Pediatric Gastroenterology Quiz

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Questions and Answers

What is the recommended fluid intake rate for older children suffering from dehydration?

3-4 mL/kg/hr

1 mL/kg/hr (correct)

0.5-1 mL/kg/hr

2-3 mL/kg/hr

Which of the following is a reason to stop PPIs or antacids prior to pH monitoring for GERD?

To lower the risk of infection

To ensure accurate pH readings (correct)

To minimize food allergies

To prevent dehydration

What is a common preparation for a child undergoing endoscopy?

Hydration with electrolytes just before the procedure

NPO for 4 hours before the tube is inserted (correct)

NPO for 8 hours before the procedure

Sedation is not necessary

During an MRI, which safety concern must be addressed regarding the child?

All jewelry and earrings should be removed Signup and view all the answers

Which type of diarrhea is typically characterized by equal losses of water and electrolytes?

Isotonic diarrhea Signup and view all the answers

What can indicate a worsening renal state in a child?

Elevated BUN levels Signup and view all the answers

Which imaging technique is used to determine the presence of reflux in the urinary system?

VCUG Signup and view all the answers

What is the normal pH range for urinalysis?

5 to 9 Signup and view all the answers

What is the recommended action if urine specimens cannot be sent to the lab within one hour?

Refrigerate the specimen immediately Signup and view all the answers

What is the most common ascending infection in children that originates from the urinary system?

Pyelonephritis Signup and view all the answers

What is the primary purpose of standard precautions in infection control?

To decrease transmission of communicable diseases Signup and view all the answers

Which of the following diseases is primarily transmitted via airborne transmission?

Tuberculosis Signup and view all the answers

What type of precautions are implemented in addition to standard precautions for infection control?

Transmission-based precautions Signup and view all the answers

Which practice is NOT included as part of respiratory hygiene/cough etiquette?

Avoiding wearing masks at all times Signup and view all the answers

Under what circumstance should gowns and gloves be used during patient care?

When there is a risk of exposure to blood or bodily fluids Signup and view all the answers

What is a common misconception regarding hospital-acquired infections?

Most patients are aware of their risks. Signup and view all the answers

Which of the following is an example of contact transmission?

Transmission through shared utensils Signup and view all the answers

When is it particularly important for healthcare providers to use gowns during patient care?

When assisting a child likely to vomit or spit up Signup and view all the answers

What is a primary concern regarding abdominal distension postoperatively?

It may signal infection or complications. Signup and view all the answers

Which symptom would indicate that a newborn may have Gastroesophageal Reflux Disease (GERD)?

Consistent projectile vomiting. Signup and view all the answers

What should be taught to parents regarding medication for GER/GERD management?

PPIs and H2 blockers reduce acid secretion. Signup and view all the answers

What is the recommended approach for feeding babies with GER?

Thickening formula and small frequent meals. Signup and view all the answers

What is a common complication of untreated Gastroesophageal Reflux Disease (GERD)?

Barrett's esophagus. Signup and view all the answers

Which sign is indicative of appendicitis in a patient?

Rebound tenderness upon palpation of the right lower quadrant. Signup and view all the answers

What management step is necessary for a child with Meckel diverticulum before surgery?

Administering IV hydration and blood transfusions as needed. Signup and view all the answers

What symptom is NOT typically associated with hypertrophic pyloric stenosis?

Weight gain during infancy. Signup and view all the answers

Which intervention is essential postoperatively for a child after appendicitis surgery?

Early ambulation to prevent complications. Signup and view all the answers

What dietary modification could benefit a child with GER/GERD?

Avoiding spicy and acidic foods. Signup and view all the answers

What is the best way to monitor for infection post-op in a surgical patient?

Monitoring vital signs such as temperature and pulse. Signup and view all the answers

What should be avoided when managing ostomy care in an infant?

Using adhesive enhancers on the stoma. Signup and view all the answers

Which diagnostic tool is commonly used to assess for abdominal issues such as appendicitis?

Abdominal ultrasound. Signup and view all the answers

What is a key characteristic of pyloric stenosis upon physical examination?

