Download Gastrointestinal Tract

GASTROINTESTINAL SYSTEM
G ASTROINTESTINAL T RACT
Begins in the mouth- terminates at anus
Mouth
Esophagus
Gastroesophageal (cardiac) Sphincter- between esophagus and stomach
Stomach
Fundus
Body
Antrum
Pyloric Sphincter- between stomach and small intestine
Small Intestine- 20 ft long, most digestion occurs here
Duodenum
Jejunum
Ileum
Large intestine- joins with small intestine with ileocecal valve
Cecum (appendix)
Ascending colon
Transverse colon
Descending colon
Sigmoid colon
Rectum
D IGESTION
Process by which food is prepared for use by the body
Mechanical- teeth, saliva, stomach churning, peristalsis
Chemical- actions of enzymes that act to breakdown fat, carb, protein
HCl in stomach, Pancreatic enzymes:
Amylase, trypsin, chymotrypsin, carboxypeptidase- protein
Lipase- fat
Amylase- starch
A SSESSMENT OF GI S YSTEM
Ask about:
Weight loss/gain and over what period of time
Bowel Function
Laxative Use
Appetite
Dysphasia, N/V/D, indigestion, blood in vomit or stool,
Mental State
P HYSICAL E XAM
Inspection
Auscultation
Palpation (gentle)
Percussion
Ask pain
D IAGNOSTIC T ESTING
Abdominal X-ray
Ultrasound- may be NPO- fat free diet to accumulate bile in gallbladder
CT- NPO 6-8 hours
MRI- soft tissues, ask about metallic implants
Upper GI- Post Procedure- Monitor stool- must make sure stool passes- Barium can set up in stool and
cause obstruction
Stop Glucophage 2 days before test with barium b/c liver damage
Lower GI- barium enema- Monitor for passion of Barium after procedure
Endoscopy- EGD- conscious sedation (Demerol and Versed)- Withhold food and fluids until gag reflex
returns NPO 6-8 hours
Proctoscopy- exams the rectum
Sigmoidoscopy- exams the rectum and the sigmoidoscopy
Colonoscopy- exams entire large intestine
Gastric Analysis and histamine test- gives acidity of the stomach contents- NPO after supper and have test
in morning. NG tube extracts stomach contents, no gum or smoking.
Stool/fecal analysis
Manometry- measure pressure
Lab studies
CEA (carcinoembryonic antigen)- can detect cancer cells, suggestive but not diagnostic
Labs to evaluate nutritional status
Albumin
Pre-albumin
Transferrin
Urine urea nitrogen to assess protein balance
E NTERAL F EEDING
Can be any location in GI tract- usually stomach, duodenum or jejunum
Preferred alternative to normal eating
NG tubes
Nasoduodenal or Nasojejunal tubes
Gastrostomy- potential complications
Displacement
Perforation of the mucosa
Reflux of stomach contents can lead to skin breakdown
Can obstruct pyloric outlet and lead to n/v
Feedings can be bolus or continuous, continuous have less complications due to slower infusion
Head of Bed needs to be at least 30 degrees
Always check placement before feeding and at least once per shift
Can cause diarrhea due to high osmolarity of formula, may decrease rate or dilute formula
Complications are more prevalent in the elderly
Always flush NG tubes with 20-30 mL before and after feedings and PRN to keep tube patent
C ASE S TUDY
You are the 1st shift LPN in a LTC facility. You are caring for Mr. George Toobe. Mr.
Toobe has a PEG tube and is receiving full-strength formula at 50 mL/hour continuously
via Kangaroo pump. What should your routine assessment consist of?
Lung sounds
Bowel sounds
Site care
Tube placement
The nursing assistant tells you that Mr. Toobe has had several diarrhea stools this am,
you know that he was recently started on his continuous feedings. What action should
you take?
Call the physician as he may slow the rate or dilute the formula
It is important that all the CNA’s caring for Mr. Toobe know:
Keep the HOB raised to 30 degrees and put pump on hold when HOB must be lowered.
