CPN: Gastrointestinal (15-20 questions)

Method used to calculate MIVF

4, 2, 1 method

If a child is > or equal to 20kg, add how much fluid to body wt for MIVF?

40ml

Most common form of dehydration; 5% fluid loss, or < 50ml/kg

Mild

Dehydration classified by a 10% wt loss, or 50-90ml/kg

Moderate

Dehydration classified by a 15% wt loss from pre-illness weight, or > 100ml/kg

Severe

Inside the vessel; Na can change based on fluid volume

Intravascular space

Interstitial fluid is located here; can see third spacing, periorbital swelling, edema, crackles

Extravascular space

When the serum Na+ increases, water does what?

Pulls into vessel to dilute Na+

Increased frequency and decreased consistency of stool

Diarrhea

Virus that frequently causes diarrhea

Rotavirus

Big complication of diarrhea

Metabolic acidosis

What is the #1 cause of vomiting?

Overfeeding

Thickening of abdominal muscle around circular pyloris muscle causing obstruction of the gastric outlet
* More common in males than females

Pyloric stenosis

Main clinical manifestations of pyloric stenosis (3)

Projectile vomiting
Presents between 1-6 months of life
"Olive-like" mass in abdomen

Frequent emesis r/t pyloric stenosis can cause what?

Metabolic alkalosis

Main surgical intervention for pyloric stenosis is called what?

Pyloromyotomy

What should be corrected prior to sx intervention for pyloric stenosis?

Electrolyte imbalances

Passage of abdominal contents to the esophagus from incompetent or poorly developed lower esophageal sphincter

GERD

Congenital defect with hereditary component:
Incomplete midline fusion of the bones and tissues of the upper jaw/palate
- Partial or incomplete
- Unilateral or bilateral

Cleft lip and/or palate

Age/weight pt needs to be before cleft lip/palate repair

10 wks, 10 lbs

Occurs when the proximal end of the esophagus ends in a blind pouch; food can't enter stomach

Esophageal atresia

Occurs when there is a connection between esophagus and trachea

Tracheoesophageal fistula (TEF)

Inflammation and obstruction of the blind sac at the end of the cecum

Appendicitis

Major s/s of appendicitis (2)

RLQ pain (McBurney's point)
Rebound tenderness

S/s ruptured appendix (2)

Instant relief of pain
Fever

Postop intervention to avoid in appendicitis pts

NO hot packs

Insensitivity to gluten found in wheat; second leading cause of malabsorption in kids; diagnosed between 6-18mo

Celiac disease

S/s celiac disease (4)

Fatty stools
Abd. distention
FTT
Muscle wasting

How is celiac disease diagnosed?

Small bowel biopsy

Teaching regarding celiac disease (3)

Gluten is in thickener (pudding, ice cream)
Read all labels
Avoid high fiber foods at time of inflamed bowel

Interventions for celiac disease (3)

Eliminate wheat, rye, barley, and oats
Substitute with corn, rice, millet
Multivitamins, folic acid

Congenital disorder of decreased GI motility and results in mechanical obstruction of intestines; absence of ganglionic cells in distal bowel

Hirschsprungs

S/s Hirschsprungs in neonates (2)

Failure to pass meconium in first 2 days of life
Feeding intolerance with bilious vomiting

S/s Hirschsprungs in older children (2)

Constipation
Abdominal distention

How Hirschsprungs is diagnosed

Rectal biopsy

Treatment of Hirschsprungs (2)

Enema to relieve obstruction
Surgical repair (resection, temporary ostomy)

Most frequent cause of intestinal obstruction kids 3 mo - 3 yr; occurs when one portion of the intestine telescopes into another leading to:
- Ischemia
- Mucous backflow into intestine
- Leaking of blood into intestine

Intussusception

Classic s/s intussusception (4)

Currant jelly stools
Sudden onset of abd pain
Inconsolable cry
Bilious vomiting

Diagnostic interventions for intussusception (3)

Abd XR
US
Barium enema to show obstruction

75-85% of intussusception cases are fixed by what?

Air enema

Bilirubin that is created when RBCs hemolyze

Unconjugated (indirect) bilirubin

Congenital anomaly; obstruction/obliteration/absence of extra hepatic biliary structures

Biliary atresia

Assessment findings with biliary atresia (7)

Pruritis
Dark urine
Pale stools
Hepatomegaly
Ascites
Splenomegaly
FTT
Inc. LFTs

Interventions for biliary atresia (2)

Surgery (Kasai procedure)
ADEK (fat-soluble vitamins)

How is Hep A transmitted?

Fecal-oral route

Preventative measures for Hep A (2)

Handwashing
Keep food preparations separate

Which NGT placement measure is not evidence-based?

Air bolus