An olive-shaped mass in the right upper quadrant. Signup and view all the answers

What is the most common organism responsible for urinary tract infections (UTIs)?

Escherichia coli Signup and view all the answers

Which symptom is indicative of an upper urinary tract infection (pyelonephritis)?

Flank pain Signup and view all the answers

What is the primary characteristic of nephrotic syndrome?

Massive proteinuria Signup and view all the answers

What should be monitored to manage hypertension in a child with acute glomerulonephritis?

Daily weights Signup and view all the answers

Which condition involves the abnormal backflow of urine from the bladder into the ureters?

Vesicoureteral reflux Signup and view all the answers

Which technique is preferred for accurately obtaining a urine sample in young children when clean catch is not feasible?

Catheterization Signup and view all the answers

What is the main purpose of sensitivity testing in the context of UTIs?

To determine antibiotic susceptibility Signup and view all the answers

What is the first-line antibiotic commonly used for uncomplicated cystitis?

TMP-SMX Signup and view all the answers

What is the most common initial management for a child diagnosed with nephrotic syndrome?

Steroid treatment Signup and view all the answers

Which of these urinary tract anomalies may require surgery if the testicle has not descended by 6 months of age?

Cryptorchidism Signup and view all the answers

After which infection is acute poststreptococcal glomerulonephritis most commonly seen?

Strep throat Signup and view all the answers

What indicates a potential obstruction in the urinary tract on imaging studies?

Presence of urolithiasis Signup and view all the answers

What discharge instruction is important for a child undergoing surgery for hypospadias?

Double diapering Signup and view all the answers

Study Notes

Infection Control Concepts

Standard Precautions: Apply to all patients.
- Hand hygiene: Wash hands before and after patient care.
- Safe injection practices: Use sterile needles and syringes.
- Respiratory hygiene/cough etiquette: Cover mouth and nose when coughing or sneezing.
- Gown and gloves: Wear when there is a risk of exposure to blood or bodily fluids.
Transmission-based precautions: Used in addition to standard precautions.
- Airborne: Transmission through the air, droplets that have evaporated.
  - Examples: Varicella, measles, TB.
  - Negative pressure room: Air inside the patient's room is vented outside, diluting airborne particles.
- Droplet: Transmission from large particles contacting mucous membranes.
  - Examples: Mumps, influenza, pertussis, epiglottitis.
- Contact: Direct contact, skin-to-skin.
  - Indirect: Transfer of organisms from contaminated objects in the environment.
  - Examples: RSV, Varicella, skin conditions (impetigo, scabies, lice).

Urinary Tract Infections

Common causes:
- Upper UTI: Pyelonephritis.
- Lower UTI: Cystitis.
- Pathogens: E. coli, Pseudomonas aeruginosa, Proteus mirabilis, Klebsiella pneumoniae, Enterococcus faecalis, Staphylococcus aureus, Candida albicans, Streptococcus agalactiae.
Frequency:
- Most common bacterial disease in children.
- Account for more than 8 million office visits per year.
- Result in more than 100,000 people hospitalized annually.
- Greater than 15% of patients who develop gram-negative bacteria die.
- One-third of gram-negative bacteria infections originate in the urinary tract.

UTIs

Alteration of defense mechanisms increases the risk of UTIs
Organisms are usually introduced via ascending route from urethra
- Bloodstream or lymphatic infection also possible
Medical equipment like catheters and stents can introduce organisms
Common nosocomial infection
- Usually caused by E. coli
- Seldom caused by Pseudomonas
- Usually caused by urologic instrumentation
Clinical Manifestations
- Dysuria
- Frequent urination (>q 2hr)
- Urgency
- Suprapubic discomfort or pressure
- Cloudy urine, possibly with blood or sediment
- Flank pain, chills, and fever indicate infection of upper tract (pyelonephritis)
- Be aware of no symptoms or vague symptoms - could only have a fever, decreased appetite, or fatigue
Pediatric Manifestations
- Assess child's appearance - are they ill? Do they have a fever?
- Assess height, weight, and BP
- Monitor diaper changes, ideally every half hour for better visibility
- Urine dipstick can be used for assessment
- Symptoms include frequency, fever, odiferous urine, blood-tinged urine, and occasionally asymptomatic generalized sepsis