GI M ANIFESTATIONS OF I LLNESS
Anorexia
Nausea- subjective
Vomitingobjective,
usually proceeded by nausea but projectile not (brain tumors, aneurism, increased intercranial
pressure, pyloric Stenosis),
can be caused by many factors,
measure amount and document appearance, color, odor
prolonged can lead to electrolyte and acid-base balance and dehydration, puts elderly at risk for
cardiac arrest and renal insufficiency
Maintain fluid and electrolyte balance and prevent aspiration
Prevention- deep, slow breaths
Fluids as tolerated, avoid spicy and greasy foods, may need IV or NG for gastric decompression
Meds- usually make them drowsy, Phenergan, Zofran, Compazine
Diarrhea- increased frequency and excessive water content
Secretory- due to abnormal increase in the production of intestinal secretion, high volume and
high sodium, inflammation of the GI mucosa and infections
Osmotic- poor water Reabsorption of the large intestines, pull in of water by contents with High
osmolarity, antibiotics, surgical procedures that speed contents through the GI tract- High
Potassium content
Mixed- increased intestinal motility and combination of secretory and osmotic factors
Consequences depend on cause and severity
Fluid and electrolyte imbalance
Irritation of the perianal skin
Assess color, consistency, amount, odor
Stool samples (C-diff, parasites)
Interventions to control cause and symptoms, prevent complications, and increase
comfort
Anti-diarrhea Meds-Lomotil or Imodium
Fluid and electrolyte replacement, barrier creams to prevent skin breakdown
Constipation- decrease in frequency of BM for what is normal for the patient
Lack of mobility, iron, antidepressants, pain meds, laxative abuse, poor diet
Intervention depends on cause, usually lifestyle change is best
Fecal Incontinence- involuntary passage of stool
Impaction, neurological injuries, injury to the perianal area, diarrhea
Skin breakdowns
Bowel training, biofeedback
Indigestion- dyspepsia, not necessarily pathologic but can be a result of disease
GI S URGERY
Incision into the thoracic cavity (thoracotomy), abdominal cavity (laparotomy) or both
Pre-op nursing care
Teaching, provide support, relieve anxiety
Cleansing enema, antibiotics
Post operative
Turn, cough, deep breath and incentive spirometer
Routine vitals
Observe for abdominal distention, bowel sounds, n/v, observe for passing gas or stool
I&O’s
Paralytic ileus- no peristalsis
Gastric decompression by NG to prevent atelectasis
At risk for
Fluid and electrolyte imbalance
Bleeding
Leaking of fluid into interstitial spaces
C OMPLICATIONS OF GI S URGERY
Fluid/electrolyte imbalances
Bleeding
Peritonitis
Infection
Immobility Risks
C OLOSTOMY
Removal of part of the colon
May be done for:
Cancer
Inflammatory bowel disease
Trauma
Perforated diverticulum
Enteric Fistula
Intestinal obstruction
Preoperative psychological support
Can be any part of the intestine- commonly cecum, transverse, descending or sigmoid
Amount and character of stool depends on location of colostomy in intestine
Care:
Change appliance ever 3-4 days- can go to 5-7 days after stoma shrinks
Empty pouch when ½ to 1/3 full
Watch for skin irritation/breakdown
Well-pouched stoma should not cause odor
Stoma will shrink for about 6-8 weeks
Healthy stoma- red/moist
I LEOSTOMY
Distal end of the ileum is used as stoma, entire colon is removed
Fecal output: early very loose to liquid- 1800-2000 mL per day
May thicken up over time and output decreases to 500-1000 mL/day
Dehydration, electrolyte imbalance
More problems with skin breakdown due to increased acid
S TOMAS
End Stoma- created by cutting bowel and brings it up the proximal (functioning) through the surface of
the skin and is single stoma. This is for permanent placement. Bowel is removed
Double-barreled stoma- usually temporary
Both proximal and distal ends brought to surface
Proximal end is functioning
Distal end is called mucous fistula
Loop stoma- Loop of bowel brought to surface, Opening in anterior wall for fecal drainage, posterior wall
intact, bridge can be removed after 7-10 days and is usually temporary
S TOMATITIS
Inflammation of the oral cavity
Cause: vitamin deficiency, infection, drugs, viral disease (burning sensation pain, fever)
T HRUSH
candidiasis fungus candida albicans: can be infected while coming through the birth canal
O RAL C ANCER
Predisposing factors: smoking, smokeless tobacco
Metastasize early
More common in men
Treatment- surgery, radiation, or both
Leukoplakia- sign of oral cancer on tongue or cheek, white patches
E SOPHAGITIS - INFLAMMATION OF THE ESOPHAGUS
Common causes: chemical irritants, smoking, reflux of gastric acids, exposure to radiation
