Gastrointestinal disorders cleft lip and cleft palate

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GASTROINTESTINAL DISORDERS Cleft Lip and Cleft Palate Cleft lip is incomplete fusion of the lip/oral cavity around 5-12 weeks gestation, and may be unilateral or bilateral. Cleft palate may or may not be present with cleft lip. Cleft palate results from the incomplete fusion of the palatine plates during intrauterine life. Cleft of the hard palate forms a continuous opening between the mouth and nasal cavity. Treatment: surgical repair of the lip occurs first at 10 weeks of age or over 10 lbs to enable infant to nipple feed and for cosmetic reasons. Logan bow is metal mouth guard used postop to protect surgical site. Cleft palate is repaired between 6-18 months, protects teeth eruption, and should be done prior to 2 years to prevent speech problems. Associated problems: feeding problems, speech problems, increased risk for ear infections, fluid in ear, and hearing abnormalities, higher prevalence of cavities, missing teeth, cross bites, and crowding. Folic acid supplements during pregnancy decrease incidence of clefts by 50%! Pyloric Stenosis A circular, muscular ring that causes obstruction in the pyloric canal. S+S: child eats well but then has PROJECTILE vomiting, fails to gain weight, and is always hungry. Upper GI studies show narrowing, and pyloromyotomy is performed to correct. GENITOURINARY DYSFUNCTION Urinary Tract Infections (UTI) Cystitis- lower, involves the urethra or bladder Pyelonephritis- upper, involves the ureters, renal pelvis, and renal parenchyma
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Etiology: infection d/t contamination from stool or hands, urinary stasis, structural abnormalities, constipation, sex, and bubble baths. S+S: 40 % are asymptomatic, non-specific in infants, and in older children: enuresis, fever, strong urine smell, frequency, urgency, dysuria, flank pain, hematuria Tx: antibiotics but must obtain urine culture before starting and use broad spectrum until sensitivities are obtained. Nephrotic Syndrome Alterations in the glomerular membrane allow proteins (especially albumin) to pass into urine, resulting in decreased serum osmotic pressure. Albumin level in the blood decreases (hypoproteinemia) and this alters the oncotic pressure causing fluid to move into interstitial spaces (causes edema). S+S: weight gain over days or weeks, edema starting as periorbital and moving to extremities, irritability, and oliguria with dark and frothy urine. Lab tests show severe proteinuria, and high specific gravity. Tx: steroids, immunosuppressant drugs, Lasix for severe edema, give albumin to replace what is lost in urine, and antibiotics if infection is present. Acute Glomerulonephritis (AGN) Glomeruli are inflamed, which impairs the kidney to filter urine properly. Acute post- streptococcal is an antibody-antigen disease that occurs after strep infection, antibody-antigen complexes accumulate in glomeruli, which decreases blood flow and filtration so water and sodium are retained. RBCs can pass into urine causing hematuria.
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  • Winter '19
  • Melissa DuVall

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