UTI Diagnostic Studies

Dipstick - identifies nitrates, WBCs, and leukocyte esterase
Microscopic urinalysis for confirmation
Culture to determine empirical findings
Urine collection methods
- Clean catch - for children who can follow instructions
- U bag
- Specimen obtained via catheterization or suprapubic needle aspiration for more accurate results
  - May be necessary when clean catch cannot be obtained
- Best time to collect urine sample: first thing in the morning, urine is more concentrated
Sensitivity testing determines susceptibility to antibiotics
Imaging studies for suspected obstruction - IVP or abdominal CT

UTI Collaborative Care Drug Therapy – Antibiotics

Antibiotics are begun after obtaining a urine sample
Change antibiotic if lab results indicate the organism isn't reactive to the current antibiotic
Uncomplicated cystitis - short-term course of antibiotics
Complicated UTIs - long-term treatment
Commonly used antibiotics
- Bactrim (TMP-SMX)
- Amoxicillin
- Cephalexin
- Gentamycin, carbenicillin
- Pyridium - changes urine color (reddish orange), but soothes urinary tract mucosa
- Combination agents (Urised) used to relieve pain – preparations with methylene blue tint

UTI Collaborative Care Drug Therapy for Repeated UTIs

Prophylactic or suppressive antibiotics
TMP-SMX given daily to prevent reoccurrence
- May need prophylactic antibiotics if recurrent UTIs

Vesicoureteral Reflux (VUR)

VUR - retrograde/backflow of urine from bladder into ureters
Primary reflux - anomaly
Secondary reflux - obstruction in the bladder
Graded from least to most severe
Increases potential for infection

Acute Pyelonephritis – Etiology and Pathophysiology

Caused by various organisms
Urosepsis - systemic infection from urologic source
- 15% of children can die from this

Glomerular Disease: Acute Glomerulonephritis (AGN)

Teach parents to administer full course of antibiotics for Strep to prevent glomerulonephritis
Ranges in severity from mild to severe
Symptoms
- Proteinuria
- Hematuria (tea colored urine)
- Oliguria - decreased urine output
- Edema
- Hypertension

Types of Glomerulonephritis

Most are post-infectious
- Pneumococcal, streptococcal, viral
May be a distinct entity or manifestation of a systemic disorder
- SLE
- Sickle cell disease
- Others

Glomerulonephritis Symptoms

Generalized edema
- Due to decreased GFR
- Begins with periorbital edema
- Then lower extremities, pulmonary, and ascites
HTN due to increased ECF
Oliguria
Hematuria - bleeding in upper urinary tract = smoky urine
Proteinuria - increased amount of protein = increased severity of renal disease

Acute Poststreptococcal Glomerulonephritis (APSG)

Often associated with prior hx of strep throat
Onset 5-12 days after other infections
Noninfectious renal disease - autoimmune
Often group A beta-hemolytic streptococci
Most common in children 6-7 years old
Uncommon in children younger than 2 years old
Can occur at any age
Prognosis
- 95% - rapid improvement to complete recovery
- 5% to 15% - chronic glomerulonephritis
- 1% - irreversible damage

Nursing Management of APSG

Daily weights, Is and Os, measure abdominal girth and document
Manage HTN - loop diuretics, thiazides
- Ace inhibitors, Ca channel blockers, beta blockers
Nutrition - regular diet recommended unless increased edema (then no salt added)
Bed rest isn't necessary or a requirement but kids don’t feel well, so they self-restrict
Antibiotic ordered if strep continues, otherwise not used

Nephrotic Syndrome

Common occurrence in glomerular injury
Not a disease, but a clinical state of proteinuria, low albumin in blood, hyperlipidemia
Characteristics
- Proteinuria
- Hypoalbuminemia
- Hyperlipidemia
- Edema
- Massive urinary protein loss

