Facts
Intussusception
More common in male infants.
Most commonly seen at ages 3 to 9 months.
most common cause of intestional obstruction
Most often occurs in healthy and well nourished children
what are the signs of appendicitis
Anorexia, abdominal pain, vomiting, obstipation, diarrhea (in kids), rebound tenderness positive signs such as Mcburney, psoas, rovsing, and obtruator.
What assesment test can be done to diagnosis appendicitis
Rovsings, Psoas, Obturator, and McBurney
What is the treatment for appendicitis
Surgery
What are the signs and symptoms of the different levels of dehydrations
Mild: Well, alert, moist membranes, skin turgor slightly decreased, pulse slightly increased, respiratory slightly increased, urine output normal
Moderate: restless, thirsty, irritable, eyes sunken, depressed fontanelle, absent tears, sticky membranes, decreased skin turgor, rapid and weak pulse, decreased BP, increased HR, increased RR, reduced UO
Severe: Drowsy, cold extremities, lethargic, very sunken and dry eyes, depressed fontanelle, dry membranes, rapid pulse, BP decreased, RR rapid, UO markedly reduced or absent
Hirschsprungs
Congenital anomaly resulting from an absence of ganglion cells in the colon
AKA megacolon
most common in down syndrome
absence of peristlsis
Diarrhea
Sudden onset
Frequent loose, watery stools
Bloody stools
Abdominal cramping
Thirst
Decreased urination
Dizziness
Fatigue
what are some test that can be done for chronic diarrhea
–Stool culture for ova and parasites
–CBC with diff, ESR, and electrolytes
–Lactose tolerance test
How do you treat and manage the types of diarrhea
Chronic Diarrhea:
–Treat the underlying cause
–Provide enteral or parenteral support
–Normalize diet
Diarrhea:
•Restore and maintain hydration
•Maintain nutrition
•Prescribe antibiotics prudently
•Treat related conditions: Sepsis and Cardiovascular collapse
How do you treat the stages of dehydration
Mild and Moderate: Oral rehydration solutions via spoon, cup, dropper, syringe.
Severe: IV fluids.
Abdominal migraine
Many get migraine headaches later
Constipation presentation
•History is key
–Neonatal Constipation
–Associated with Potty Training
–Dietary Recall
–Medication Use
•Physical Exam
–Sphincter Tone
–Rectal Vault
–Palpable fecal mass to LLQ
How can you test for Constipation
KUB
How do you treat constipation
•Corrected by dietary changes
–Remove constipating foods such as bananas, rice, and cheese
–Increase fluids and fiber-rich foods such as whole grains, fruits, vegetables
•Miralax
•Glycerin suppository Caution parents to avoid use of laxatives, stool softeners, enemas
What are the causes of diarrhea
•Primarily viral or bacterial
•Bacterial pathogens usually are C. difficile, salmonella, Giardia, and Campylobacter
•Most commonly viral, usually due to rotaviruses or adenoviruses
Can have parasitic causes
Celiac Disease
Inherited, autoimmune disorder
chronic malabsorption syndrome (gluten intolerance)
How does pyloric stenosis present
•Regurgitation and non-projectile emesis during first few weeks of life
•Projectile emesis begins 2 to 3 weeks of life
•Constantly hungry
•Weight loss
•Dehydration
•Constipation
What test can determine pyloric stenosis
Upper GI series
Ultrasound
Typically an olive shaped mass at epigastric area
How is pyloric stenosis treated
Surgical intervention and education that they may still have emesis after the procedure
How do you know it is vomiting versus pyloric stenosis
Vomiting will be from a viral cause or bacterial. Pyloric stenosis will have an olive shape mass, progectile vomiting and is usual found in the first few weeks of life. They will have poor weight gain.
Encopresis
Fecal soiling or fecal incontinence
Usually d/t underlying constipation
occurs after an age when child should have BM control.
Overfeeding, choking, gagging, coughing, hoarseness, discomfort, and sometimes refusal,
pattern vomiting, bilious vomiting, Growth charts show FTT, torticollis, anemia, tooth erosion,
What test can be done to determine GERD
•pH probe
•Endoscopy
•Gastric emptying
•Video swallow study
Education of position after feeding and not laying down flat right after feeding. Elevate HOB. Smaller more frequent meals. Thickened formula, try hypoallergenic formula
–Histamine 2 receptor agonists
–PPI
Chrons involves the entire GI tract (skip lesions)
UC affects the rectal and colonic muscosa causing diffuse inflammation.