Pediatric GI

  1. What are the primary electrolyte in ECF and ICF?
    • ECF:sodium
    • ICF: K and Mg
  2. Fill in: ECF in infants contain more (a), which increase risk For (b).
    • a: Na and Cl
    • b: electrolyte imbalance
  3. These s/s are:
    numbness, Facial twitch, tingling around mouth, hyperactive reflexes and muscle cramps

  4. itching, lethargy, anorexia, thirst,   behavioral changes, bradycardia

  5. muscle weakness, leg cramps, arrhythmias,
    hypotension, irritablilty, weak pulses

  6. irritability, anxiety, twitching, nausea, diarrhea, arrhythmia’s, cardiac arrest

  7. Normal ranges For Na?
  8. Normal K range?
  9. Normal Calcium range?
    8.5-11.0 mg/dl
  10. mg range?
  11. Normal CL range?
  12. Too much of this electrolyte can cause Kussmaul's
  13. What tests do you run For vomiting and diarrhea?
    Labs, stool, x-rays
  14. List 4 ways acidosis can occur
    Diarrhea, DKA, fever, hypoxia
  15. True or False: Vomiting, pyloric stenosis and cystic fibrosis can cause Alkalosis
  16. What are ranges for ph acid and
    • acid: <7.35
    • alkalosis: >7.45
  17. What is minimum urine output for infants and toddlers in ml/kg?
  18. 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
  19. 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)
  20. 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
  21. What can these s/s indicate:
    Decreased/absent BS
    bowel sounds in chest
    R. sided cardiac sounds
    resp. distress
    tachypnea, scaphoid abdomen
    Diaphragmatic Hernia:opening in diaphragm where abdominal contents herniated into thoracic cavity, deviating contents
  22. What is this term: Protusion of portion of stomach through diaphragm.

    Coughing, vomiting, wheezing, FTT

  23. What is this term: Opening in part of diaphragm where abdominal contents herniated into thoracic cavity, deviating contents

  24. What is this term: Imperfect closure of umbilical ring that lets gut push outward during straining of crying

    C. Umbilical Hernia
  25. 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
  26. What are 4 factors that contribute to GERD?
    • Neurological impairment
    • developmental delay
    • some meds
    • obesity
  27. What is a barium swallow?
    It is an xray examination of the upper GI, specifically the pharynx (back of mouth) and esophagus. 

  28. 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
  29. List 3 meds for tx of GERD
    • Reglan
    • Ranitidine (H2 blocker)
    • Omeprazole (PP inhibitor)
  30. 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.
  31. 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.
  32. 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
  33. This is the "cardinal sign" of appendicitis
    Pain (rebound tenderness) in RLQ at McBurney Point
  34. List Pre-op and post-op intervntions of appendicitis
    • Pre-op: NPO, IVF, pain manage, abx, ?NGT
    • Post: IVF, pain manage, NPO -> advance diet slowly, abx, NGT or drains
  35. 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
  36. For Inflammatory bowel disease (Ulcerative colitis and Crohns) List the:
    Diagnostic tests
    Medical Interventions
    Nutritional Support
    Surgical Types
    • Diagnostic: colonoscopy, biopsy
    • Interventions: Corticosteroids, amniosalicylates, Immunomodulators
    • Nutrition: TPN, Increase calories, supplements
    • Surgical: Total colectomy, Illeostomy
  37. 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
  38. 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
  39. 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)
  40. 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
  41. 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.
  42. 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
  43. What are s/s of intussusception?
    Inconsolable crying, pain, bilious vomit

    red currant jelly stools (mixture of mucus and blood)
  44. An infant seen with red currant jelly stools shows signs for what?
  45. 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
  46. 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
  47. What are the manifestation of volvulus? (twisting of bowel)

    What is the tx?
    Infants manifest pain,bilious vomiting, and bowel obs.

    Rotational surgery
  48. 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.
  49. 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
  50. 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
  51. What dz causes gluton intolerance and why?
    Celiac: d/t abnormal lining in the intestines
  52. What are s/s of celiac dz?
    • anorexia
    • n/v
    • foul smelling stool
    • slow weight gain
    • irritable
  53. How can celiac dz be diagnosed?
    • Biopsy
    • Stool specimen
    • Labs: IgG/IgA
  54. 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.
  55. What are s/s of Biliary Atresia?
    Jaundice, Pruritis (itchy skin), dark urine, pale stool, hepatomegaly, ascites (accumulation of protein-containing fluid)
  56. What is the bolus rate for all kids for dehydration?

    __ ml/kg
    20ml/kg using gravity delivery
  57. What's the best way to keep an infant calm with a ccleft lip/pal post op?
  58. This GI disorder is when intestines are born outside of the body, covered by a sac.
  59. 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
  60. Why is pain control important post-op appy?
    GEt them walking to get peristalsis moving.
  61. 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
  62. 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.
  63. 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
  64. What is the dz that traps bile inside the liver, as bile flow from the liver to the gallbladder is blocked?
    Biliary Atresia
  65. Which two GI obstructions or dz will you not see meconium in the first 24 hours?
    • Imperforated Anus
    • Hirschprung Dz
  66. What do these s/s indicate:
    vomiting: bile stained with fecal breath
    thin extremities
    stools: thin / ribbon like
    anorexia n/v
Card Set
Pediatric GI
Lecture note