therapy
S&S: burning pain, dysphasia, can lead to ulceration and stricture of the esophagus
Diagnosis: symptoms, endoscopy
Treatment: relief of symptoms and removal of the cause
G ASTRITIS - INFLAMMATION OF THE STOMACH
Acute- caused by irritation by drugs (aspirins, steroids, alcohol)
Anorexia
Epigastric pain
Treatment: antacids, remove cause, Karafate (Sucralfate)
Chronic- elderly, atrophy of gastric mucosa,
Poor appetite
Nausea
Epigastric pain
Bleeding
Treatment: avoid irritants, small, frequent, bland meals, B12 supp
H IATAL H ERNIA
Can be called hiatus hernia or diaphragmatic hernia, protrusion of the stomach into the
diaphragm
Symptoms
Heartburn, epigastric pain
Can feel like chest pain
n/v
stomach distention
Risk factors
Obesity
Pregnancy
aging
Diagnosis
EGD
Barium swallow
Interventions
Small frequent meals
Avoid foods that cause and smoking
Should not wear tight fitting clothes
Avoid straining with bowel movements
HOB elevated
G ASTROESOPHAGEAL R EFLUX D ISEASE - GERD
Lower esophageal sphincter- stomach contents flow back into the esophagus (associated with
Hiatal hernia)
Risk factors
Smoking
Coffee
Alcohol
Chocolate
Peppermint
Pregnancy
Obesity
Fatty foods
Symptoms:
Heartburn after eating
Mid sternal pain may be mistaken for MI
Complications
Esophageal stricture and ulceration
Esophagitis
Barrett’s esophagus (pre-malignant)
Treatment:
Minimize foods that can irritate the mucosa
Avoid tight clothing
Elevate HOB
Avoid eating close to bedtimes
Small, frequent, bland meals
Proton pump inhibitors
Diagnosis
Esophageal pH testing
Upper GI
Endoscopy
Surgery- Fundoplication
Wraps the fundus around the lower esophagus to tighten the esophagus to
prevent reflux
P EPTIC U LCER D ISEASE erosion of the lining of the upper GI tract- as deep as muscle layer down to the abdominal cavity
Usually duodenum, stomach, lower esophagus
Affects 10% of the population- usually not in children, but duodenal more common in men between 30-50
yrs. Stomach ulcers more prevalent In women over 60
H. Pylori Helocobactor Pancreatic tumors produced
Can be caused by pancreatic cancer
Patients that have chronic severe illness and burns will have increased risk. Chronic stress causes
parasympathetic response that increases gastric juices.
Complications:
Obstruction, usually pyloric sphincter or gastric outlet
Bleeding- either slow (coffee grounds vomitus) or severe bleed (bright red vomitus), IV volume
expanders, NG tube, blood transfusion, reduce acid, prevent nausea, iced saline lavage for severe
vomiting
Perforation- ulcer erodes the wall of the stomach or intestine and the GI contents leach into the
peritoneal cavity- EMERGENCY- surgery needed. Surgery washes the cavity with antibiotics to
keep infection down.
Symptoms
Dull, boring pain
Pain occurs between meals and early in the morning
N/V
Anemia if bleeding
Diagnosis
Upper GI
Endoscopy
Stool specimen for occult blood
Histamine test for pH
Tests to confirm H. Pylori
Treatment
Healing can take from 4-8 weeks
Diet modification
Medication- antacids and Anticholinergics, histamine blockers
Antibiotics if H. Pylori
Small, frequent, bland meals
Surgery
Gastrectomy- removal of part of the stomach
Bilroth I- connect stomach to the duodenum
Bilroth II- connect stomach to the jejunum
NG tube 24-48 hours after surgery for decompression, do not remove without
MD order
For total gastrectomy, will need 12 injections for rest of life for intrinsic factor
Dumping syndrome- nausea, weak, faint, (food moves too fast through the GI
tract and makes the chyme more hypertonic causing water to be pulled from
the blood stream)
Vagotomy- resection of the vagus nerve to reduce stimulation of acid production
Antrectomy- remove a large part of the stomach, usually the antrum
Pyloroplasty – enlargement of the pyloric sphincter
G ASTROENTERITIS
Inflammation of stomach and intestines- occurs in conjunction with other diseases and usually caused by
virus or from bacterial infection from food
Primary Symptoms
Diarrhea, cramping, vomiting
Will start within a few hours after eating bad food
Diagnostic- stool samples and cultures
Treatment
Treat dehydration
Contact precautions
I RRITABLE B OWEL S YNDROME
Signs and Symptoms
Abdominal pain
Bloating
Alternating bouts of diarrhea and constipation
DOES NOT INVOLVE AN INFLAMMATORY PROCESS
Cause: stress, chocolate, milk, alcohol, caffeine
NO BLEEDING FEVER OR WEIGHT LOSS
I RRITABLE B OWEL D ISEASE
Group of chronic disorders in the small and large intestines that cause inflammation or ulceration
Affects approximately 2 million people in the US. Caused by genetic and environmental factors.
