True or False: Vomiting, pyloric stenosis and cystic fibrosis can cause Alkalosis
True
What are ranges for ph acid and
alkalosis?
acid: <7.35
alkalosis: >7.45
What is minimum urine output for infants and toddlers in ml/kg?
2-3
List Post-Op interventions for cleft lip and cleft palate
Arm Restraints (NO NO's)
Clean site after feedings with sterile water
Keep infant calm
Pain management/sedatives
What are the three Cs and which dz are they referring to?
The 3 C's during feedings:
1. Coughing
2. Choking
3. Cyanosis
Refers to Esophgael Atresia (EA) or without Tracheosophageal Fistula (TEF)
How long will a post-op of tracheoesophageal malformation be on a chest tube for? NPO time?
Chest tube: 24-48 hours
NPO: 10-14 days
What can these s/s indicate:
Decreased/absent BS
bowel sounds in chest
R. sided cardiac sounds
resp. distress
retractions
tachypnea, scaphoid abdomen
Diaphragmatic Hernia:opening in diaphragm where abdominal contents herniated into thoracic cavity, deviating contents
What is this term: Protusion of portion of stomach through diaphragm.
Coughing, vomiting, wheezing, FTT
C.
What is this term: Opening in part of diaphragm where abdominal contents herniated into thoracic cavity, deviating contents
B.
What is this term: Imperfect closure of umbilical ring that lets gut push outward during straining of crying
C. Umbilical Hernia
What is this term: Weak abdominal wall causes herniation of gut on one side of umbilical cord. Usually on the outside of the body not covered by a sac
Gastrochisis
What are 4 factors that contribute to GERD?
Neurological impairment
developmental delay
some meds
obesity
What is a barium swallow?
It is an xray examination of the upper GI, specifically the pharynx (back of mouth) and esophagus.
GERD
Fill in: For tx of GERD, after feeding, maintain HOB up for __a__ minutes, and 30-45 degrees for __b__ hours.
a. 20 mins
b. 1-2 hours
List 3 meds for tx of GERD
Reglan
Ranitidine (H2 blocker)
Omeprazole (PP inhibitor)
What is Fundoplication for?
The standard surgical method for treatment of GERD: the fundus of he stomach is wrapped and sutured around the lower end of the esophagus to reduce pressure and acid reflux.
This term occurs in children >4 y/o that develops from chronic constipation. It is the repeated passing of stool (usually involuntary) into clothing.
Encopresis: typically happens after impacted stool collects into the colon and rectum, becoming too full.
What are the classic s/s of appendicitis?
Classic is fever, malaise, anorexia, and diffuse periumbilical pain (eventually localizing in RLQ)
s/s of infection
This is the "cardinal sign" of appendicitis
Pain (rebound tenderness) in RLQ at McBurney Point
List Pre-op and post-op intervntions of appendicitis
State whether these s/s are for Ulcerative Colitis (UC) or Crohns:
1. Location: Colon
2. Location: Anywhere on GI tract
3. Abd. pain
4. dirrhea with occasional hemorrhage and anemia
5. diarrhea, nonbloody
6. Moderate weight loss
7. Severe weight loss
8. fever
9. abd. mass
10. No mass
1. UC
2. CR
3. UC
4. CR
5. CR
6. UC
7. CR
8. CR
9. CR
10. UC
For Inflammatory bowel disease (Ulcerative colitis and Crohns) List the:
Diagnostic tests
Medical Interventions
Nutritional Support
Surgical Types
This condition results when the circular area of muscle surrounding the pylorus hypertrophies, obstructing gastric emptying.
It is an uncommon condition in infants that blocks food from entering the small intestine.
Pyloric stenosis
A major manifestation of this is progressive projectile, nonbilious vomiting.
It can also be felt as a movable, palpable, firm, olive-shaped mass at RUQ
Pyloric Stenosis
List tx of Pyloric Stenosis
Immediate hospitalization: IVF, and correction of metabolic alkalosis d/t vomiting
surgical repair via pyloromyotomy (incision of pyloric muscle to release the obstruction)
This is a serious condition in which part of the intestine slides into an adjacent part of the intestine. This "telescoping" often blocks food or fluid from passing through.