Types of Nephrotic Syndrome

Minimal change nephrotic syndrome - little structural change to glomeruli
- Also called - idiopathic nephrosis, nil disease, uncomplicated nephrosis, childhood nephrosis, minimal lesion nephrosis
Can be congenital
Considered chronic, 80% have complete remission with steroid treatment
- 20% will continue to have relapses until adulthood

Changes in Nephrotic Syndrome

Glomerular membrane
- Normally impermeable to large proteins
- Becomes permeable to proteins, especially albumin
- Albumin lost in urine (hyperalbuminuria)
- Serum albumin decreases (hypoalbuminemia)
- Fluid shifts from plasma to interstitial spaces
Hypovolemia
Ascites

Nephrotic Syndrome Management

Supportive care
- Rest and quiet activities appropriate for age
Diet - regular diet if remission, if edema then sodium restriction
- No evidence to support high protein
Steroids at time of dx, decrease proteinuria
- Prednisone has least number of side effects
Drug alert: all steroids
- Concerned about obesity, GI bleeding, bone loss, infections
- Monitor for side effects
- Some children don’t respond to steroids, then use Cytoxan
Diuretics - decrease fluid overload

Family Issues

Family support
- Kids are at home during relapse unless severe edema or proteinuria
- Do they have the support they need?
- Notify if worsening symptoms
- Social isolation - tired, don’t feel well, no energy, immunosuppressed, change in physical appearance due to edema (self-esteem)

Nephrotic Syndrome Nursing Interventions

Ensure adequate fluid intake (patients with urinary problems may think fluid intake will make them more uncomfortable)
- Dilutes urine, making the bladder less irritable.
- Flushes out bacteria before they can colonize.
- Avoid alcohol, caffeine, citrus juices, chocolate, and spicy foods.
Discharge to home instructions
Follow up on urine specimens or cultures as needed
Recurrent symptoms typically occur in 1 to 2 weeks after therapy
Encourage adequate fluid intake even after clearing the infection.
Low-dose, long-term antibiotics to prevent relapses or reinfections
Explain rationale to enhance compliance
Aseptic technique during catheterization
Avoid unnecessary catheterization and early removal of indwelling catheters
- Prevents nosocomial infections
- Wash hands before and after contact
- Wear gloves for care of the urinary system
- Routine and thorough perineal care for all hospitalized patients
- Avoid incontinent episodes by answering the call light and offering a bedpan at frequent intervals

