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GI
Functional GI Disorders o No structural abnormality o Infantile Colic: Recurrent episodes of excessive crying and fussiness in an otherwise healthy infant. o Functional Dyspepsia: Chronic upper abdominal discomfort or pain without identifiable cause on testing. o Irritable Bowel Syndrome: Chronic disorder with abdominal pain linked to bowel habit changes, without identifiable structural disease. o Functional Abdominal Pain: Chronic or recurrent abdominal pain not associated with meals or bowel movements and no identifiable disease. o Functional Constipation: frequent constipations without an identifiable cause o Functional Diarrhea : frequent loose stools without an identifiable cause o Rumination Syndrome : when a person repeatedly regurgitates recently eaten food o Cyclic Vomiting Syndrome : vomiting in cycles o Aerophagia : swallowing air Disorders of Motility: o Problem with movement through GI tract o Diarrhea/Constipation o Hirschsprung Disease o Vomiting o GERD Diarrhea o Three or more loose stools in a 24 hour period o Can cause dehydration and severe illness o Can lead to metabolic-ASSidosis GET THE ABGS, LOW BICARB ON CMP COMPLETE METABOLIC PANEL o Acute Diarrhea is commonly caused by Norovirus/Rotavirus o Risk factors: Poor hygiene, immunocompromise, pathogen exposure o Treatment: Oral rehydration solution/IV fluids.
o ANTIDIARRHEALS ARE USED WITH EXTREME CAUTION IN KIDS Constipation o Less that two bowel movements per week, can be painful o Bristol Stool chart o Common causes: dietary changes, withholding behavior, inactivity o Complications: fecal impaction, fissure, rectal prolapse, UTIs o Treatment: PEG solution Hirschsprung’s Disease (Congenital Aganglionic Megacolon) o Structural anomaly o Lack of ganglionic cells in colon segments , causing decreased motility and mechanical obstruction o Newborns: Failure to pass meconium within first 24-48 hours, refusal to eat, abdominal distention o Very foul smelling, ribbon like stool o Diagnosis: rectal biopsy o Treatment: Pre-surgery: High calorie/protein and low fiber 1 st: Temp colostomy 2 nd: 18-24 months later second surgery Vomiting o Forceful ejection of gastric contents o Muscle contractions and sphincter relaxation/opening. Vomiting center is the medulla o Gastroenteritis is the leading cause in kids o FORCEFUL VOMITING MAY SUGGEST PYLORIC STENOSIS Gastroenteritis o Inflammation of the GI tract o Management: Oral rehydration solutions (ORS) GER o Spit up that normally resolves on it’s own in 12- months GERD o More severe and chronic. LES is weak or relaxes inappropriately. Acid irritates esophagus and causes inflammation
Low FODMAP Diet: Helps manage bloating, gas, diarrhea and constipation. Avoid : Garlic, onions, wheat, rye, milk, ice cream, apples, pears, honey, high fructose corn syrup. Eat : Carrot, spinach, zucchini, bananas, strawberries, blueberries, rice, oats, quinoa, lactose free milk. Hard cheeses, poultry, fish, eggs. Peptic Ulcer Disease o Chronic sores in stomach or upper small intestine. Damaged protective lining. o Primary Causes : H Pylori, heavy NSAID use, stress/illness, Zollinger-Ellison syndrome o Symptoms : Upper ab pain Serious: Black tarry stools/coffee ground emesis o Treatment : PPIs (-prazole). Antacids/H2 blockers (-ine), Antibiotics for H Pylori (2 week triple med therapy). Meckel’s Diverticulum o Small pouch/bulge present in intestinal wall at birth o S/S: Painless rectal bleeding, abdominal pain o Diagnosis: Meckel’s Scan o Monitor for bright red bleeding, black stool. Biliary Atresia o Bile ducts are blocked or absence, causing bile to back up in the liver. Leads to liver damage and cirrhosis. o S/S: Jaundice, dark urine at pale clay colored stools, enlarged liver and difficulty gaining weight. o Treatment : Kasai procedure (damage ducts removed, intestine attached to liver for drainage) Liver transplant if this fails o Nutritional support is crucial post-op (Vitamins: DEAK) Structural Defects o Physical malformation o Cleft lip, cleft palate, hernia, esophageal atresia, tracheoesophageal fistula. Cleft Lip and Cleft Palate o Complications : Feeding difficulties, growth and development delays due to the feeding issues.