Infectious agents, food additives, birth control pills, stress exacerbations.
Crohn’s Disease
Ulcerative Colitis
Specific cause unknown, may be food allergies or autoimmune. One of the most serious
diseases. Periods of remission and exacerbation. May be passing 20-30 stools a day.
Ulcers form on the lining of the intestine that may bleed leading to anemia. Can be a slow bleed
or severe hemorrhage. Nutritional and Vitamin deficiencies
Colonoscopy with biopsy, stool specimens, history and physical for diagnosis
Interventions: physical and psychological rest, fluid and electrolyte management, control
inflammation, prevent infection
Pharmacology: manage inflammatory response at the mucosal level; amino salicylates, steroids,
sulfasalazine, Mesalamine, olsalazine
Chronic, persistent inflammation, almost always presents before the age of 30.
Fibrosis and narrowing of bowel lumen
Begins in the rectum and spreads through the colon
Frequent diarrhea, bloody, mucoid
May have mild cramping pain in left lower quadrant- often relieved by defecation
Cancer can be complication
Diagnosis: stool specimen, colonoscopy, Upper GI
Anti-diarrheal can cause toxic mega colon
Treatment: TPN, improve nutritional and fluid levels, psychological support
Surgery: total colectomy with ileostomy
Crohn’s Disease
Chronic, progressive
Can affect any part of GI tract, but usually small intestine. Terminal ileus and anus usually
involved.
Lesions in patches with patches of normal lymphoid tissue.
Abdominal Pain- most common symptom. Diarrhea
Young adults- higher incidence among Jews
Requires ongoing therapy, but rarely surgery
Prone to abscess and fistula formation, anal fissure, perianal abscesses, and partial bowel
obstruction
Often results in disability and incapacity
Associated with complications in other parts of body- arthritis, kidney stones, gallstones,
cutaneous manifestations (pyoderma gangrenousum) and inflammation of eyes
Stool may be fatty and have foul odor
Milk, fatty foods, emotional upsets, stress, other physical illness can bring on attack
Diarrhea not as severe as ulcerative colitis, but may have urgency and flatus
Diagnosed by x-rays, upper GI, barium enemas, colonoscopy will have high risk of perforation
Complications: lesions of the rectum and anus, fissure, ulcers, fistulas and abscesses.
Treatment: supportive, aimed at obtaining remission, anti-diarrheal, anti-inflammatory,
immunosuppressant agents. Mesalamine
Pg 448 good chart for manifestations and complications of UC and CD
A PPENDICITIS
Inflammation of the vermix appendix, fills and empties frequent, but because narrow it is easily
obstructed and can cause infection- E. Coli. Distention can cause rupture. Can abscess and cause
peritonitis
Risk of fatal complications increase with delay of treatment
Pain in the right lower quadrant- McBurneys point (halfway between the umbilicus and anterior iliac
crest- rebound tenderness
Always surgical intervention before rupture (clean). If removed after rupture it is called dirty
appendectomy.
Di bit administer laxatives or enemas or apply heat to the abdomen because these measures may cause
perforation of the appendix.
P ERITONITIS
Inflammation of the peritoneum and the abdominal cavity. Can be a complication of a bacterial, fungal,
or viral infection. Can come from female reproductive or GI contents in the peritoneum
Signs and symptoms: severe abdominal pain. Will lie on back or side with flexed knees to try to alleviate
pain. Any movement is painful. N/V/D. paralytic ileus. Abdominal distention and tenderness. High white
cells. Can progress to septic shock.
Every patient who has GI surgery is at risk.
Interventions: antibiotics, fluid and electrolyte replacement, resolve paralytic ileus, pain control. NPO,
NG. Usually in ICU.