Defects of the Genitourinary Tract

Phimosis
- Narrowing of the preputial opening of the foreskin
- Prevents retraction of the foreskin over the penis
- Normal finding in babies and young boys
- Reassure parents that this is normal
- Will go away and disappear as the child grows
Hydrocele
- Fluid-filled mass in the scrotum
- Swollen, enlarged, painful, red, pressure at the base of the penis
- Diagnosed by shining a light to illuminate fluid-filled area
  - Does light travel through?
- Resolves by 1 year of age, then surgery
- Post op
  - Temporary swelling and discoloration of the scrotum
  - If dressing is used, remove by 2-3 days, then bathe
  - Avoid straddle toys for 2-4 weeks
  - If older boy, avoid strenuous activity for 1 month
Cryptorchidism
- One of the testes does not descend down due to a narrow canal, lack of sensitivity to maternal hormones, or congenital defect of gonads
- Concerns: testes fail to descend, higher temperature in the abdomen, so an increased risk of infertility and malignancy
- Usually descend spontaneously by 3 months, if not, an orchiopexy is performed
  - Remove testes from the abdomen into the scrotum
  - Performed before 6 months of age
  - Prevents infection and pain control
Epispadias and hypospadias
- Congenital defects, the urethral meatus is in an abnormal location
- Epispadias
  - Tip of penis is on top of the shaft
- Hypospadias
  - Tip of penis is on the bottom of the shaft
  - Occurs with downward curvature of the penis, and associated with cryptorchidism
- Diagnosed visually at birth or using US
- Surgery done at 6-12 months to minimize psychological effects
- Child should have an adequate urinary stream at the end of surgery
- Dorsal foreskin may be used for this surgery, so the child should not be circumcised before surgery
- Post op
  - Protect surgical site from injury
  - Wrapped in dressing, stent in place
  - Fresh blood on the dressing and stent can happen immediately post op - not afterwards
  - Over the next few hours, urine should become less bloody
  - Slight blood tinge for a few days
- Stent shouldn’t get accidentally pulled out - medical restraints used
- Adequate fluids for adequate urine output to keep the stent patent
  - If no urinary output within 1 hr, concern that the stent is obstructed
- Pain control - caudal nerve block
- Anticholinergic for bladder spasms
- Antibiotics until stent comes out
Discharge instructions
- Double diapering: use two diapers, first diaper collects stool, the outer diaper collects urine
- Prevent injury
  - No bathing until the stent is out
  - No straddle toys or straddling on the hip for at least 2 weeks - hold the child in another way
  - Call the hospital if fever, urine that comes out any other way, bright red bleeding
Chordee
- Can occur in conjunction with epispadias/hypospadias
- Hooked or crooked condition of the penis
- Can be corrected surgically
Exstrophy of the bladder
- Posterior bladder pushes out through the lower abdominal wall
- Females: split clitoris
- Boys: short penis
  - Usual inguinal hernias and cryptorchidism
- Surgical repair to repair the abdominal wall
- Pre op
  - Cover the exposed bladder with plastic wrap or a transparent dressing to keep the mucosa moist until surgery
  - Avoid abduction of legs
  - Maintain good alignment and provide psychosocial support
- Post op
  - Monitor Is and Os
  - Urine is blood-tinged initially
  - Expected output in weight in kgs
  - Administer medications: antibiotics, analgesics, and muscle relaxants
  - Prevent complications
  - Avoid leg abduction
  - Observe for: wound infection, UTI, obstructions, increased bladder spasms, decreasing urine output, bright red blood
Obstructive uropathy and posterior urethral valves
- Malformation of the urinary tract, obstruction
  - Abnormalities resulting in urine backflow into the kidneys
  - Patho – several congenital lesions
- Obstruction may occur in either the upper or lower urinary tract
  - Common sites of obstruction - ureteropelvic valve, ureterovesicular junction, posterior urethral valve
- Risk of renal failure, especially if bilateral kidney involvement

Obstruction Sites in the Urinary System

Post op care
- Accurate Is and Os
- Pain management
- Incision care
- Diaper placement
- Ostomy care
- Observe for signs of infection

GU Surgeries: Psychosocial Issues

Self-esteem - changes in appearance, functioning, incontinence
Self-confidence
Sexual identity
Sexual functioning - fertility

Benefits and Complications of Circumcision

Benefits
- Decreased incidence of UTI, sexually transmitted infections, AIDS, and penile cancer
- In female partners a decreased incidence of cervical cancer
Complications
- Alterations in the urinary meatus
- Unintentional removal of excessive amounts of foreskin
- Damage to the glans penis

Enuresis: Two Types

Primary
- Child has never had a dry night
- Maturational delay, small functional bladder
- No psychological cause
Secondary
- Child who has been reliably dry for at least 6 months begins bed wetting
- Stress, infections, sleep disorders
Treatment
- Multi-approach
- Fluid restriction
- Bladder training
- Timed voiding
  - Enuresis alarms
- Reward system
- Medications – desmopressin, oxybutynin, imipramine

Testicular Torsion

A testicle is abnormally attached to the scrotum and twisted
Requires immediate surgery because ischemia can result if the torsion is left untreated, leading to infertility
May occur at any age but most commonly occurs in boys aged 12 to 18 years

