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Gastrointestinal Tract Disorders

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GASTROINTESTINAL TRACT DISORDERS By DR. Areefa Albahri (Alkasseh) Assistance Prof. of MCH Islamic University of Gaza DR. Areefa Albahri ... – PowerPoint PPT presentation

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Title: Gastrointestinal Tract Disorders


1
Gastrointestinal Tract Disorders
  • By
  • DR. Areefa Albahri (Alkasseh)
  • Assistance Prof. of MCH
  • Islamic University of Gaza

2
  • Main function GI is turning food into nutrients
    which can be absorbed by the human body to
    provide energy needed for survival
  • Accessory organs that assist the GI tract by
    secreting enzymes to help break down food into
    its component nutrients (salivary glands, liver,
    pancreas and gall bladder)

3
Gastrointestinal Tract Assessment
  • Health history
  • Gestational age and birth weight
  • Nutritional history (length of breast feeding,
    introduction of solid food).
  • Neonatal infancy GI problems
  • Family factors (life style, hereditary problems)
  • Present changes in childs life (start
    schooling, new sibling or death in the family)
  • Assessment of the digestive function in a 24hr
    (food intake and elimination)

4
Gastrointestinal Tract Physical Exam
  • Physical parameter (Wt and Ht)
  • Skin Color
  • Inspection of oral cavity
  • S S of dehydration
  • Abdominal and rectal assessment
  • Peristalsis
  • Abdominal Tenderness
  • Distended abdomen
  • Displaced heart (diaphragmatic hernia)
  • Hair (loss of pigment or brittle)

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  • Cleft Lip Cleft Palate
  • incomplete fusing of soft and hard tissues of lip
    and palate (top of mouth) respectively. May occur
    together or separately, one side or both.
  • Among the most common facial anomalies
  • Genetic basis is present (family history for
    presence of the defect in other siblings)
  • Incidence rate of cleft lip is 17800
  • Incidence rate of cleft palate alone in 12000
  • May result in communication between the nasal and
    oral cavities
  • Cleft lip may be unilateral or bilateral
  • Cleft lip may be accompanied with cleft palate
  • Cleft palate may be present without cleft lip
    (non-visible) early sign is dripping milk from
    nose

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  • Assessment should be focused on
  • In newborn compromised sucking ability
  • Respiratory status
  • Family reaction
  • Complication
  • Feeding problem
  • Hearing problem
  • Speech difficulties
  • Social
  • Management
  • Surgical repair for cleft lip during the first
    few weeks of life
  • Initial repair for cleft palate during 4-6 months
    of age and the surgical correction between 6-18
    months

10
Nursing care Provide adequate nutrition and
prevent aspiration and infection (otitis
media) During feeding Upright position Feed
slowly Burp frequently
11
  • After the surgical operation
  • Restrains may be necessary to prevent disturbance
    of the surgical site
  • No tooth brushing
  • Prevent infection
  • Follow-up assessment of
  • Growth
  • Speech
  • Teeth development.
  • Nursing diagnosis
  • Altered nutrition R/T physical defect /
    difficulty eating
  • Risk for aspiration
  • Risk for infection
  • Risk for impaired verbal communication
  • Altered family process

12
Hypertrophic Pyloric Stenosis
An overgrowth of the circular muscle of the
pylorus, results in obstruction/ partially /
narrowing of the pyloric sphincter Cause is
unknown, however there is a hereditary
component The stomach contractions increase in
frequency and force to empty the stomach
content. Usually develops in the first few weeks
of life
13
  • CM
  • Regurgitation small amounts of milk immediately
    after feeding
  • Projectile vomiting
  • Vomiting may occur during feeding or shortly
    after feeding
  • Vomitus contain NO bile
  • Gastritis due to prolonged stay of stomach
    content
  • Wt loss and dehydration
  • Metabolic alkalosis( blood pH above 7.45, levels
    of other blood components, including salts like
    potassium, sodium, and chloride, fall below
    normal ranges. The level of bicarbonate in the
    blood will be high, usually greater than 29
    mEq/L. Urine pH may rise to about 7.0 in
    metabolic alkalosis.
  • Failure to thrive
  • Dehydration

