Gastrointestinal System Disorders for Pedia

8/14/2019 Gastrointestinal System Disorders for Pedia

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Anatomy & Physiology

Upper GI Tract mouth,esophagus, stomach

Mouth - buccal cavity entrance to the GI tract;

food is broken down &mixed with saliva


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Esophagus at birth 10cms. in length; 18-25cms by adulthood

Upper esophagealsphincter prevents thereflux of esophagealcontents into


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pharynx & lungs

Lower esophagealsphincter prevents the

reflux of gastric contentsinto the lower esophagus


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Stomach a muscular

pouch that receives thebolus. Chyme is

produced by a mixture ofbolus & digestive juices


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Chyme is propelled intothe pylorus & duodenum

Mucus bicarbonatelayer in the stomach acts

as a buffer to neutralizeacidity


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Lower Gastrointestinal

SystemLiver

DuodenumGall bladder

Pancreas


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Jejunum

Ileum

Cecum

Appendix


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Ascending colon

Transverse colonDescending colon


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Sigmoid colon

RectumAnus


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Duodenum 1st part of

the of the smallintestine; extends from

pylorus to jejunum


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Partially digestedchyme enter the

duodenum; acted bypancreatic enzymes &

bile for further digestionof fats, carbohydrates &

proteins


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Pancreas oblong in

shape gland located atthe back of stomach that

secretes enzymes thataids in the digestion of

food & secretes insulin &glucagon for the

maintenance of


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Liver largest organ of

the body; located underthe right diaphragm; it

predominantly lies in theright upper quadrant


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Functions:

Phagocytosis

Bile production

Detoxification


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Glycogen storage &

breakdownVitamin storage


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Gall bladder sac-likestructure attached to theunderside of the rightlobe of the liver; stores

bile to be secreted intothe duodenum in the

presence of fats


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Jejunum & ileum form

the remainder of thesmall intestine.

Absorption of VitaminB12 at terminal ileum


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Absorption of nutrients

& vitamins happen herethrough the microvilli &

villi by diffusion & activetransport


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Cecum- the beginning

of the large intestine;blind pouch about 2-3

inches long; begins inthe ileocecal valve


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Ascending/transverse/des-cending colon formspart of the largeintestine

Function of the largeintestine is for waterabsorption


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that occurs in the cecum

& ascending colonIntestinal bacteria aid in

the synthesis of VitaminB & K; & final breakdownof bile


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Secretes mucus &

peristalsis of wastehappen

Rectum the last 7-8

inches of the digestive

tract


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Anal canal- the last 1-2inches of the digestivetract

Stool is stored in therectum until thedistension of rectal wallsin preparation for the

defecation reflex


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Diagnostics:Fiberoptic endoscopy

ColonoscopyBarium enema


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Assessment:GI disorders among

children can lead todehydration especially if

vomiting & diarrhea arethe presentingsymptoms


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Assess for poor skin

turgor, dry mucousmembranes & lack of

tearing


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Alert: All children withdiarrhea must be seen

by a health care providerbecause of rapid change

in fluids & electrolytelevels


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Greater percentage offluid held extracellularly

rather thanintracellularly


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Vomitingforcible ejection of

stomach contentsthrough the mouth


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Etiology:Infections

ObstructionsMotion sickness


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Metabolic alterationsPsychological alterations


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Allergic reactionsSide effects of

medications(chemotherapy)

Toxic effects ofmedications


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Manifestations:Sour milk curds without

green or brown colorUndigested food

(stomach)


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Diagnostic Evaluation:CBC

Electrolyte studiesBlood Urea Nitrogen

(BUN)Glucose levels

rin t t


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Radiographic studies

Blood culturesArterial blood gas

analysis


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Assessment:Major concern:

DehydrationFluid & electrolyte

imbalance


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Accurate monitoring of

intake & outputAssess weight

Fontanels in infants


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Skin turgor

Eyes/skinHeart/respiratory rates


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Nursing diagnoses:Fluid volume deficit

Imbalanced Nutrition:Less than Body

Requirements


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Interventions:Position child upright or

side lyingEducate family

regarding appropriatefeeding techniques (eg.