Alterations in GI Function

Gastrointestinal Structure and Function

Development of the GI tract
- Meconium - first fecal material passed by the newborn after birth
  - Contains residue of swallowed amniotic fluid
  - Expelled shortly after birth
  - Shows that the GI tract is patent
- Swallowing
  - For the first 3 months, automatic reflex, no voluntary control
  - By 6 months, swallow, able to hold food in the mouth, able to spit food out
    - Starting on solid foods
Digestion
- Chemical digestion - GI secretions produced by the stomach and small intestine
  - Hydrochloric acid, water, electrolytes
- Mechanical digestion - churning food
- Peristalsis - moving food down with muscle contractions
- Chyme - partially digested food along with acidic substances
Absorption
- Small intestine - pump and osmosis
- Large intestine - completes absorption of water and sodium
  - Colonic bacteria - synthesize vitamin K, B12, and some of the vitamin B complex
- Bacteria can affect the color, odor of stool, and amount of gas

Clinical Manifestations

Failure to thrive - with some GI disorders of kids, the child stops growing (no longer accelerating) or remaining below the 5th percentile for height and weight
- Very small, not as tall or weigh as much as they should
- Could come with a developmental delay

Assessment of GI Function

Known GI disease or trying to rule it out
- Malabsorption - not absorbing nutrients, affects growth
- Fluid and electrolyte disturbances - diarrhea? 1-2mL/kg/hr for newborn and 1mL/kg/hr for older kids
MRI
- Really loud, sounds like banging on the wall
- Ensure they are safe
- Have to hold very still
- Large magnet - visualizes internal body structure
- More enclosed than a CAT scan
- May use contrast dye here too
- Can offer headphones with no magnet in it
- Make sure no metal on child - jewelry, earrings
- May need sedation to hold still

Endoscopy

Visualizes the GI tract - see abnormalities, lesions
If need biopsy
Need sedation
pH monitoring for GERD
- What is the acidic pH of GI secretions?
- What is the severity of the reflux?
NPO for 4 hours before the tube is inserted - check medications child has been on
- Antacids or PPIs need to be stopped 24 hours before pH monitoring is done
- Sometimes stopped up to 7 days before - interferes with the pH

Stool Sample

WBCs
Ova and parasite
Bacterial cultures
Fecal fat
Stool pH
Rotazyme (rotavirus)
Blood

Dehydration

Volume depletion, fluid volume deficit
Seen in kids with diarrhea - losing fluids and not replenishing orally
Isotonic diarrhea, hypotonic diarrhea, hypertonic diarrhea
- Are water and electrolytes lost in equal amounts? Or one more than the other?
  - Usually isotonic
Mild/moderate/severe dehydration
- Use weight initially as baseline - how much weight has been lost?

Postoperative Care for Gastroschisis

Monitor for signs and symptoms of infection: fever, pain, redness, swelling, drainage.
Measure abdominal distention, any increase is worrisome.
Teach ostomy care for stage one patients: pouch adhering to stoma, assessing skin site, no adhesive enhancers.
Newborn skin is thin and prone to damage, do not use adhesive enhancers, as it could strip the skin and increase the risk of latex allergy.
Support the family and refer them to ostomy support groups.
Discharge instructions: family knows s/s of infection, obstruction, malnourishment, ostomy care, and procedures involved in a takedown.

Gastroesophageal Reflux (GER)

Can occur at any age.
Gastric contents reflux into the esophagus, irritating the lining.
Reflux may occur without GERD (tissue damage).
GERD can occur without regurgitation (spitting up).
Frequency and persistency can make it abnormal.
Physiologic until 1 year of age.
Becomes pathologic with failure to thrive, no more growing, bleeding, or dysphagia.
Usually due to relaxation of the lower esophageal sphincter.
Signs and Symptoms: spit up, regurgitation, vomiting, hunger, irritability, crying, eating a lot/refusing feedings, failure to thrive (poor weight gain).
Look for respiratory changes as aspiration of gastric contents can occur.
Diagnosis: duration of symptoms, abnormal physical exam findings, gastric acidity assessment, endoscopy with biopsy (looking for changes in esophageal cells which can increase the risk of Barrett’s esophagus).
Assess gastric emptying time.

Complications of Gastroesophageal Reflux (GERD)

Reflux coming into the esophagus or oropharynx.
Most often in premature infants, those with neurologic conditions, asthma, cystic fibrosis, and cerebral palsy.
Assessing for abnormalities: laryngitis, hoarseness, pneumonia, anemia, Barrett’s esophagus, FTT/poor growth.

