Gastrointestinal System Disorders For Pedia

Anatomy & Physiology Upper GI Tract – mouth, esophagus, stomach Mouth - buccal cavity – entrance to the GI tract; food is broken down & mixed with saliva

Esophagus – at birth 10

cms. in length; 18-25 cms by adulthood Upper esophageal sphincter prevents the reflux of esophageal contents into

pharynx & lungs Lower esophageal sphincter prevents the reflux of gastric contents into the lower esophagus

Stomach – a muscular

pouch that receives the bolus. Chyme is produced by a mixture of bolus & digestive juices

Chyme is propelled into

the pylorus & duodenum Mucus bicarbonate layer in the stomach acts as a buffer to neutralize acidity

Lower Gastrointestinal System Liver Duodenum Gall bladder Pancreas

Jejunum Ileum Cecum Appendix

Ascending colon Transverse colon Descending colon

Sigmoid colon Rectum Anus

Duodenum – 1st part of

the of the small intestine; extends from pylorus to jejunum

Partially digested

chyme enter the duodenum; acted by pancreatic enzymes & bile for further digestion of fats, carbohydrates & proteins

Pancreas oblong in

shape gland located at the back of stomach that secretes enzymes that aids in the digestion of food & secretes insulin & glucagon for the maintenance of

Liver – largest organ of

the body; located under the right diaphragm; it predominantly lies in the right upper quadrant

Functions: Phagocytosis Bile production Detoxification

Glycogen storage &

breakdown Vitamin storage

Gall bladder – sac-like

structure attached to the underside of the right lobe of the liver; stores bile to be secreted into the duodenum in the presence of fats

Jejunum & ileum – form

the remainder of the small intestine. Absorption of Vitamin B12 at terminal ileum

Absorption of nutrients

& vitamins happen here through the microvilli & villi by diffusion & active transport

Cecum- the beginning

of the large intestine; blind pouch about 2-3 inches long; begins in the ileocecal valve

Ascending/transverse/d

es-cending colon forms part of the large intestine Function of the large intestine is for water absorption

that occurs in the cecum & ascending colon Intestinal bacteria aid in the synthesis of Vitamin B & K; & final breakdown of bile

Secretes mucus &

peristalsis of waste happen Rectum – the last 7-8 inches of the digestive tract

Anal canal- the last 1-2

inches of the digestive tract Stool is stored in the rectum until the distension of rectal walls in preparation for the defecation reflex

Diagnostics: Fiberoptic endoscopy Colonoscopy Barium enema

Assessment: GI disorders among children can lead to dehydration especially if vomiting & diarrhea are the presenting symptoms

Assess for poor skin

turgor, dry mucous membranes & lack of tearing

Alert: All children with diarrhea must be seen by a health care provider because of rapid change in fluids & electrolyte levels

Greater percentage of

fluid held extracellularly rather than intracellularly

Vomiting forcible ejection of

stomach contents through the mouth

Etiology: Infections Obstructions Motion sickness

Metabolic alterations Psychological alterations

Allergic reactions Side effects of

medications (chemotherapy) Toxic effects of medications 

Manifestations: Sour milk curds without green or brown color Undigested food (stomach)

Diagnostic Evaluation: CBC Electrolyte studies Blood Urea Nitrogen (BUN) Glucose levels Urine tests

Radiographic studies Blood cultures Arterial blood gas

analysis

Assessment: Major concern: Dehydration Fluid & electrolyte imbalance

Accurate monitoring of

intake & output Assess weight Fontanels in infants

Skin turgor Eyes/skin Heart/respiratory rates

Determine/describe

type & force of vomiting (regurgitation, projectile vomiting) Assess amount, color, consistency, time (ACCT)

Nursing diagnoses: Fluid volume deficit Imbalanced Nutrition: Less than Body Requirements

Interventions: Position child upright or side lying Educate family regarding appropriate feeding techniques (eg. Burping)

Educate family

(avoiding certain foods) fatty foods Minimize stimuli ( stress, anxiety) Avoid unfavorable smelling food

Therapeutic Management: Oral Rehydration Treatment (ORT) IV therapy (prolonged vomiting neonates/infants) Anti-emetics

