Pediatrics 1
Pediatrics Final Exam Study Guide
CHAPTER 24: The Child with Gastrointestinal Dysfunction
❖ Clinical Manifestations of Gastrointestinal (GI) Dysfunction
• Failure to thrive
• Dehydration
• Spitting up, regurgitation
• Nausea, vomiting, diarrhea, constipation
• Abdominal pain, distention, GI bleeding
• Jaundice
• Dysphagia
• Pain – big one
• Fever
❖ Dehydration
• Total output exceeds total intake regardless of cause
• Results from a number of different diseases
• Lack of intake or abnormal loss
• Renal, GI, integumentary, respiratory (4 big systems)
❖ Daily Maintenance Fluid Requirements
• Calculate child’s weight in kg
• Allow 100 ml/kg for first 10 kg body weight
• Allow 50 ml/kg for second 10 kg body weight
• Allow 20 ml/kg for remaining body weight
❖ Diarrhea
• Acute diarrhea is leading cause of illness in children under 5yo
• 20% of all deaths in developing countries are related to diarrhea and dehydration
▪ Contaminated water and soil; hand hygiene to prevent diarrhea (fecal-oral route contamination)
• Acute infectious diarrhea: variety of causes
▪ C-diff can cause diarrhea, rotavirus is the number one cause of diarrhea, antibiotic therapy is the
second cause of diarrhea
• Etiology of Diarrhea
▪ Rotavirus
▪ Salmonella, Shigella, and Campylobacter organisms
▪ Giardia
▪ Cryptosporidium
▪ Clostridium difficile
▪ Antibiotic therapy
• Prevention of Diarrhea
▪ Teach personal hygiene
▪ Careful food preparation
▪ Hand washing
❖ Constipation
• An alteration in frequency, consistency, or difficulty in emptying bowels
• May be secondary to other disorders
• Idiopathic (functional)
• Chronic constipation
• Constipation in Infancy
▪ Often related to diet
▪ Constipation in exclusively breast-fed infant almost unknown
▪ Formula-fed infants may develop constipation
, Pediatrics 2
▪ Changes in Exclusively breast-feeding to formula-feeding
▪ Give 3 weeks for dietary change for baby to assimilate to new diet
• Constipation in Childhood
▪ Environmental changes
▪ Control – they can control (by holding) their stool
▪ Encopresis – so much rock hard stool in colon, that smears or water only stool can pass through rectum
▪ Management
▪ Diet, stressors (bullying in school, a death in the family, recent move, etc.),
❖ Hirschsprung Disease
• Also called congenital aganglionic megacolon
• Mechanical obstruction from inadequate motility of intestine
• Incidence: 1 in 5000 live births; more common in males and in Down syndrome
• Absence of ganglionic cells in colon – allows stool to back up, distension happens, and stool does not
pass through
• Clinical Manifestations of Hirshsprung Disease
▪ Aganglionic segment usually includes the
▪ Accumulation of stool with distention
▪ Failure of internal anal sphincter to relax Newborns
▪ Older Infants and Children
º Newborn – no meconium within two days
º Older children – chronic constipation, chronic abdominal distension
• Diagnostic Evaluation of Hirschsprung Disease
▪ X-ray, barium enema
▪ Confirm diagnosis with rectal biopsy (to tell if ganglion cells are present or not)
• Therapeutic Management of Hirschsprung Disease
▪ Surgery – cut out portion that is aganglionic, Do a colostomy (temporary), pull through the portion;
for children with partial aganglionic colon (bowel improvement)
▪ Two stages – temporary colostomy, then repair when healing has happened
❖ Gastroesophageal Reflux (GER)
• Passage of abdominal contents to the esophagus from an incompetent or poorly developed lower
• 4 Risk Factors
• Complications – aspiration pneumonia
• GERD
• Small frequent feedings, HOB at 30-45 angle (or your arm when feeding an infant)
• Breast-feeding – 2 ways (baby’s body across the chest, or football grip)
• Thickening of breast-milk for infants – pumped and added with thickener (rice cereal consistency), then
bottle- feed to baby
• Medication – Pepcid, Proton-pump inhibitors, proton-pump kinetics
❖ Acute Appendicitis
• Caused by an inflammation of the lumen of the appendix
• Diagnostic evaluation
• Therapeutic management:
▪ Ruptured appendix
▪ Prognosis
• Nursing considerations:
▪ Pain
• Appendix – looks like a little piece of inflated balloon hanging on the end of the large intestine
• Referred tenderness – traveling pain, transient pain, pain radiating on right upper quadrant
• Nausea, vomiting, diarrhea, anorexia (no desire to eat), pain, fever
• Missed appendicitis (influenza like symptoms), it can rupture
, Pediatrics 3
• Enlarge and inflame with fecal matter (bacteria goes to peritoneum when appendix ruptures)
• Classic sign of ruptured appendix – immediate relief of abdominal pain
