Gastrointestinal Dysfunction in Children

Gastrointestinal Dysfunction in Children

• The gastrointestinal (GI) system is responsible for absorbing and digesting food and fluids, and eliminating waste.
• Key organs of the GI system include the esophagus, stomach, pancreas, large and small intestines, gallbladder, and liver.
• Infants have smaller stomach capacities than older children or adolescents.
• Stomach capacity increases with age. A 30-day-old infant has a stomach capacity of 90 ml, and an adult stomach holds 2-3 liters.

Pediatric Differences

• Newborns have poor swallowing control and increased peristalsis.
• Newborns may have limited enzyme function, impacting bilirubin conjugation, gluconeogenesis, deamination, plasma protein, and ketone formation.

Newborn Period

• Meconium should be passed within 24-36 hours of birth.
• Conditions to assess for if meconium is not passed include Hirschsprung disease and hypothyroidism, meconium plug, or meconium ileus (CF).

GI Problems in Infancy

• Nutritional imbalances
• Colic
• Food sensitivities
• Failure to thrive

Structural Defects

• Head: Cleft lip and cleft palate
• Esophagus and Stomach: Esophageal atresia, tracheoesophageal fistula, pyloric stenosis, gastroesophageal reflux
• Intestines: Omphalocele, gastroschisis, intussusception, volvulus, Hirschsprung disease
• Anus: Anorectal malformations, ostomies

Cleft Lip/Cleft Palate

• Facial malformations occurring during embryonic development.
• Can appear separately or together.
• Etiology (cause) and pathophysiology (how it works) should be studied.
• Diagnostic evaluation is also a key part of the process.

Surgical Correction of Cleft Lip/Palate

• Lip repair typically precedes palate repair.
• Surgeons use Z-plasty to help reduce scar retraction.
• Cleft palate repair is typically done at 6-18 months of age.

Cleft Lip/Palate Feeding

• Issues and interventions regarding feeding are important to note.
• Special feeding equipment, such as modified nipples, may be needed.
• Breastfeeding issues may also need to be addressed.

Question 1 (Rationale for Elbow Restraints)

• Elbow restraints are used postoperatively to prevent children from touching the surgical site for healing.

Question 9 (Rationale for Child's Statement)

• The child may have difficulty communicating pain effectively or might be apprehensive about surgery. A ruptured appendix would cause different symptoms.

Pathophysiology of Esophageal Atresia and Tracheoesophageal Fistula

• In the common type, the upper esophagus ends in a blind pouch connected to the trachea. A fistula connects the lower esophagus to the trachea.

Hypertrophic Pyloric Stenosis

• A constriction of the pyloric sphincter preventing passage of stomach contents.
• Key signs include projectile vomiting, dehydration, and a palpable olive-shaped mass.
• Treatment usually involves surgical correction.

Gastroesophageal Reflux (GER)

• The transfer of gastric contents into the esophagus.
• GER becomes abnormal when frequent and severe.
• Symptoms in infants can include spitting up, forceful vomiting, and excessive crying. In children, it may manifest as heartburn, abdominal pain, difficulty swallowing, and chronic cough.

Inflammatory Disorders

• Appendicitis, Necrotizing Enterocolitis (NEC), Meckel's Diverticulum, Inflammatory Bowel Disease (Crohn's disease and ulcerative colitis), Peptic Ulcer, and acute diarrhea
• Each condition has unique symptoms and treatments.

Inflammatory Disorders: Appendicitis

• Earliest symptoms: periumbilical pain and vomiting; later right-lower quadrant pain.
• Important diagnostic differentiator: children who are hungry likely do not have appendicitis.

Inflammatory Disorders: Meckel's Diverticulum

• Congenital malformation of the GI tract.
• Common symptoms include rectal bleeding and abdominal discomfort.

Inflammatory Disorders: Ulcerative Colitis

• Inflammation within the colon and rectum.
• Symptoms include ulceration, bleeding, anorexia and anemia.