14
  • Assessment
  • Olive-like mass at right epigastrium under the
    edge of the liver
  • Peristaltic waves can be noted after feeding
    moving from left to right
  • Ultrasoundgraphy
  • Treatment is by surgery to allow better passage
    of milk
  • Nursing Care
  • Monitor intake and output
  • Assess vomitus
  • Prevent dehydration
  • Monitor Wt and Ht
  •  

15
Intussusception
16
  • Is an invagination of part of the intestine into
    an adjacent distal portion of the intestine.
  • Occurs in healthy infants around 6 months of age
    and rarely occur before 3 months or after 3-years
    of age
  • More common in male infants
  • The cause is unknown.
  • The most common type is near the ileocecal valve
    pushing into the cecum and onto the colon.
  • The involved intestine become inflamed and
    edematous with bleeding from the mucosa
  • Untreated intussusception can lead to intestinal
    gangrene, peritonitis and death
  • Diagnosis by barium enema ( if there is
    intraperitoneal air from a bowel perforation
    thus enema is contraindicated)

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  • Assessment is focused on
  • Stool inspection (currant-jelly stools)
  • CM such as Pain
  • Abdominal palpation
  • Early symptoms
  • Crampy abdominal pain and a drawing up of the
    knees to the chest
  • Periods of apathy
  • Poor feeding and vomiting
  • Late symptoms
  • Worsening vomiting, becoming bilious
  • Abdominal distension/ Palpable abd. Mass
    (sausage-shaped)
  • Heme positive stools
  • Followed by currant jelly stools Jelly stools
    due to leaking of blood and mucus into the
    intestinal lumen as a result of venous
    engorgement
  • Dehydration
  • If untreated, necrosis and perforation are
    possible

19
  • Treatment
  • Supportive therapy (Fluid Antibiotics)
  • Hydrostatic barium
  • Operation
  • Manual
  • Resection and reanastamosis

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Hirschsprungs Disease (aganglionic megacolon)
A congenital anomaly resulting from an absence of
ganglion cells in the colon (lack of nerve ending
in the sigmoid colon) Autosomal dominant genetic
mutations More common in male children with
down syndrome peristalsis cannot occur
22
  • CM
  • Newborn
  • Failure to pass meconium after birth (during the
    firs t 24 hr)
  • Poor feeding and spitting up
  • Visible bowel loops
  • Bile-stained vomitus
  • Abdominal distention
  • Infancy
  • Failure to thrive
  • Constipation Abdominal distention
  • Diarrhea vomiting/ Explosive watery stool
  • Fever

23
  • Childhood (more chronic)
  • Constipation
  • Ribbon-like foul smelling stools
  • Abdominal distention
  • Palpable fecal masses
  • Poorly nourished
  • Lethargy, nausea and anorexia
  • Treatment by surgery (removal of non-motile part)
  • Colostomy/ileostomy care after surgery
  • After surgery high fiber diet is established
  • Prevent enterocolitis
  •  
  •  

24
Celiac Disease
  • A disease of malabsorption abnormal immune
    reaction to gluten
  • Celiac disease is a hereditary intolerance of
    gluten (protein found in wheat, oats, rye)
  • Gluten protein (gliadin) causes inflammation and
    damages villi in the small bowel
  • Enzyme insufficiency (peptidase) causes
    accumulation of toxic gluten peptide
  • Gluten toxicity results from alteration in
    immunologic response
  • It is the second cause of malabsorption after CF

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  • CM (related to malabsorption and malnutrition)
  • Problem starts after the introduction of solid
    food
  • Diarrhea Steatorrhea (stool is bulky, fatty foul
    smelling)
  • Wt loss
  • Weakness
  • Abdominal pain distention
  • Bone joint pain
  • Anemia (malabsorption of iron)
  • Vit. Deficiency
  • Failure to thrive ( without SS of GI problems)
  • Behavioral changes irritability, apathy and
    uncooperative

28
Anti-tissue transglutaminase antibodies (tTGA)
or anti- endomysium antibodiesCBCSerum protein
29
Dietary management a gluten-free diet In acute
phase Corticosteroid Fluid replacement N/G to
decrease the distention
30
  • Complications (if not treated)
  • Iron deficiency anemia
  • Osteoporosis
  • infertility or recurrent miscarriage
  • depression or anxiety
  • tingling numbness in the hands and feet
  • seizures