Dehydration Fluid loss in excess of fluid intake Can cause fluid & electrolyte deficiencies

Classification: Isonatremic dehydration – most common type of dehydration in children Water & electrolytes are lost the same proportion they exist in the body

Normal serum Na level

(135-145 mEq./L)

Hyponatremic dehydration – electrolyte loss greater than water loss Serum Na less than 130 mEq./L

Hypernatremic dehydration – water loss is greater than the electrolyte loss Serum Na concentration above 150 mEq./L

Etiology: GI tract- vomiting, diarrhea, malabsorption Endocrine system: fever, DM,

Skin – burns Lungs – tachypnea Kidneys - Renal failure Heart - CHF

Neonates/infants –

vulnerable to the effects of dehydration

Mild dehydration – 4-5%

loss of body weight; fluid volume loss less than 50ml/kg

Moderate dehydration –

6-10% loss of body weight; fluid volume loss 50-100 ml/kg.

Severe dehydration –

10% or more loss of body weight; fluid volume loss of 100 ml/kg or more

Signs & symptoms of Dehydration: Fewer wet diapers (6-8 hours) No tears when crying (if older than 2-4 months) Sticky/dry mouth

Irritability/high pitched

cry Difficulty in awakening Increased RR/DOB

Sunken

fontanels/sunken eyes with dark circles Abnormal skin color, temperature or dryness

Signs of impending shock: Changes in heart rate Changes in sensorium Urine output Skin qualities Fontanels (infants)

Pathophysiology: Reduced fluid intake Increased fluid loss Vomiting, diarrhea, fever, hyperventilation/burns Trauma, hemorrhage, DM

Rapid ECF loss

Electrolyte imbalance

ICF Loss

Cellular dysfunction

Hypovolemi c shock

Death

Management: Directed toward correcting the fluid & electrolyte imbalance & then treating the causative factors

Oral rehydration therapy

(Rehydralyte, Pedialyte, Infalyte) Rehydralyte (WHO’s solution) – best source of oral rehydration

Children (mild to moderate dehydration) 50-100 ml/kg of ORT over 4 hours

Parenteral fluid &

electrolyte therapy Lactated Ringer’s solution/0.9% NaCl

Assessment Parameters: Intake & output Urine output & Specific gravity Output < 2-3 ml./kg./hr – infants & toddlers

1-2 ml/kg/hr –

preschoolers & young school- age children 0.5 ml./kg/hr in schoolage children or adolescents Specific gravity above

Weight crucial indicator

of fluid status Stools/vomitus Sweating Skin, Mucous membranes & presence of tears

Anterior fontanel Vital signs/behavior

Nursing diagnosis Fluid volume deficit

Diarrhea One of the most common disorders in childhood Increased in the frequency, fluidity & volume of stools

Gastroenteritis –

diarrhea caused by infection Acute diarrhea can lead to dehydration, electrolyte imbalance & hypovolemic shock

Most common viral

pathogens - rotavirus & adenovirus Bacterial pathogens include – Campylobacter jejuni, Salmonella, Giardia lamblia & Clostridium difficile

Mild Diarrhea Fever, anorectic, irritable & appear unwell 2-10 loose, watery stools per day

Dry mucous

membranes, rapid pulse, warm skin Normal skin turgor, normal urine output

Management: Rest the GI tract; 1 hour after offer OHT Ask parents to wash hands after changing diapers

Continue breastfeeding Notify healthcare

provider if condition worsens

Severe diarrhea Rectal temperature is

high (103-104⁰) F Pulse/RR weak & rapid Skin pale/cool

Depressed fontanelle,

sunken eyes, poor skin turgor Bowel movement every few minutes Liquid green stool, mixed with mucus &

Urine output is scanty &

concentrated Elevated hemoglobin, hematocrit & serum protein levels

Treatment: Focus is centered in regulating electrolyte & fluid balance Oral or IV rehydration therapy

Rest the GI tract Identifying the

responsible organism All children with severe diarrhea must have a stool culture taken

IV fluids – NSS or 5%

glucose in NS Nursing diagnosis: Fluid volume deficit