• Can show signs of sepsis (septic shock), depends on how sick the patient is
• Treatment – if there is a rupture, give heavy antibiotics (to reduce spread of bacteria and infection),
significant surgery and clean out the belly
❖ Inflammatory Bowel Disease (IBD)
• 2 main forms of chronic intestinal inflammation
▪ Ulcerative colitis – it affects 2 main layers of bowel (mucosa, and submucosa)
▪ Crohn’s disease – any layer of the bowel wall and GI tract
❖ Acute Hepatitis
• Causes:
▪ Alcohol, drugs, sex – adult population, causes of Acute Hepatitis
▪ Children – viral illnesses, chemical reactions, drug reactions (drug is too strong for the liver to
process), underlying disease processes, some other issue with the liver
▪ Baby with Fetal-Alcohol Syndrome can eventually develop Acute Hepatitis – has inborne dysfunction
❖ Biliary Atresia
• AKA extrahepatic biliary atresia
• Congenital anomaly
• Biopsy for diagnosis
• Lacks correct plumbing
• Management
• Atresia – means without, not there
• Biliary – bile ducts
• Diagnosed within first 3mos for a Kasai procedure to be successful
• 2 management protocols – Kasai procedure (new biliary bridge; 30% breakdown; palliative process to delay
transplant [for body to grow], needs liver transplant whether or not procedure will work; lasts short period
of time to 12 years)
❖ Cleft Lip/Cleft Palate
• Facial malformations that occur during embryonic period
• May appear separately or together
• Partial or Complete
• Unilateral or Bilateral
• Complications: nutrition, risk for aspiration, respiratory distress, language acquisition (speech), teeth
development (dentition), prone to ear infections (Eustachian tubes drain, back-up of fluid, not able to
process secretions)
• Variations in clefts of lip and palate at birth.
▪ A, Notch in vermilion border.
▪ B, Unilateral cleft lip and palate.
▪ C, Bilateral cleft lip and palate.
▪ D, Cleft palate
• Surgical Correction-Cleft Lip
▪ Closure of lip defect
▪ Often (almost always) precedes the correction of the palate
▪ 10 weeks/10 lbs
º Post-op Considerations
▪ Complications: respiratory distress
▪ Maintain intact suture line, “back to bed” sleep on the back (not prone), use elbow immobilizers (to
keep from bending and touching)
• Surgical Correction of Cleft Palate
▪ Typically 12-18 months of age (Range 6-24 months)
Pediatrics Final Exam Study Guide
CHAPTER 24: The Child with Gastrointestinal Dysfunction
❖ Clinical Manifestations of Gastrointestinal (GI) Dysfunction
• Failure to thrive
• Dehydration
• Spitting up, regurgitation
• Nausea, vomiting, diarrhea, constipation
• Abdominal pain, distention, GI bleeding
• Jaundice
• Dysphagia
• Pain – big one
• Fever
❖ Dehydration
• Total output exceeds total intake regardless of cause
• Results from a number of different diseases
• Lack of intake or abnormal loss
• Renal, GI, integumentary, respiratory (4 big systems)
❖ Daily Maintenance Fluid Requirements
• Calculate child’s weight in kg
• Allow 100 ml/kg for first 10 kg body weight
• Allow 50 ml/kg for second 10 kg body weight
• Allow 20 ml/kg for remaining body weight
❖ Diarrhea
• Acute diarrhea is leading cause of illness in children under 5yo
• 20% of all deaths in developing countries are related to diarrhea and dehydration
▪ Contaminated water and soil; hand hygiene to prevent diarrhea (fecal-oral route contamination)
• Acute infectious diarrhea: variety of causes
▪ C-diff can cause diarrhea, rotavirus is the number one cause of diarrhea, antibiotic therapy is the
second cause of diarrhea
• Etiology of Diarrhea
▪ Rotavirus
▪ Salmonella, Shigella, and Campylobacter organisms
▪ Giardia
▪ Cryptosporidium
▪ Clostridium difficile
▪ Antibiotic therapy
• Prevention of Diarrhea
▪ Teach personal hygiene
▪ Careful food preparation
▪ Hand washing
❖ Constipation
• An alteration in frequency, consistency, or difficulty in emptying bowels
• May be secondary to other disorders
• Idiopathic (functional)
• Chronic constipation
• Constipation in Infancy
▪ Often related to diet
▪ Constipation in exclusively breast-fed infant almost unknown
▪ Formula-fed infants may develop constipation
, Pediatrics 2
▪ Changes in Exclusively breast-feeding to formula-feeding
▪ Give 3 weeks for dietary change for baby to assimilate to new diet
• Constipation in Childhood
▪ Environmental changes
▪ Control – they can control (by holding) their stool
▪ Encopresis – so much rock hard stool in colon, that smears or water only stool can pass through rectum
▪ Management
▪ Diet, stressors (bullying in school, a death in the family, recent move, etc.),
❖ Hirschsprung Disease
• Also called congenital aganglionic megacolon