Inflammatory Disorders: Crohn's Disease

• Inflammatory bowel disease (IBD) affecting any part of the GI tract.
• Symptoms include abdominal pain, severe diarrhea, and malabsorption.

Inflammatory Disorders: Peptic Ulcer

• Loss of mucosal, submucosal and muscular layer.
• Key symptoms should be studied; treatment may involve medical and surgical interventions.

Disorders of Motility:

• Gastroenteritis (Acute Diarrhea)
• Constipation
• Encopresis

Disorders of Motility: Gastroenteritis/Acute Diarrhea

• Leading cause of illness in young children.
• Factors to consider include infection prevention measures, such as hand-washing and water supply precautions
• Complications include dehydration.

Intestinal Parasitic Disorders

• Common triggers for intestinal parasitic infection include camping, drinking contaminated water and exposure to pets or wildlife.
• The condition is treated using antihelmintic medications.

Dehydration

• Dehydration occurs in various forms, such as isotonic, hypotonic, and hypertonic.
• Diagnosing and treating dehydration requires appropriate assessment and rehydration strategies.

Malabsorption Disorders

• Celiac disease, lactose intolerance, and short bowel syndrome
• Each condition results in an inability to absorb certain nutrients or food properly.
• Dietary restrictions and supplemental feeding are often necessary therapies.

Celiac Disease

• Gluten-induced enteropathy, causing impaired nutrient absorption.
• Symptoms include fatty stools, malnutrition, and abdominal distension.
• Strict gluten-free diet is crucial for management and remission.

Lactose Intolerance

• Involves difficulty digesting lactose, a sugar found in milk and dairy products.
• Symptoms include bloating, abdominal discomfort, pain and flatulence.
• Treatment typically involves avoiding lactose-containing foods, or using lactose-free alternatives, or enzyme replacement.

PKU-Phenylketonuria

• Metabolic disorder due to a lack of phenylalanine hydroxylase, impacting phenylalanine metabolism.
• Results in toxic levels of phenylalanine in the body, causing various problems, including cognitive impairment, and a characteristic musty odor in urine.
• Early recognition and dietary management are crucial for avoiding severe health consequences.

Short Bowel Syndrome

• Malabsorptive disorder resulting from extensive small-bowel resection.
• Treatments usually include nutritional support and medical therapies.

Hepatic Disorders

• Hyperbilirubinemia, Biliary Atresia, Viral Hepatitis, and Cirrhosis
• Each condition encompasses a wide range of causes, symptoms, potential complications and treatment options.

Hepatitis

• Viral infections affecting the liver
• Transmission via contaminated food or water, blood, or close contact are prominent aspects of the condition.
• Key phases to document include Anicteric (5-7 days) and Icteric (4weeks).
• Prevention and supportive care are central elements of management.

Cirrhosis

• End-stage of liver disease.
• Irreversible condition with various etiologies such as biliary atresia, chronic hepatitis, hemophilia, or cystic fibrosis.
• Potential for various complications

Injuries to the GI System

• Abdominal trauma and poisoning(referring to specific antidotes/intervention for particular toxins)
• Lead poisoning (varied symptoms depending on exposure level)
• Foreign object ingestion.

Nursing Management of All GI Disorders

• Includes preventive strategies, pain control, effective diet and hydration management, and emotional support.
• The nurse’s role extends to both pre- and postoperative care.

Nursing Management: GI Disorders Requiring Surgery

• Addresses pre-operative anxiety, prepares the patient for surgery, and manages post-operative care, including pain assessment, wound healing, fluid and nutrition management and infection prevention.

Developmental Considerations

• GI pain considerations vary between infant, child and adolescent ages.
• Each age group has specific needs for assessment and management.

Summary

• Focuses on the varied causes of GI disorders, common symptoms, and the role of nurses in preventive education and post-treatment support.