31
Inflammatory bowel diseases Ulcerative Colitis
Crohns Disease
  • Inflammatory bowel disease (IBD) refers to
    chronic conditions that cause inflammation in
    some part of the intestines.
  • The intestinal walls become swollen, inflamed,
    and develop ulcers
  • IBD can cause discomfort and serious digestive
    problems
  • Symptoms depend on which part of the digestive
    tract is involved
  •  
  • Causes of the inflammation in IBD involves a
    complex interaction of several factors
  • The genes the patient has inherited,
  • The environment and the immune system. antigens
    in the environment may cause of the inflammation
    or they may stimulate the body's defenses to
    produce inflammation

32
  • Symptoms of IBD
  • The symptoms of ulcerative colitis and Crohn's
    disease are similar
  • Abdominal pain or cramping
  • Diarrhea multiple times per day
  • Bloody stools
  • Weight loss
  • Mouth sores and skin problems
  • Arthritis
  • Eye problems that affect vision

33
  • Inflammatory bowel diseases Crohns disease
  • Crohn's Disease is characterized by a chronic
    inflammatory process that may affect any segment
    of the gastrointestinal tract, from mouth to
    anus.
  • The inflammatory process usually extends through
    all layers of the intestinal wall
  • Skip lesions
  • Treated by medication to decrease inflammation
    and usually control the symptoms but does not
    provide a cure
  •  

34
  • Inflammatory bowel diseases
    Ulcerative Colitis
  • Ulcerative Colitis is characterized by
    continuous inflammation confined to the large
    intestine.
  • Inflammation is limited primarily to the mucosa
    and does not extend through all layers.
  • Treated by
  • The primary treatment options are medications
    that decrease the abnormal inflammation in the
    colon lining and control the symptoms..
  • Ulcerative colitis is potentially curable if the
    colon is removed
  •  

35
  • Inborn errors of metabolism
  • Galactosemia
  • Phenylketonuria
  • Congenital hypothyroidism
  •  

36
  • Galactosemia
  • Lack of galactose-1-phosphate uridyl-transferase
    enzyme.
  • Inherited as autosomal recessive.
  • Failure of conversion of galactose to glucose,
    accumulation of galactose leads to damage of the
    liver brain.
  • Should be suspected in any infant who vomits,
    refuses feeds, fails to thrive become jaundiced
    in the first week
  • Long term effect ovaries damage, speech delay,
    learning difficulties
  • Treatment may include stopping BF replacement
    by a special low-lactose milk.

37
Phenylketonuria
  • Autosomal recessive genetic disorder causing
    mutation of the gene that producing phenylalanine
    hydroxylase enzyme that is necessary to
    metabolize the amino acid phenylalanine to
    tyrosine.
  • Phenylalanine is converted into phenylketone
    which is detected in the urine
  • The disease may present clinically with
  • Seizures
  • Excessively fair hair and skin
  • "Musty Odor" to the baby's sweat and urine
  • Early cases of PKU were treated with a
    low-phenylalanine diet.
  • Children with PKU must adhere to a special diet
    low in Phe for optimal brain development.
  • The diet requires severely restricting or
    eliminating foods high in Phe, such as meat,
    chicken, fish, eggs, nuts, cheese, milk dairy
    products.
  • If PKU is left untreated, it can cause problems
    with brain development, including mental
    retardation, brain damage and seizures.

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  • Appendicitis
  • Inflammation of the appendix Caused by an
    obstruction.
  • Fecalith (hard feces)
  • Lymphoid obstruction
  • Infection
  • Swelling of the appendix reduces blood flow
    causing
  • Ischemia
  • necrosis
  • Perforation (rupture) may occur which may cause
    peritonitis, sepsis or abscess

40
  • CM
  • PAIN (pain is the first sign)
  • Starts around the belly and moves to the lower
    right quadrant of the abdomen
  • Right lower quadrant localized tenderness
  • Right lower quadrant rebound tenderness
  • Fever, nausea, vomiting diarrhea
  • WBC over 15,000
  • Elevated C-reactive protein
  • CM In neonate (non specific)
  • Irritability/ lethargy
  • Abdominal distention abdominal mass
  • Vomiting

41
  • In infants and older children
  • Vomiting diarrhea Pain fever
  •  
  • S S of appendix perforation
  • Fever
  • Sudden relief from pain
  • Subsequent increase in pain and rigidity guarding
    of the abdomen
  • Progressive abdominal distention
  • Tachycardia, rapid-shallow breathing
  • Pallor , chills and irritability

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