H ERNIA
Projection of a loop of an organ, tissue, or structure, through a congenital and acquired defect. Usually in
the abdomen
Umbilical- weakness in the abd wall at the umbilical ring. Can see when baby cries or strain. Usually
resolve on their own. 3-5 years before surgery.
Femoral- where femoral artery passes into the femoral canal. More common in women.
Inguinal- part of the intestine projects through the inguinal canal. More common in men
Incisional- from wound
Reducible- if they can be gently manipulate them back into the cavity
Incarcerated- not able to be reduced
Strangulated- when blood supply is reduced, will have to do emergency surgery to prevent necrosis
Hernias are usually not painful unless blood supply is disrupted. Most hernias for adults are repaired
surgically.
Hernioctomy- removal. Hernioplasty- repair
Fluid, fiber rich diet, stool softeners, small frequent meals, no heavy lifting, avoid constipation
I NTESTINAL O BSTRUCTION
Can be partial or complete but is always serious. Partial can resolve on its own, but may require surgical
intervention
Occurs when any condition exists that prevents the passage of bowel contents through the intestine.
Causes: strangulated hernia, twisting of the bowel, cancerous lesions, postoperative adhesions, usually
occurs in the small intestine. Vomiting, decreased electrolytes, can also lead to decreased HCl, metabolic
alkalosis, the higher the obstruction the earlier and more acute the symptoms, wave like pain, will vomit
gastric contents and then will have fecal content from above the obstruction. Lower obstruction, no
vomiting but blood mucus.
Abdominal distention- must measure girth and strict I&O’s
Symptoms of hypovolemic shock
Death can result in hours from complete obstruction
NG tube for decompression, may need intestinal decompression, NPO, monitor vital, HOB elevated 20-30
degrees
D IVERTICULAR D ISEASE
Diverticulum- pouch or sac arising from any tubular structure.
Low fiber diet contributes to development of this disease.
Diverticulosis- multiple diverticulae scattered through the colon
Diverticulitis- fecal matter fills the diverticulum and leads to inflammation
Mild to severe pain often in LLQ. May have fever and increased WBC. If rupture can cause peritonitis,
septicemia, and septic shock.
Treatment: high fiber diet unless having inflammation symptoms. Avoid seeds, nuts, and corn. If
inflammation, low fiber diet.
IV fluids, antibiotics, gastric decompression
H EMORRHOIDS
Dilated veins similar to varicose veins.
Thrombosed- blood clot in veins
Factors: straining with bowel movements, heavy lifting, pregnancy, prolonged constipation
Symptoms: awareness of a mass in the rectum, constipation, bleeding, bright red blood that is not mixed
with feces, If thromobosed, severe pain.
Usually resolve without treatment, but if much discomfort can instruct warm compresses or sitz baths.
Analgesic ointments, stool softeners, steroid suppositories, can be surgically excised or can be injected
with saline solution. Pain relief main issue post op
C ANCERS
Small Intestine- not seen as often as other areas, symptoms are intestinal obstruction, bleeding and upper
abdominal pain. Prognosis: poor- metastasizes early to the liver and lymph node
Colorectal cancer- most prevalent intestinal cancer in US. Equal in men and women. Prognosis: earlygood. Risk: ulcerative colitis, diverticulitis, low fiber diet. Symptoms: rectal bleeding, alternating
constipation and diarrhea, excessive flatus, cramping lower abd, abd distention. If tumor is in transverse
colon, obstruction will be likely. ¾ can be detected with colonoscopy and recommended for pts. Over 50.
May do radiation and chemo pre and/or post op. Curative is always surgery. May have colostomy.
ACCESSORY ORGANS
C HOLECYSTITIS
Inflammation of the gallbladder- more common in women
Four F’s
1. Fat
2. Female
3. Fair
4. Over 40
Causes: obstruction, gallstone or tumor. Usually gallstones. Bile can’t leave the gallbladder, water is
absorbed and becomes more concentrated irritating the gallbladder, causing inflammation, and
thickening. Possible rupture and gangrene.
Acute Attack: Biliary Colic: sudden onset of nausea and vomit. Pain RUQ. Fatty foods with indigestion and
heartburn. Fever, Jaundice.