• Mechanical obstruction from inadequate motility of intestine
• Incidence: 1 in 5000 live births; more common in males and in Down syndrome
• Absence of ganglionic cells in colon – allows stool to back up, distension happens, and stool does not
pass through
• Clinical Manifestations of Hirshsprung Disease
▪ Aganglionic segment usually includes the
▪ Accumulation of stool with distention
▪ Failure of internal anal sphincter to relax Newborns
▪ Older Infants and Children
º Newborn – no meconium within two days
º Older children – chronic constipation, chronic abdominal distension
• Diagnostic Evaluation of Hirschsprung Disease
▪ X-ray, barium enema
▪ Confirm diagnosis with rectal biopsy (to tell if ganglion cells are present or not)
• Therapeutic Management of Hirschsprung Disease
▪ Surgery – cut out portion that is aganglionic, Do a colostomy (temporary), pull through the portion;
for children with partial aganglionic colon (bowel improvement)
▪ Two stages – temporary colostomy, then repair when healing has happened
❖ Gastroesophageal Reflux (GER)
• Passage of abdominal contents to the esophagus from an incompetent or poorly developed lower
• 4 Risk Factors
• Complications – aspiration pneumonia
• GERD
• Small frequent feedings, HOB at 30-45 angle (or your arm when feeding an infant)
• Breast-feeding – 2 ways (baby’s body across the chest, or football grip)
• Thickening of breast-milk for infants – pumped and added with thickener (rice cereal consistency), then
bottle- feed to baby
• Medication – Pepcid, Proton-pump inhibitors, proton-pump kinetics
❖ Acute Appendicitis
• Caused by an inflammation of the lumen of the appendix
• Diagnostic evaluation
• Therapeutic management:
▪ Ruptured appendix
▪ Prognosis
• Nursing considerations:
▪ Pain
• Appendix – looks like a little piece of inflated balloon hanging on the end of the large intestine
• Referred tenderness – traveling pain, transient pain, pain radiating on right upper quadrant
• Nausea, vomiting, diarrhea, anorexia (no desire to eat), pain, fever
• Missed appendicitis (influenza like symptoms), it can rupture
, Pediatrics 3
• Enlarge and inflame with fecal matter (bacteria goes to peritoneum when appendix ruptures)
• Classic sign of ruptured appendix – immediate relief of abdominal pain
• Can show signs of sepsis (septic shock), depends on how sick the patient is
• Treatment – if there is a rupture, give heavy antibiotics (to reduce spread of bacteria and infection),
significant surgery and clean out the belly
❖ Inflammatory Bowel Disease (IBD)
• 2 main forms of chronic intestinal inflammation
▪ Ulcerative colitis – it affects 2 main layers of bowel (mucosa, and submucosa)
▪ Crohn’s disease – any layer of the bowel wall and GI tract
❖ Acute Hepatitis
• Causes:
▪ Alcohol, drugs, sex – adult population, causes of Acute Hepatitis
▪ Children – viral illnesses, chemical reactions, drug reactions (drug is too strong for the liver to
process), underlying disease processes, some other issue with the liver
▪ Baby with Fetal-Alcohol Syndrome can eventually develop Acute Hepatitis – has inborne dysfunction
❖ Biliary Atresia
• AKA extrahepatic biliary atresia
• Congenital anomaly
• Biopsy for diagnosis
• Lacks correct plumbing
• Management
• Atresia – means without, not there
• Biliary – bile ducts
• Diagnosed within first 3mos for a Kasai procedure to be successful
• 2 management protocols – Kasai procedure (new biliary bridge; 30% breakdown; palliative process to delay
transplant [for body to grow], needs liver transplant whether or not procedure will work; lasts short period
of time to 12 years)
❖ Cleft Lip/Cleft Palate
• Facial malformations that occur during embryonic period
• May appear separately or together
• Partial or Complete
• Unilateral or Bilateral
• Complications: nutrition, risk for aspiration, respiratory distress, language acquisition (speech), teeth
development (dentition), prone to ear infections (Eustachian tubes drain, back-up of fluid, not able to
process secretions)
• Variations in clefts of lip and palate at birth.
▪ A, Notch in vermilion border.
▪ B, Unilateral cleft lip and palate.
▪ C, Bilateral cleft lip and palate.
▪ D, Cleft palate
• Surgical Correction-Cleft Lip
▪ Closure of lip defect
▪ Often (almost always) precedes the correction of the palate
▪ 10 weeks/10 lbs
º Post-op Considerations
▪ Complications: respiratory distress
▪ Maintain intact suture line, “back to bed” sleep on the back (not prone), use elbow immobilizers (to
keep from bending and touching)
• Surgical Correction of Cleft Palate
▪ Typically 12-18 months of age (Range 6-24 months)