Burping)


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Educate family(avoiding certain foods)fatty foods

Minimize stimuli ( stress,anxiety)Avoid unfavorable

smellin food


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Therapeutic

Management:Oral Rehydration

Treatment (ORT)IV therapy (prolonged

vomitingneonates/infants)

Anti-emetics


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DehydrationFluid loss in excess of

fluid intakeCan cause fluid &

electrolyte deficiencies


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Classification:Isonatremic dehydration

most common type ofdehydration in children

Water & electrolytes arelost the same proportionthey exist in the body


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Normal serum Na level

(135-145 mEq./L)


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Hyponatremic

dehydration electrolyteloss greater than waterloss

Serum Na less than 130mEq./L


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Hypernatremicdehydration water loss

is greater than theelectrolyte loss

Serum Na concentrationabove 150 mEq./L


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Etiology:GI tract- vomiting,

diarrhea, malabsorptionEndocrine system: -

fever, DM,


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Skin burns

Lungs tachypneaKidneys - Renal failure

Heart - CHF


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Neonates/infants

vulnerable to the effectsof dehydration


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Mild dehydration 4-5%

loss of body weight; fluidvolume loss less than50ml/kg


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Moderate dehydration

6-10% loss of bodyweight; fluid volume loss50-100 ml/kg.


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Severe dehydration

10% or more loss ofbody weight; fluidvolume loss of 100 ml/kgor more

Si & t f


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Signs & symptoms of

Dehydration:Fewer wet diapers (6-8

hours)No tears when crying (if

older than 2-4 months)Sticky/dry mouth


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Irritability/high pitched

cryDifficulty in awakening

Increased RR/DOB


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Sunken

fontanels/sunken eyeswith dark circles

Abnormal skin color,temperature or dryness


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Signs of impending shock:

Changes in heart rate

Changes in sensorium

Urine outputSkin qualities

Fontanels (infants)


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Pathophysiology:Reduced fluid intakeIncreased fluid loss

Vomiting, diarrhea,fever,

hyperventilation/burns

Trauma, hemorrhage,DM


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Rapid ECF loss

Electrolyteimbalance

ICF Loss


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Cellular

dysfunction

Hypovolemic shock

Death


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Management:Directed toward

correcting the fluid &electrolyte imbalance &then treating thecausative factors


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Oral rehydration therapy(Rehydralyte, Pedialyte,

Infalyte)Rehydralyte (WHOs

solution) best source oforal rehydration


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Children (mild to

moderate dehydration)50-100 ml/kg of ORT

over 4 hours


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Parenteral fluid &

electrolyte therapyLactated Ringers

solution/0.9% NaCl


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Assessment Parameters:Intake & output

Urine output & Specificgravity

Output < 2-3 ml./kg./hr infants & toddlers


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1-2 ml/kg/hr preschoolers & young

school- age children0.5 ml./kg/hr in school-

age children oradolescents

Specific gravity above


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Weight crucial indicatorof fluid status

Stools/vomitusSweating

Skin, Mucousmembranes & presence

of tears


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Anterior fontanel

Vital signs/behavior


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Nursing diagnosisFluid volume deficit


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DiarrheaOne of the most

common disorders inchildhood

Increased in thefrequency, fluidity &volume of stools


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Gastroenteritis diarrhea caused by

infectionAcute diarrhea can lead

to dehydration,electrolyte imbalance &hypovolemic shock


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Most common viral

pathogens - rotavirus &adenovirus

Bacterial pathogensinclude Campylobacter

jejuni, Salmonella,Giardia lamblia &

Clostridium difficile


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Mild DiarrheaFever, anorectic,

irritable & appear unwell2-10 loose, watery

stools per day


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Dry mucousmembranes, rapid pulse,

warm skinNormal skin turgor,

normal urine output


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Management:

Rest the GI tract; 1 hourafter offer OHT

Ask parents to washhands after changing

diapers


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Continue breastfeeding

Notify healthcareprovider if condition

worsens


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Severe diarrhea

Rectal temperature is

high (103-104) FPulse/RR weak & rapid

Skin pale/cool


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Depressed fontanelle,sunken eyes, poor skinturgor

Bowel movement everyfew minutes

Liquid green stool,mixed with mucus &


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Urine output is scanty &concentrated

Elevated hemoglobin,hematocrit & serum

protein levels


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Treatment:Focus is centered in

regulating electrolyte &fluid balance

Oral or IV rehydrationtherapy


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Rest the GI tract

Identifying the

responsible organismAll children with severe

diarrhea must have astool culture taken


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IV fluids NSS or 5%

glucose in NSNursing diagnosis:

Fluid volume deficit

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