Diagnosis/Treatment: Abd. X-ray and ultrasound. EKG to rule out cardiac. Oral cholecystogram. IV fluid,
electrolyte replacement, IV antibiotics, cholecystectomy (usually after acute attack is over)
Cholelithiasis- gallstones, more common in women. Pregnancy increases risk. Made of cholesterol,
Bilirubin, and calcium. Fat intolerance.
Treatment: analgesics, HOB 45-60 degrees raised with knees flexed. Laparoscopic surgery.
P ANCREATITIS
Inflammation of the pancreas caused by release of pancreatic enzymes which causes auto-digestion of
pancreatic tissue
Most caused by gallstones, alcoholism
Acute: abd pain radiating to back, N/V, bowel sounds decreased or absent, abd. Tenderness and fever,
WBC high, serum amylase elevated 2- 2 ½ above normal. Pleural effusion, abscesses or pseudocyst in
pancreas, tachycardia and hypotension and can progress to shock.
Treatment: pain meds, surgical drainage,
Chronic: chronic pain that waxes and wanes from day to day in upper abdomen radiating to the back, can
become addicted to narcotics for pain, pancreatic calcifications, fatty stools, diabetes,
Acute interventions: reduce pancreatic activity, maintain fluid and electrolyte imbalance, NG, total
Parenteral nutrition, if cause is gallstones, then remove gallbladder
Chronic interventions: pancreatic enzyme injections, insulin, nerve block.
L IVER
Largest accessory organ
Metabolism of carbohydrates, fats, proteins
Regulation of blood glucose by storing as glycogen and releasing as glucose as needed
Removal of ammonia
Breakdown fats for energy
Converts to fat
Synthesis of proteins for ketone bodies
Vitamin storage- Vitamin K and other fat soluble vitamins
Detoxification
D ISORDERS OF THE L IVER
Viral Hepatitis- diffuse inflammatory reaction that can cause liver cells to degenerate and die.
A- source primarily human feces- spread by fecal/oral route
B- most commonly transmitted via blood- can progress to chronic liver disease
C- Parenteral transmission- drug abusers, health care workers, one of leading causes of liver transplant
D- Delta virus- can transform Hep B into severe, chronic hepatitis
E- primarily in developing countries- fecal/oral
All can cause chronic liver disease
Labs: AST, ALT elevated; PT will be prolonged. Alkaline phosphatase will be elevated
Assessment- mild or sever symptoms- anorexia, fatigue, n&v, chills, headache, fever, jaundice (not always)
No specific therapy; rest and encourage PO fluids, good nutrition
PREVENTION
C IRRHOSIS
Chronic
Diffuse destruction and regeneration of liver cells causing an accumulation of fibrous connective tissue
that obstructs the biliary channels in the liver
More common in men middle aged or older
7th leading cause of death by disease in the US
Causes: chronic hepatitis; cystic fibrosis; blockage of the bile ducts; severe reactions to drugs and
environmental toxins; alcoholism causes Laennec’s and is the most common type in the US, repeat bouts
of CHF can cause also
Develops slowly usually over a period of years
Liver cells become infiltrated with fat- the liver size increases
Liver function decreases- unable to metabolize protein normally- leads to increased ammonia levels in the
blood
Early signs and symptoms: anorexia, indigestion, nausea, flatulence, bowel habit changes, dull, heavy
feeling in RUQ, gynecomastia (enlargement of the breast in men), nosebleed, bleeding gums
Progressive: jaundice, spider angiomas on the face, trunk, and neck, anemia, thrombocytopenia,
peripheral neuropathy
Late: portal hypertension, ascites, hypoalbunemia, collateral circulation resulting in esophageal varices,
hemorrhoids, decreased renal blood flow
Hepatic coma or hepatic encephalopathy- terminal complication due to increased ammonia
Interventions:
Manage symptoms- no cure
Diet
Daily weights
Skin care
Mouth care
Diuretic therapy- Spironalactone (Aldactone) Potassium sparing diuretic
Lactulose- traps ammonia to be expelled in the feces
Leveen shunt- shunts the fluid from the abdomen back into the circulatory system- can cause the
blood to be too dilute
Sengstaken-Blakemore tube to tamponade esophageal varices
PEDIATRIC GI
C LEFT L IP
Characterized by fissure or opening in upper lip
More in boys
One or both sides of the lip
May be accompanied by cleft palate
Common congenital abnormalities
Treatment- surgical repair- usually about 2 months old
Surgery improves sucking and appearance
Watch for oral or systemic infection, before and after until suture heals may be fed with syringe with
rubber tip, Haberman feeder, or medicine dropper.