It is also the most common cause of intestinal obstruction in children younger than 3
Intussusception
In 75% of cases, intussusception can be corrected by...
If they don't work, what will be needed?
Barium enema or air enema
Laparotomy would be needed if enemas fail, and tx prolonged over 24 hours.
What is a laparotomy and what dz would it be used?
a surgical incision into the abdominal cavity, for diagnosis or in preparation for surgery.
Used when enemas fail for intussusception
What are s/s of intussusception?
Inconsolable crying, pain, bilious vomit
red currant jelly stools (mixture of mucus and blood)
An infant seen with red currant jelly stools shows signs for what?
Intussusception
What is tx of intussusception?
What is the goal?
Hydrostatic reduction with barium or air enema until free flow of barium is seen in the terminal ilium
If it fails, prep for surgery
Goal: restore bowel to its normal position and function
This is a condition caused by a malrotation or twisting of the bowel, causing obstruction
What age is the msot common presentation?
Volvulus: <1 month of age
What are the manifestation of volvulus? (twisting of bowel)
What is the tx?
Infants manifest pain,bilious vomiting, and bowel obs.
Rotational surgery
What is Hirschprungs disease?
a birth defect in which nerve cells are missing at the end of a child's bowel needed to expel stools.
What are clinical manifestations of Hirschprungs dz?
Infant who cannot pass meconium in first 24 hours or require repeated rectal stimulation
Develop obstruction in first month with poor feeding, bilious vomiting, and abd. distention
What are surgical stages of Hirschprung's disease? When is it done?
1st involves creating diverting colostomy with ganglion segment so it can decompress
2nd, the aganglionic segment is removed and the ganglionic bowel is pulled through the rectum
Procedure is not done until child is a year old or delayed 3-6 months when in an older child
What dz causes gluton intolerance and why?
Celiac: d/t abnormal lining in the intestines
What are s/s of celiac dz?
anorexia
n/v
foul smelling stool
slow weight gain
irritable
How can celiac dz be diagnosed?
Biopsy
Stool specimen
Labs: IgG/IgA
What is Biliary Atresia?
is a rare disease of the liver and bile ducts that occurs in infants. Symptoms of the disease appear or develop about two to eight weeks after birth. Cells within the liver produce liquid called bile. Bile helps to digest fat.
What are s/s of Biliary Atresia?
Jaundice, Pruritis (itchy skin), dark urine, pale stool, hepatomegaly, ascites (accumulation of protein-containing fluid)
What is the bolus rate for all kids for dehydration?
__ ml/kg
20ml/kg using gravity delivery
What's the best way to keep an infant calm with a ccleft lip/pal post op?
Sedation
This GI disorder is when intestines are born outside of the body, covered by a sac.
Omphalocele
What are education tips for tx of GERD
Small, frequent feedings
Upright pos
Maintain HOB up for 20 minutes at 30-45 degrees, for 1-2 hours after each meal
thickened foods
Why is pain control important post-op appy?
GEt them walking to get peristalsis moving.
What is the most common bowel obstruction in <2 y/o? How is it corrected?
Intussusception: 75% of cases can be corrected with barium enema, or Laparotomy if enema fails
List surgical treatment (2 stages) of Hirschprungs dz
When is the procedure done?
1st: involves creating diverting colostomy with ganglion segment so it can decompress
2nd: the aganglionic segment is removed and the ganglionic bowel is pulled through the rectum
Not done until the child is 1 year old or delayed 3-6 months when in an older child.
This GI dz can lead to liver failure and death.
What is it and what are its s/s?
Biliary Atresia: congenital anomaly involving obstruction or abscence of extrahepatic biliary structures
s/s: jaundice, pruritis, dark urine, pale stool, ascitis
What is the dz that traps bile inside the liver, as bile flow from the liver to the gallbladder is blocked?
Biliary Atresia
Which two GI obstructions or dz will you not see meconium in the first 24 hours?
Imperforated Anus
Hirschprung Dz
What do these s/s indicate:
vomiting: bile stained with fecal breath
thin extremities
stools: thin / ribbon like
anorexia n/v
