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esophagus, stomach, proximal duodenum
foregut
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distal duodenum, jejunum, ileum, cecum, proximal colon
midgut
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distal colon/rectum
hindgut
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esophagus/stomach are identifiable at ? weeks gestation
4
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uncoordinated contractions of the gut and delayed gastric emptying
26 weeks gestation
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motility fully developed and coordination of sucking/swallowing
36 week gestation
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thick, greenish black material consisting of epithelial cells, digestive tract secretions and amniotic fluid
meconium
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automatic reflex action for first 3 months of life
swallowing
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required to convert nutrients from usable energy
digestion
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responsible for absorption of water & sodium
Large intestine
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the shape of an infant's stomach should be what?
rounded and dome-shaped
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diaphragmatic hernia
scaphoid
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normal, especially in epigastric area
pulsations
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protrusion through the umbilicus or rectus abdominis muscles
umbilical hernia
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usually palpated 1-3 cm below right costal margin; greater than 3 cm is hepatomegaly, which may indicate infection, cardiac failure, liver disease
Liver
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often the presenting symptom in children with celiac disease
Pica
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most common in children from 6 months to 3 years old
foreign bodies
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Seek medical advice for what pertaining to foreign bodies? (6)
sharp/large objects, batteries, aspiration, GI perforation, lodged in esophagus/pharynx, small smooth objects
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leading cause of illness in children younger than 5
acute diarrhea
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How to calculate how much fluid to give a child with diarrhea:
allow 100 mL/kg for first 10 kg of body weight; allow 50 ml/kg for second 10 kg body; allow 20 mL/kg for remaining body weight
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inappropriate passage of feces; often with soiling
Encopresis
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mechanical obstruction from inadequate motility of intestine
Hirschsprung Disease
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usually involves the rectum and some portion of the distal colon
Hirschsprung Disease
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S/S of hirschsprung disease (4)
aganglionic segment usually includes rectum & distal colon; accumulation of stool with distention; failure of internal/sphincter to relax; enterocolitis may occur
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Newborn S/S of hirchsprung disease (4)
failure to pass meconium w/in the first 48 hours of life; abdominal distension that is relieved by rectal stimulation or enemas; vomiting; neonatal enterocolitis
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what kind of diet does a patient need before having surgery for Hirschsprung disease?
Low fiber, high calorie, high protein
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Transfer of gastric contents into the esophagus; occcurs in everyone
GER
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associated with apnea, bronchospasm, laryngospasm, pneumonia
GERD
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therapeutic management for GER: (5)
small, frequent feeds; continuous NG feeds severe cases, fequent burping, thickening of feeds controversial, positioning controversial
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promotes gastic emptying and increases lower esophageal sphincter pressure
Prokinetic agents
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Reduce amount of acid present in gastric contents
Tagamet, zantec, pepcid
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proton pump inhibitors that inhibit gastric acid secretion
Prilosec, prevacid
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nursing considerations for GER: (4)
educate parents about positioning, feeding changes, educate about medications, inflammatory diseases
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acute inflammation and infection of vermiform appendix/most common causes of abdominal pain; due to a closed-loop obstruction of the appendix
Acute appendicitus
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most common congenital malformation of GI tract; results from imcomplete obliteration of fetal omphalomesenteric duct that connects with the yolk sac; usually occurs w/o symptoms
Meckel Diverticulum
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S/S of meckel diverticulum (6)
rectal bleeding, sudden bright red stool, tarry stools, pain, inflammation, obstruction
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includes ulverative and Crohn's disease
Inflammatory bowel disease
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S/S of ulcerative colitis
intestinal bleeding, moderate to severe diarrhea, abdominal tenderness, mild anemia, anorexia, weight loss
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inflammation/ulceration of continous segments of the rectum/colon causing varying degrees of bleeding and edema
ulcerative colitis
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chronic inflammatory disease that can affect any part or the entire GI tract from the mouth to the anus
Chrohn Disease
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S/S of crohn disease
diarrhea, abdominal pain and cramping, fever, weight loss, extraintestinal manifestations
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Goals of treatment for inflammatory bowel disease (4)
control inflammation and reduce symptoms; obtain long term remission; promote normal growth/development; normal lifestyle
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most effective drugs for treating IBD
corticosteroids (prednisone)
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effective in maintaining remission in mild to moderate disease
aminosalicylates
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side effects include HA, nausea, abdominal pain, rash
azulfidine sulfasalazine
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side effects include worsening diarrhea, rectal bleeding, nephritis, pancreatitis, hair loss, hepatits, pericarditis
mesalamine (asacol, pentasa)
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use to treat CD; alters cellular or humoral immunity; facilitates remission, decreases likelihood of recurrence
immunomodulators
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constriction of pyloric sphincter with obstruction of gastric outlet; results from hypertrophy of the circular muscle of pylorus
hypertrophic pyloric stenosis
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S/S of HPS (3)
projectile vomiting, hungry/irritable, dehydrated with weight loss
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Lab values for HPS (3)
matabolic alkalosis, decreased Na and K; increased BUN
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Therapeutic management for HPS (4)
rehydration, surgery, resume feedings of clear liqueds 4 to 6 hrs post op, progress to full feeds w/in 48 hrs
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telescoping or invagination of one portion of intestine into another; most commonly occurs b/w 3 months and 3 years
intussusception
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S/S of intussusception (6)
sudden onset abdominal pain, palpable sausage shaped abd mass, currant jelly stools, rectal bleeding, lethargy, sepsis
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due to abnormal rotation around around the superior mesenteric artery during embryonic development
malrotation
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occurs when intestine is twisted around itself and compromises blood supply go intestines
Volvulus
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intermittent vomiting, recurrent abdominal pain, abdominal distention, lower GI bleeding
malrotation and volvulus
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characterized by chronic diarrhea and malabsorption of nutrients; may result in failure to thrive; digestive, absorptive, anatomic defects
malabsorption syndromes
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also called gluten-induced enteropahy and celiac sprue
celiac disease
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four characteristics of celiac disease
steatorrhea, general malnutrition, abdominal distention, secondary vitamin deficiencies
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therapeutic management for celiac disease (2)
gluten free diet; nutritional supplements esp. iron, folic acid, and fat soluable vitamins
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nursing considerations for celiac disease (4)
dieatary management, read all labels, easier with infants and children than adolescents, may be lactose intolerance
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result of decreased mucosal surface area, usually due to extensive resection of small intestine
short bowel syndrome
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goal management of SBS (4)
preserve bowel length, maintain optimum nutritional status while intestinal adaption occurs, stimulate intestinal adaption, minimize compliations
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What are the stages of maintenance of SBS? (3)
TPN, enternal feeding, exclusive enteral feeds
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incomplete fusion of structures surrounding oral cavity
cleft lip/palate
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failure of esophagus to develop as a continuous passage or failure of esophagus and trachea to develop into separate structures; may occur separately or in combination
esophageal artesia/tracheoesophageal fistula
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S/S of esophageal artesia/T. fistula includes: (4)
constant drooling, normal suck with sudden cough/gag, abdominal distention with distal TEF, frequent aspirations in neonatal period
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herniation of abdominal contents through the umbilicus; usually enclosed inperitoneal sac
omphalocele (belly button)
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herniation of intestine lateral to the umbilicus, usuallly right of umbiliucs, abdominal contents are exposed
Gastroschisis
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