What are 4 ways that children’s GI system are different than adults?
- smaller stomach
- LES not fully developed until 1 month old
- under 6 months oral intake is primarily liquid
- Increased risk for dehydration
How many mL can newborn stomachs hold?
10-20 mLs
How many mL can 2 month olds hold?
200 mLs
What does an under developed LES cause in newborns?
reflux/regurgitation
What are children MOST at risk for?
dehydration
What are 3 reasons children are at higher risk for dehydration?
- Can’t tell us when they are thirsty
- increased metabolic rate
- higher surface area compared to weight
What is a child’s TFI (total fluid intake) based on?
child’s DAILY weight
What are infants’ output based on?
number of wet diapers a day
(6 is goal)
What are the 9 common GI issues in children?
1.Acute Appendicitis
2. congenital abnormalities
3. Dehydration
4. GERD
5. Inflammatory bowel disease (IBD)
6. Liver disease (hepatitis/cirrhosis)
7. Nutritional disturbances (less in Canada)
8. Obstruction- intussusecption
9. Peptic Ulcer disease
What are 4 examples of GI congenital abnormalities in children?
- Abdominal hernias
- Cleft lip or palate
- Congenital esophageal atresia (no connection to stomach)
- Hirschprungs disease
What’s the main reason kids end up with dehydration?
Gastroenteritis
What is the number one reason for mortality and morbidity in children?
Gastroenteritis
What are the causes of gastroenteritis?
Viruses and bacteria
- Rotavirus (common)
- norovirus
- E. Coli
- Salmonella
- C diff
What are the symptoms of Gastroenteritis?
N&V
diarrhea
fever
malaise
What are the risks associated with dehydration from gastroenteritis?
1.Loss of electrolytes
2.acid-base imbalance (metabolic acidosis)
3.hypovolemic shock
What are the first 3 signs of dehydration in children?
- thirsty- baby cries all the time
- urine output reduced
- dry mucous membranes - very dry lips
What are the signs of mild dehydration?
- <5% body weight loss
- normal vitals
- increased thirst
- slightly dry mucous membranes
- slightly decreased urine output
What are the signs of moderate dehydration?
- 5-10% body weight loss
- increase HR
- decreased skin turgor
- Sunken fontanel/eyes
- Delayed cap refill
- Listless
What are the signs of severe dehydration?
- > 10% body weight loss
- HR increase, BP decrease
- Lethargic
- Comatose
- Cool mottled extremities
When an infant first comes in, we don’t have a baseline. What do we have to rely the most on to determine dehydration?
Symptoms
What is the first vital sign change of dehydration in children?
increase HR
What vital sign shows us that the child will soon become severely dehydrated?
BP decrease
How many mL/kg do we rehydrate in mild dehydration?
50 mL/kg over 4 hours ORS
How many mL/kg do we rehydrate in moderate dehydration?
100mL/kg over 4 hours with ORS
-
Week 1 Endocrine lecture154
-
Week 1 peds13
-
Week 2 gas exchange & peds18
-
Week 2 Head and Neck Ca, Lung Ca W2414
-
Week 2 COPD25
-
Week 2 Pulmonary embolism11
-
Week 3 Perfusion Lecture81
-
Week 3 Peds24
-
Week 4 vavlular and Vascular Lecture127
-
Week 5 Upper GI bleed/ PUD/ Gastric CA63
-
Week 5 - inflammatory bowel disease23
-
Week 5 Elimination, infection, inflammation lecture10
-
Week 5 - Bowel obstruction23
-
Week 5 Diverticular Disease, Hernia, Hemorrhoids14
-
Week 6 - Gerd/hernia & esophageal CA35
-
Week 6 Peds45
-
Week 6 Cholecystitis/pancreatitis/hepatitis/cirrohsis45
-
week 7 Mobility75
-
Week 8 burns92
-
Week 9 cellular regulation, breast cancer, leukemia67
-
Week 9 Complications of Chemotherapy & Radiation Therapy45
-
Week 10 elimination issues119
-
Week 11 TBI/Brain Tumors36
-
Week 11 ICP37
-
Week 11 Intracranial Regulation Meningitis, TIA, Stroke65
-
Week 11 Peds neuro28
-
Week 12- Pre-op18
-
Week 12 Intra-op29
-
Week 12 post-op47