Therapeutic Management of GER/GERD

Conservative approach: avoid foods that cause reflux (spicy, fried, caffeine, citrus fruits/juices).
Small frequent meals rather than 3 large meals.
For babies: thicken formula (add 1 teaspoon of rice cereal per 1 ounce of formula).
After feeding: HOB elevated, keep infant upright.
Sleep supine (on back, not on belly).
Frequent burping during feeds.
Avoid overfeeding.
With severe GERD, surgery may be needed (Nissen Fundoplication).
Candidates for surgery include persistent respiratory symptoms, frequent aspirations, and no response to management.
Surgery creates a one-way valve by wrapping the fundus around the esophageal sphincter.
Severe cases: G-tube may be needed for 6-8 weeks or longer after surgery for feeding.

Nursing Management: GER/GERD

Teach parents to hold infant/cuddle during feeds and keep them in an upright position.
Weigh babies daily.
Small frequent feeds, thickened formula, and split nipple.
Elevate HOB.
Encourage non-nutritive sucking (especially with G tube and J tube feedings).
Educate about G tube and J tube care.
PPIs or H2 blockers decrease hydrochloric acid secretion and can increase lower esophageal tone.

Acute Appendicitis

Obstruction of the lumen of the appendix in the RLQ.
Average age of onset is 10 years.
Signs and Symptoms: RLQ pain (guarding the RLQ, pain is greatest at McBurney’s point), rebound tenderness, nausea, vomiting, anorexia.
When there is no pain at all, the appendix may have ruptured. Signs of rupture include pallor.
Diagnosis: abdominal ultrasound, lab test (elevated white blood cells), elevated C reactive protein (inflammatory marker).
Assessments: atraumatic care, administer antibiotics, and manage pain.
If rupture occurs: longer length of stay, longer antibiotic course, more extensive wound care, and pain management.
Post-operative Care: encourage splinting with a pillow, do not apply heat or ice to the surgical site, NGT to low wall suction, monitor VS and temperature, monitor for return of bowel sounds, good pain management, NPO (why they need NGT), diet returns as bowel sounds do.

Meckel Diverticulum

Outpouching of the lower part of the intestine.
Congenital, a leftover piece of the umbilical cord.
2% of the population, 2:1 ratio males to females.
Commonly located within 2 feet of the ileocecal valve, 2 cm in diameter, and 2 inches in length.
Two types of ectopic tissue: pancreatic and gastric.
Common before the age of 2.
Some are asymptomatic, others have abdominal pain and bloody/mucus stool.
Diagnosis: detect the location of the outpouching in the lower intestine.
Preoperative Care: transfusion with packed RBCs, IV hydration, supplemental O2, antibiotics, and monitor stool and blood lost.
Surgery removes the outpouching.
Postoperative Care: administer O2, pain management, IV hydration, antibiotics for infection, assess for bowel sounds (NPO until they return) and NGT to wall suction.

Paralytic Ileus

Impaired motility, acquired or born with.
Signs and Symptoms: pain, nausea, vomiting, abdominal distention, change in stool pattern from baseline.

Hypertrophic Pyloric Stenosis

Enlarged pylorus muscle causes narrowing of the pylorus and obstruction.
Common cause of gastric outlet obstruction in babies.
Occurs within the first few weeks of life (1 week to 5 months).
Signs and Symptoms: spit out a lot, regurgitation, non bilious vomiting ½ hour to 1 hour after feeding, projectile vomiting, waves of peristalsis on abdomen, always hungry, palpate olive-shaped mass to the right of the umbilicus (enlarged hypertrophy muscle), dehydration, metabolic alkalosis can occur.
Diagnosis: abdominal ultrasound.
Preoperative Care: correct fluid and electrolyte imbalances, monitor intake and output.

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Test your knowledge on important topics in pediatric gastroenterology and urology, including fluid intake for dehydrated children, safety during imaging procedures, and infection control measures. This quiz covers common practices and protocols that healthcare professionals should be aware of when treating young patients.