PEDS: GI DISORDERS

Malabsorption syndromes

are disorders associated with some degree of impaired digestion or absorption. They include digestive defects, absorptive defects, and anatomic defects.

Hirschsprung disease

(also known as congenital aganglionic megacolon) is a mechanical obstruction caused by inadequate motility of part of the intestine. Hirschsprung disease requires surgical removal of aganglionic segments of bowel

Obstruction

in the gastrointestinal tract occurs when the passage of nutrients and secretions is impeded by a constricted or occluded lumen or when there is impaired motility (paralytic ileus). General signs of obstruction include colicky abdominal pain, nausea and vomiting, abdominal distention, and decreased stool output.

Meckel diverticulum

is a congenital malformation of the gastrointestinal tract characterized by bloody stools. The most common clinical presentation in children includes painless rectal bleeding, abdominal pain, or signs of intestinal obstruction. The standard treatment for symptomatic Meckel diverticulum is surgical removal.

Constipation

is a symptom, not a disease. It is defined as a decrease in bowel movement frequency or trouble defecating for more than 2 weeks. Constipation with fecal soiling is encopresis. The majority of children have idiopathic or functional constipation because no underlying cause can be identified. Chronic constipation may occur as a result of environmental or psychosocial factors, or a combination of both. Transient illness, withholding and avoidance secondary to painful or negative experiences with stooling, and dietary intake with decreased fluid and fiber all play a role in the etiology of constipation.

Intussusception

is one of the most common causes of intestinal obstruction during infancy and is characterized by abdominal pain and blood in stools. The condition occurs when one segment of the bowel telescopes into another segment, pulling the mesentery with it. Treatment is either nonsurgical hydrostatic reduction or surgical reduction.

Hypertrophic pyloric stenosis

occurs when the circumferential muscle of the pyloric sphincter becomes thickened, resulting in elongation and narrowing of the pyloric channel. Hypertrophic pyloric stenosis is recognized by characteristic projectile vomiting, malnutrition, dehydration, and a palpable mass in the epigastrium, and is relieved by pyloromyotomy.

Postoperative care

of the child with abdominal surgery involves assessing for return of peristalsis, providing hydration and nutrition, intravenous fluids, wound care, and psychological support.

Hirschsprung Disease: Clinical Manifestations

•Childhood -Constipation -Ribbon-like, foul smelling stools -Abdominal distention -Visible peristalsis -Easily palpable fecal mass -Undernourished, anemic appearance

Hirschsprung Disease

•Congenital anomaly •A mechanical obstruction caused by inadequate motility of part of the intestine •1 in 5000 births •Four times more common in males than females •Can be acute, life threatening, or chronic condition

Intussusception: Nursing Care

•Educate parents: Hospitalization, nonsurgical technique of hydrostatic reduction, possible surgery •Passage of a normal brown stool usually indicates that it has reduced itself which should be immediately reported to the practitioner who will need to alter the diagnostic and therapeutic care plan •Post Op: Monitor for passage of the enema, stool patterns

Pyloric Stenosis

•Infant hungry, eagerly accepts a second feeding after vomiting episode •No evidence of pain or discomfort except chronic hunger •Weight loss •Distended upper abdomen •Visible gastric peristaltic waves that move from left to right across the epigastrium

Pyloric Stenosis: Diagnosis

•Olive-like mass is easily palpated when the stomach is empty, infant is quiet, abdominal muscles are relaxed •Vomiting occurs 30-60 min after feeding •Projectile - 3 to 4 ft from the child when side-lying; 1 ft or more in back-lying position •Nonbilious emesis, usually consisting of stale milk •Dehydration, lethargy, malnourished

Intussusception: Clinical Manifestations

•Sudden acute abdominal pain •Child screaming and drawing knees to chest •Child appearing normal and comfortable between episodes of pain •Vomiting •Lethargy •Passage of red, currant jelly like stools (stools mixed with blood and mucus) •Tender, distended abdomen •Palpable sausage shaped mass in RUQ •Empty RLQ (Dance sign) •Eventual fever and other signs of peritonitis... rigid abd means prepare for surgery immediately!