Hypertrophic Pyloric Stenosis, GERD, and Ileocolic Intussusception and Hirschsprung Disease

Question 1

Hypertrophic Pyloric Stenosis

Answer 1

Obstruction of circular muscle of pyloric canal
Initially good feeder with occasional vomiting; Becomes projectile; always hungry, irritable, fails to gain weight, fewer & smaller stools
Most common in 1st born children
Surgically corrected; good prognosis

Question 2

Assessment of HPS (4)

Answer 2

visible peristaltic waves, hyperactive bowel sounds; olive-shaped mass in upper quadrant when palpated, projectile vomiting (hydration status; monitor vomiting)

Question 3

Nursing Management (7)

Answer 3

Meet fluid needs (NPO, IV, accurate I&O)
Minimize weight loss (daily weight; small, frequent feedings 4-6 hrs post-op)
Promote rest & comfort (pre-op: swaddling, cuddling, pacifier. Pre-op: pain management)
Prevent infection (incision clean & dry, temperature)
Supportive care (explanations for parents)
Discharge teaching (sign of infection of incision; fold diaper away from incision, occasional vomiting may occur first 24-48 hours post-op)

Question 4

Gastroesophageal Reflux (GER)

Answer 4

transfer of gastric contents into esophagus
Most common cause is transient relaxation of LES
Children prone to develop GER: BPD, TEF or EA repairs, neurological disorders, CF, CP, preterm

Question 5

Differentiate between GER and GERD

Answer 5

difference is severity and it is a progression
GER: normal and very common and doesn’t require medical intervention. Peaks at 4 months and resolves at 1 year.

Question 6

Manifestations of GER

Answer 6

Hungry & irritable, weight loss, history of vomiting & upper respiratory infections, hematemesis, apnea, gagging or choking after feeding
- most common is passive regurgitation or emesis

Question 7

Diagnosis of GER

Answer 7

history, upper GI series, 24-hour pH probe monitoring, endoscopy with biopsy

Question 8

Treatment of GER

Answer 8

Depends on severity of condition
Mild: modify feeding habits (thicken feeds, avoid foods that aggravate); medications (h2 receptor antagonists, proton pump inhibitors); upright positioning after feeds
Severe: surgery (Nissen fundoplication) with G-tube for 6 weeks)

Question 9

Nursing care of GER

Answer 9

Daily weight; signs of respiratory distress
Adequate nutrition: small, frequent feedings, raise upper body 30 degrees after feeds; G-tube

Question 10

Ileocolic Intussusception

Answer 10

invagination or telescoping of one portion of intestine into another
Results in obstruction -> inflammation, edema, decreased blood flow -> ischemia, perforation, peritonitis & shock
Medical emergency! potentially life-threatening

Question 11

Manifestations of II

Answer 11

Sudden onset of crampy abdominal pain, inconsolable crying, & drawing up of knees; may develop bilious emesis & lethargy; red, currant jelly stools; tender & distended abdomen; palpable sausage-shaped mass in RUQ

Question 12

Hirschsprung Disease (Congenial Aganglionic Megacolon)

Answer 12

watch for the meconium. Need to see that because it indicates a bowel that is working.
ABSENCE OF AUTONOMIC PARASYMPATHETIC GANGLION CELLS IN ONE OR MORE SEGMENTS OF COLON
Lack of innervation produces absence of peristalsis which causes accumulation of intestinal contents & bowel distension proximal to defect (megacolon)
Results in mechanical obstruction from inadequate motility of part of intestine

Question 13

Manifestations of Hirschsprung Disease

Answer 13

Failure to pass meconium within 24-48 hrs, bilious vomiting, abdominal distension, FTT, constipation, visible peristalsis, palpable fecal mass