o Post-op: Elbow restraints to prevent touching surgical site. Loosen frequently. Early dental care is needed. Parents need guidance on feeding/milestones. o Pain Management: Opioids initially Hernias o Weakness in abdominal wall allowing for protrusion. Risk bowel ischemia. o Inguinal : groin/scrotum/labia Surgical repair o Umbilical : around belly button Watch and wait Esophageal Atresia (EA) o Esophagus fails to form a continuous passage, ends in a blind pouch. o S/S: Frothy saliva/drooling, choking, coughing, difficulty breathing when feeding. Tracheoesophageal Fistula (TEF) o Abnormal connection between esophagus and trachea. Food or liquid enters lungs and causes respiratory problems. o S/S: Cyanosis when feeding, frequent pneumonia, distended abdomen. Obstructive Disorders o Pyloric Stenosis and Intussusception Pyloric Stenosis o Olive shaped mass o Projectile vomiting after feeding. Intussusception o LIFE THREATENING o Segment of intestine at telescopes into adjacent part. o Common in ages 3 months to six years. o S/S: Sudden severe abdominal pain with intermittent crying RED JELLY LIKE STOOL PALPAPBLE ABDOMINAL MASS (SAUSAGE SHAPED) DANCE SIGN: EMPTY RLQ o Treatment: Air or Barium enema (diagnostic/therapeutic) Celiac Disease: o Don’t eat gluten you dumbass
Hydration to flush all the bad shit out o Adequate fluid intake, prevent constipation, avoid urine withholding, teach proper hygiene. Bacteriuria o Presence of bacteria in the urine clinically significant and requires treatment when symptoms are present. Pyelonephritis: o Kidney infection resulting from bacteria ascending from the bladder. o CBA to check Cystitis o Untreated cystitis can ascend to the kidneys, becoming a pyelonephritis, potentially leading to urosepsis and kidney damage. Urethritis o Inflammation of the urethra Glomerulonephritis o Inflammation of the glomerular capillaries, leading to impaired filtration. o Results in water retention, reduced urine output, and edema o Commonly associated with post-infectious diseases, particularly group A strep o Presentation: oliguria, hematuria, dark colored urine, hypertension, pallor, facial edema. o Labs : Urinalysis (hematuria and proteinuria) o Diagnostics : Kidney biopsy, kidney ultrasound Other imaging may be considered if no response to initial treatment o Treatment : Supportive care focuses on normalizing fluid and electrolyte balance. Reduction of sodium intake. (BP MONITORING) I&O and daily weights. Nephrotic Syndrome o Increased protein permeability in the glomerular basement membranes o S/S: proteinuria, hypoalbuminemia, hyperlipidemia, edema o Presentation: fatigue, frothy/foamy urine, hematuria
o At an increased risk for infection o FACIAL EDEMA (PERIORBITAL) o Treatment: Corticosteroids (prednisone): 2mg/kg for 6 weeks, then 1.5mg/kg for 6 weeks Diuretics Albumin infusions Antibiotics for infection Low salt, maybe low fluids o REPORT AND COLD SYMPTOMS Wilms’ Tumor (Nephroblastoma) o Kidney cancer essentially o Presentation: palpable, non-tender abdominal flank mass. Often asymptomatic. Anemia. HEMATURIA o DO NOT PALPATE ABDOMEN o Anemia is usually caused by hemorrhage of the tumor o Hypertension can be caused by excess renin Vesicoureteral Reflex (VUR) o Retrograde flow of urine from the bladder into the upper urinary tract. o DOES NOT CAUSE UTIS, BUT INCREASES RISK OF PYLONEPHRITIS Enuresis (BED WETTING) o Inappropriate urination usually at night, but can occur during the day o Occurs at least twice a week for at least 3 months o Regression happens when they’re stressed o Primary : never free without the pee o Secondary : they were free, but regressed o Risk factors: Emotional stress, being male, behavioral disorders o Nursing care: Restrict fluids about two hours before bedtime. Teach child/parents to urinate prior to bedtime Avoid caffeine in the afternoon. Use positive reinforcement. Encourage keeping a calendar of wet/dry days. Wake child at scheduled intervals during the night to void. o Medications :
Hyperkalemia treated with dietary restriction of potassium rich foods, insulin, and resins Chronic Kidney Injury o Gradual onset, progressive, not reversible o S/S: swelling, edema, decreased output, protein/blood in urine, decreased appetite, fatigue hypertension, vomiting o Treatment : aims to delay further disease progression o Meds: ACE inhibitors, vitamin D o Dietary : Monitor protein, sodium, potassium, and fluid intake Renal Function Studies o CBC, CMP, UA, creatinine, GRF, BUN, urine culture/sensitivity o High creatinine levels indicate reduced kidney function o GFR measures filtration efficiency 15 or below they need dialysis
