need antibiotics

Question 18

ulcerative colitis

Answer 18

• inflammation- colon / rectum only
• bloody diarrhea
• severe anorexia, weight loss, and growth retardation
• anal / perianal lesions

Question 19

crohns

Answer 19

inflammation- all GI
regular diarrhea
mild / moderate: weight loss/anorexia

Question 20

peptic ulcer

Answer 20

primary ulcer = idiopathic or related to H pylori
secondary = from stress

related to diet, drugs
pain, hematemesis, melena, ab pain

Question 21

hypertrophic pyloric stenosis

Answer 21

constriction of the pyloric sphincter w/ obstruction of the gastric outlet

projectile vomiting (3-4 feet)

olive shaped mass in epigastric region

failure to thrive / always hungry

Question 22

intussusception

Answer 22

telescoping or invagination of one portion of intestine into another

sudden onset cramping in ab / inconsolable crying w/ drawing knees up to chest

T= air enema, saline enema, surgery

if baby poops = fixed!

palpable mass in UR quad

currant-jelly like stool

Question 23

malrotation

volvulus

Answer 23

intestines do not coil / rotate properly when formed in utero

V = complication that occurs when intestine is twisted around itself and compromises blood supply

M/V can happen together or separate

Question 24

celiac

Answer 24

gluten induced enteropathy

steatorrhea, general malnutrition, ab distention, secondary vitamin deficiencies

T = eliminate gluten

Question 25

short bowel syndrom

Answer 25

decreased mucosal surface area usually resulting from small bowel resection phase 1 = TPn phase 2 = enteral may need a transplant

Question 26

GI bleeding

Answer 26

stomach bleed = coffee grounds emesis, hematemesis, black tarry stools lower gi bleed = hematochezie (bright red rectal bleed) emergent care = IV, O2, suction if severe; treat the main cause

Question 27

hepatitis

Answer 27

T = antiretrovirals; prevent spread; nutritional support A/B vaccines ``` hep A = fecal oral route hep B = perinatally acquired hep C = parenteral exposure to virus Hep D = in people who have already had hep B Hep E= contaminated water / fecal oral ```

Question 28

biliary atresia

Answer 28

bile ducts obstructed bc they didn't develop normally leads to liver damage prolonged jaundice (after 2 weeks of age) poor prognisis / surgery

Question 29

esophageal atresia / | tracheoesophageal fistula

Answer 29

``` EA= esophagus fails to develop as a continuous single passage to stomach TF = failure of trachea and esophagus to separate ``` frothy saliva, drooling, choking, coughing, respiratory distress, T = Est airway / surgical repair continuous suction with indwelling catheter in esophageal pouch

Question 30

omphalocele

Answer 30

bowell covered with peritoneal sac outside of skin T= surgery . thermal regulation, infection prevention

Question 31

gastroschesis

Answer 31

bowel is out of skin and not covered in sac herniates through a defect in ab wall surgery cover with sterile moist dressing

Question 32

inguinal hernia

Answer 32

processus vaginalis remains open allowing ab structure or fluid to force into it - looks like a painless inguinal or scrotal swelling surgical correction