Gastrointestinal Disease

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Congenital Disorders

Back 1

• Disorders that babies are born with; physical malformation or physiological process that doesn’t work right
• Esophageal atresia, Imperforate anus, Pyloric stenosis, Celiac disease, Hirschsprung’s disease, Intussusception

Front 2

Pyloric Stenosis

Back 2

• Narrowing (stenosis) of the pyloris (sphincter at the bottom of the stomach); this allows or disallows food or fluid to go from the stomach to the small intestines, & caused by hypertrophy of the muscle (too thick & tight).

Front 3

Pyloric Stenosis Pathophysiology

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 obstruction at the lower end of stomach caused by hypertrophy of (sphincter) muscles of the pylorus or spasms of sphincter—think of this as a tight rubber band

Front 4

Pyloric Stenosis Symptoms

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• Symptoms usually do not appear until the infant is 2 or 3 weeks old & can happen as early as 7 days, bc the child is on a liquid diet it takes a while for this to manifest
• Incidence is higher in boys

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Pyloric Stenosis S/S

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 projectile vomiting** of milk and mucus after feeding, dehydration (if vomiting goes on for few days) bc newborn shouldn’t be sick so we wont think gastroenteritis

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Pyloric Stenosis Treatment

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 Surgery is called pyloromyotomy (cuts the pyloris muscle so food may pass); they cut the pyloric band to loosen the muscle so that food can pass—releasing the rubberband wrapped around the muscle

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Pyloric Stenosis Nursing Care Preoperatively

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Infant is given intravenous fluids to treat or prevent dehydration
 To give gut rest, so not taking anything by mouth
 Thickened feedings may be given by a teaspoon or through a nipple with a large hole
¬ Thickened liquids are heavier and will help to prevent refluxing and projectile vomiting..
 Infant is burped before and during feedings to remove any gas accumulated in the stomach (relieve gas or air bubbles within the stomach)
 Place infant on right side after feeding to facilitate stomach drainage into the intestines.
¬ On right side post feeding to promote emptying from the stomach to the small intestines.
 Post eating  high fowlers (gravity to keep food down.)
 If infant vomits, nurse is instructed to re-feed the infant

Front 8

Pyloric Stenosis Nursing Care Postoperatively

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Monitor intravenous fluids; provide feedings as prescribed by surgeon, document intake and output, monitor surgical site. They heal quicker than adults, and their metabolism is higher; this allows them to eat sooner post surgery than an adult (GI system works quicker) Physiological difference b/t child and adults

Front 9

Celiac Disease

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 Also known as gluten enteropathy and sprue (wheat, barley, rye, and oats are to be avoided; gluten intolerance)
 Research shows that this is triggered by the environment, but there is a genetic link
 Leading malabsorption problem in children
 Thought to be caused from inherited disposition with environmental triggers (nature—genetic makeup and nurture—something in the environment, physiologic)

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Celiac Disease pathophysiology

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intolerance to gluten, the protein component of wheat, barley, rye and oats resulting in the accumulation of the amino acid glutamine, which is toxic to the mucosal cells this leads to atrophy of the intestinal villi, resulting in malabsorption of food.

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Celiac Disease symptoms

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not evident until 6 months to 2 years of age when foods containing gluten are introduced
 Wheat, barley, oats, and rye
 Repeated exposure to gluten damages the villi of intestines, resulting in malabsorption deficiency

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Celiac Disease characteristic profile

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 Characteristic profile is abdominal distention with atrophy of the buttocks
 Infant presents with failure to thrive; not growing at normal rate
 Infant is irritable
 Stools are large, bulky, and frothy

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Celiac Disease diagnosis

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 Diagnosis confirmed by serum immunoglobin A (IgA) and small bowel biopsy

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Celiac Disease treatment

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 Lifelong diet restricted in wheat, barley, oats, and rye gain weight, no further damage (macrobiotic diet)
 Detailed parent teaching is essential
¬ A professional nutritionist or dietitian can aid in identifying foods that are gluten free