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Gastroenteritis, Hirschsprung Disease (HD), Celiac, Umbilical hernia,…
Gastroenteritis
Treatment
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May want to avoid milk, high-fat, or spicy foods
In infants, continue breastfeeding/formula on demand
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What is it
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Bacterial causes include salmonella, shigella, some strains of E.coli, Giardia (based on the cause, people will refer to it is “traveler’s diarrhea”, “food poisoning” etc.)
Very common, especially in young children in childcare centers
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S/S
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Dehydration
Infants: must have at least 3 wet diapers in a 24 hour period (1 every 8 hours), otherwise they are dehydrated
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Dx
May do stool for culture, O&P, WBC
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Celiac
Symptoms
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Intestinal (diarrhea, bloating, constipaion)
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What is it
When the villi are damage, nutrients cannot be absorbed and diarrhea, abdominal pain, malnutrition, and growth failure result
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Umbilical hernia
S/S
Appears as a bulge at the area of the navel, especially when the child coughs, cries or strains
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More common in...
girls, particularly African American girls
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Treatment
Surgical correction if it does not close on its own by about age 3-4 years (earlier if hernia is particularly large)
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Appendicitis
s/s
Begins with nausea, vomiting, fever and non-specific abdominal pain,
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Treatment
No rupture
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Second Line: Laparoscopic Appendectomy, antibiotics
Third Line: Open Appendectomy, antibiotics
Ruptured
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IVFs, NPO, TPN and Lipids
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Pyloric Stenosis
S/S
At first, baby seems to spit up more and more
Projectile vomiting (often in an arc, over several feet)
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Changes in stools
Less frequent, harder, mucus may be present
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Dehydration
Sunken fontanel, wrinkled appearance to skin, dry MMs, fever wet diapers
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What is it
Narrowing of the muscles in the pylorus, preventing food/liquids from being passed from the stomach to the small bowel
The muscles around the pylorus become progressively thicker over the first weeks of life, leading to symptoms at this age
Intussusception
What is it
A “telescoping” of the bowel, leading to obstruction or lack of blood flow to intestines
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Not associated with a congenital defect, cause is unknown
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Treatment
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Slow introduction of oral fluids, nutrition
Observations for reoccurrence, which usually happens in 72 hours if it is going to happen
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Symptoms
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Drawing up the knees, guarding
Periods of calm, pain free time
As it worsens...
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Vomiting, sometimes bilious
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Diaphragmatic Hernia
Treatment
Delivery at a facility with infant ECMO, pediatric surgery team, high acuity NICU
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What is it
In addition to being displaced, heart and lungs may be underdeveloped
Condition in which the diaphragm fails to fuse in utero; abdominal contents invade thoracic cavity displacing lungs, heart
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Constipation
Treatment
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Dietary change, including increased fiber
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Hernias
Appears as a bulge in the groin area, especially visible when child cries, coughs or stands
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S/S
if reducible: soft, non-tender, able to be pushed back into abdomen, stooling normally
If incarcerated: can’t push back in, pain, fever, tachycardia, bilious vomiting, no stooling
If strangulated: all of the above and erythema, edema over mass
What is it
Condition in which an organ or tissue (usually bowel) pushes through an opening or weak spot in a muscle wall
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If the organ or tissue can be pushed back through the opening, it is called reducible. If not, it is called incarcerated. If the blood supply to that organ or tissue is cut off, it is call strangulated.
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Omphalocele
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Dx/tx
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Tx
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After birth, cover immediately with sterile, saline soaked gauze
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Imperforate Anus
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What is it
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Sometimes found on newborn exam, but may not be visible to naked eye (higher up)
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Inflammatory Bowel Diseases
(Areas of the GI tract become inflamed and develop open sores (ulcers) and produce mucus/pus)
Crohn's
Dx
Colonoscopy with biopsy is used, but it only allows for visualization of the lower portions of the small intestine
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Stool cultures for occult blood, WBCs, O&P, etc.
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What is it
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Inflammation can “skip” or “jump”, leaving normal areas between patches of diseased intestine
Most commonly affects the end of the small bowel (ileum), but can affect ANY part of the GI tract, from mouth to anus
Cause unknown, possibly genetic
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Diet: Varies, but generally
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Avoid carbonated, caffeinated beverages
Avoid fried, spicy, greasy foods
Avoid red meat, dark poultry
S/S
Persistent diarrhea, possibly bloody
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Constipation, leading to bowel obstruction
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Rectal abscesses, fistulas
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Management
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•Surgery not usually helpful (used for complications only, like abscesses)
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•Nutritional supplementation (iron, calcium, Vit. D)
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Ulcerative colitis
Dx
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Stool cultures for occult blood, WBCs, O&P, etc.
Managment
Chronic, can be managed with surgery
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Nutritional supplementation (iron, calcium, Vit. D)
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What is it
Does not leave patches, it is continuous
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S/S
Frequent, loose BMs, usually bloody
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Vomiting
Management
Rehydrate
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Small, frequent feedings (include carbs)
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