Gastrointestinal Disorders in Children Things to Ask About the GI History: What is the child’s normal eating behavior? What is the child’s normal elimination pattern? Has there been weight loss? Is there history of any previous illness? Is the child having abdominal pain? Does the patient have diarrhea? Does the patient have vomiting? Review family history for GI problems Celiac Disease An autoimmune disorder that causes damage to the small intestine ( villi ) when gluten is ingested IgE response ??? Patho: o When the villi are damage, nutrients cannot be absorbed and diarrhea, abdominal pain, malnutrition, and growth failure result What is gluten? o Protein found in wheat, rye, barley Is this a gluten allergy? – NOT celiac Gluten is a protein found in all of the following except: o Wheat o Corn o Rye o Barely Symptoms o Abdominal pain/bloating o Chronic diarrhea o Vomiting o Pale, foul-smelling or fatty stools – not absorbing o Weight loss o Fatigue o Delayed growth and puberty -look younger o ADHD symptoms – because they’re not sleeping Really tired because not sleeping fight sleeping Diagnosis and Treatment o Diagnosis: small intestine biopsy – see damaged villi Screening: tTG-IgA blood test – if autoimmune rxn to gluten o Treatment Gluten-free diet! – no wheat barley or rye
Appendicitis Inflammation and possible rupture of the appendix Symptoms & Diagnosis o Symptoms Begins with nausea, vomiting, fever and non-specific abdominal pain, Eventually pain radiates to RLQ (McBurney’s Point) Rebound Tenderness at RLQ - push & release Inability to ambulate or jump – complain of stomach pain all the time Cannot jump with appendicitis - painful Assessment may differ in young children – may not be able to pinpoint the source of pain To localize pain- point with 1 finger to where it hurts o Diagnosis US, X-ray, CT – choice to method depends on physician & hospital Increased WBC UA to r/o UTI – abd pain common sx with dif dz Positive Psoas Sign : pain on extension of hip Positive Obturator’s Sign : pain on internal rotation of the flexed thigh Treatment and Nursing Considerations o For Appendicitis without Rupture: best situation First Line: antibiotics and close monitoring Admit with IV abx & monitor pt Abx can cause inflammation to go down Second Line: Laparoscopic Appendectomy, antibiotics Third Line: Open Appendectomy, antibiotics VERY uncommon o What do you do if your patient, who has Appendicitis without Rupture, suddenly reports no pain? Suspect rupture, fluid has leaked out & doesn’t hurt anymore
Infection risk ↑ o Ruptured Appendix Open Appendectomy with Wash Out ( although it is going to laparoscopic! ) Becoming less common, lap even if has ruptured Conservative, moderate & extreme approach Post-Op IV antibiotics Close monitoring IVFs, NPO, TPN and Lipids Diaphragmatic Hernia Patho: o
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- Spring '17