Table of Contents:
1. Childhood GI 3. Intussusception
Obstructions Overview 4. Hirschsprung Disease
2. Hypertrophic Pyloric
Stenosis
Pyloric Stenosis, Intussusception, & Hirschsprung Disease
1. Childhood GI Obstructions Overview
Pyloric stenosis, intussusception,
and Hirschsprung disease are all GI TABLE 1. GASTROINTESTINAL OBSTRUCTIONS
obstructions that can cause vomiting
Hypertrophic
and changes in stool and abdominal Intussusception Hirschsprung
Pyloric Stenosis
assessment (TABLE 1).
Lack of
2. Hypertrophic Pyloric Stenosis Thickening
Telescoping peristalsis
Hypertrophic pyloric stenosis: Cause of pyloric
of bowel from absent
sphincter
Thickened pyloric sphincter ganglion
obstructs food from entering the cells
duodenum (small intestine)
(FIGURE 1). Bilious or Bilious or
Nonbilious,
Diagnosed with ultrasound Vomiting nonbilious, nonbilious,
projectile
Surgically corrected with laparoscopic nonprojecti nonprojectile
pyloromyotomy le
Assessment findings: Meconium
Nonbilious projectile passage
vomiting (ejected several Red, delayed >48
Stool Varies
feet) “currant hr after birth
jelly” stool and/or
Emesis is nonbilious
ribbon- like
because stomach contents
stool
never reach the intestine.
Loss of hydrochloric acid
Sausage-
Metabolic alkalosis Abdominal Olive-shaped Abdominal
shaped RUQ
Olive-shaped RUQ mass Assessment RUQ mass distension
mass
Signs of dehydration (TABLE 2)
Hunger after vomiting
Bowel
Weight loss due to poor
Major perforation
nutrient absorption Dehydration Enterocolitis
Complication Peritonitis +
Interventions: Shock
Nursing care focuses on:
1. Restoring fluid and electrolyte balance high risk for dehydration due to
before surgery immature kidneys and a greater
2. Providing post-pyloromyotomy monitoring body surface-to-mass ratio.
and
nutritional support
1. Restore fluid and electrolyte balance before
surgery:
Assess for signs of dehydration (see TABLE 2).
Children with vomiting or diarrhea are at
, To relieve vomiting: as needed.
Keep the client NPO. Maintain strict I&O (weigh diapers, record
Insert NG tube for decompression. emesis and NG output).
Administer IV fluids and electrolyte replacement
1. Childhood GI 3. Intussusception
Obstructions Overview 4. Hirschsprung Disease
2. Hypertrophic Pyloric
Stenosis
Pyloric Stenosis, Intussusception, & Hirschsprung Disease
1. Childhood GI Obstructions Overview
Pyloric stenosis, intussusception,
and Hirschsprung disease are all GI TABLE 1. GASTROINTESTINAL OBSTRUCTIONS
obstructions that can cause vomiting
Hypertrophic
and changes in stool and abdominal Intussusception Hirschsprung
Pyloric Stenosis
assessment (TABLE 1).
Lack of
2. Hypertrophic Pyloric Stenosis Thickening
Telescoping peristalsis
Hypertrophic pyloric stenosis: Cause of pyloric
of bowel from absent
sphincter
Thickened pyloric sphincter ganglion
obstructs food from entering the cells
duodenum (small intestine)
(FIGURE 1). Bilious or Bilious or
Nonbilious,
Diagnosed with ultrasound Vomiting nonbilious, nonbilious,
projectile
Surgically corrected with laparoscopic nonprojecti nonprojectile
pyloromyotomy le
Assessment findings: Meconium
Nonbilious projectile passage
vomiting (ejected several Red, delayed >48
Stool Varies
feet) “currant hr after birth
jelly” stool and/or
Emesis is nonbilious
ribbon- like
because stomach contents
stool
never reach the intestine.
Loss of hydrochloric acid
Sausage-
Metabolic alkalosis Abdominal Olive-shaped Abdominal
shaped RUQ
Olive-shaped RUQ mass Assessment RUQ mass distension
mass
Signs of dehydration (TABLE 2)
Hunger after vomiting
Bowel
Weight loss due to poor
Major perforation
nutrient absorption Dehydration Enterocolitis
Complication Peritonitis +
Interventions: Shock
Nursing care focuses on:
1. Restoring fluid and electrolyte balance high risk for dehydration due to
before surgery immature kidneys and a greater
2. Providing post-pyloromyotomy monitoring body surface-to-mass ratio.
and
nutritional support
1. Restore fluid and electrolyte balance before
surgery:
Assess for signs of dehydration (see TABLE 2).
Children with vomiting or diarrhea are at
, To relieve vomiting: as needed.
Keep the client NPO. Maintain strict I&O (weigh diapers, record
Insert NG tube for decompression. emesis and NG output).
Administer IV fluids and electrolyte replacement