Logan’s bow- helps immobilize the upper lip while healing
***NEED TO AVOID SUCKING MOTIONS UNTIL SUTURES HEAL****
Should avoid crying until sutures heal
Should be kept off of their abdomen, and need to gently cleanse suture line,
Need to let the parents know that they can hold, and comfort infant
C LEFT P ALATE
Failure of hard palate to fuse at midline- forms passageway between nasopharynx and nose
Feeding complications
Increased risk of respiratory and middle ear infections, speech difficulties
Surgical treatment
Can predispose babies to emotional problems because of difficult feeding times. May not have regular
tooth eruptions, drooling, and late speech.
Will be fed liquids by cup and then advance to soft diet. Avoid hot foods and liquids. No straws.
Ear aches and dental problems are complications
P YLORIC S TENOSIS
Narrowing and obstruction of lower end of stomach. Overgrowth of circular muscles of pylorus or spasms
of pyloric sphincter
2-3 weeks old- more boys
Projectile vomiting
Most common surgical condition of the digestive tract in infants
Olive-shaped mass in the RUQ
Constant hunger, dehydration, malnourishment
Surgical treatment to enlarge the opening of the pyloric muscle
Will try thickened formula pre-op to help prevent vomiting, place on right side in Fowler’s after feeding,
feed slowly and burp often
H IRSCHPRUNGS D ISEASE
Absence of ganglionic innervations to the muscle of a segment of bowel
Chronic constipation- Ribbon like stools
More in boys and incidence higher in children with Down’s syndrome
Watch for failure to pass meconium, abdominal distention, vomiting, and failure to thrive. Colon can be
distended increasing surface tension, do not give tap water enema as will over absorb.
Treatment: surgical, may have to have temporary colostomy.
I NTUSSESCEPTION
Telescoping of one part of intestine into another part just below it- frequently at the ileocecal valve
Leads to intestinal obstruction and strangulation and may burst causing peritonitis
Occurs more in boys
May have spontaneous reduction, if treated in 24 hours, good prognosis. Barium enema
Sudden, severe pain, vomiting, Currant Jelly stools, fever, signs of shock, EMERGENCY, may feel
sausage shaped mass in the RUQ
G ASTROENTERITIS
Inflammation of stomach and intestines
Treatment focuses on identifying and eradicating disease (sorbitol)
Hydration- Pedialyte
V OMITING
Common
Persistent or projectile- investigate
Can lead to dehydration- electrolyte imbalance
Causes- improper feeding, increased intercranial pressure, viral infections
Constant vomiting can lead to alkalosis, aspiration, and aspiration pneumonia
Document time, amount, color, consistency, if projectile, measure to rehydrate
G ASTROESOPHAGEAL R EFLUX
Many infants have
May have esophagoscopy, barium swallow, pH monitoring ordered
Treatment- depends on severity of symptoms
Severe- vomiting, weight loss, failure to thrive
Avoid over feeding, place in Fowler’s after eating, may do antacid meds, surgery is last resort,
fundoplication
D IARRHEA
Sudden increase in stools with fluid consistency, may have mucous, blood, or greenish color
Acute- sudden, d/t inflammation, infection, medication,
Chronic- lasts more than 2 weeks and can be indicative of malabsorption
Infectious- rotavirus, E. Coli, salmonella, C-diff
Isotonic vs. hypotonic- if patient has lost equal amounts of fluid and electrolytes are lost is isotonic
(shock), more electrolytes than fluid hypotonic (water intoxification), hyper tonic, more fluid than
electrolytes (dehydration)
Treatment- BRAT diet
make sure the kidneys are working before giving potassium to IV fluids
C ASE S TUDY
Dee Hydration is 1 year old who presents with hypotonic dehydration- What is she at risk for? Water intoxication
P INWORMS (E NTERBIASIS )
Most common worm infection
Comes out at night to lay eggs
Oral entry
Scotch tape test
Vermox-Povan
All family members treated
R OUNDWORMS (A SCARIASIS )
Can be asymptomatic- may cause abdominal pain
Caused by unsanitary disposal of feces and poor hygiene
Eggs ingested- can survive for weeks in the soil
Chronic cough with no fever
Vermox-Povan