GI/GU Knowledge Check
Elimination: Gastric
Dehydration
• Classifications
1. Isotonic – equal fluid and sodium loss; most common.
2. Hypotonic – more sodium lost than water; risk for shock.
3. Hypertonic – more water lost than sodium; neurological symptoms more likely. (most
dangerous)
• Clinical Manifestations
o Weight loss, dry mucous membranes, poor skin turgor, sunken eyes/fontanel, lethargy,
tachycardia, decreased urine output.
• Therapeutic Management
o Assess severity, restore fluids and electrolytes orally or IV (oral rehydration solution for
mild/moderate; IV isotonic fluids for severe), monitor I&O, parent education.
• Maintenance Fluid (Holliday-Segar method):
o 8 kg → 800 mL/day
o 10 kg → 1,000 mL/day
o 15 kg → 1,250 mL/day
o 25 kg → 1,500 mL + (5×20) = 1,600 mL/day
o 40 kg → 1,500 mL + (20×20) = 1,900 mL/day
• Normal Urine Output:
o Infants: 2–3 mL/kg/hr
o Toddlers/Preschoolers: 2 mL/kg/hr
o School-age: 1–2 mL/kg/hr
o Adolescents: 0.5–1 mL/kg/hr
Diarrhea
• Acute Diarrhea
o Definition: Sudden increase in watery stools lasting <14 days.
o Causes: Viral (rotavirus, norovirus), bacterial, parasites, antibiotic use, food intolerance.
o Diagnosis: Stool cultures, O&P, blood work, hydration status.
, o Prevention: Handwashing, safe food/water prep, rotavirus vaccine.
o Therapeutic Management: Oral rehydration therapy, continued feeding, IV fluids if
severe.
o Priority Goal: Prevent dehydration and electrolyte imbalance.
• Chronic Diarrhea
o Definition: Lasts >14 days.
o Causes: Malabsorption (celiac disease, lactose intolerance), inflammatory bowel disease,
chronic infection.
o Clinical Manifestations: Frequent watery stools, weight loss, growth failure, fatigue.
o Diagnosis: Stool studies, blood tests, growth monitoring, endoscopy.
o Prevention: Treat underlying cause, proper nutrition, education.
o Therapeutic Management: Correct dehydration, treat cause, dietary modifications.
Cleft Lip and Palate
• Pathophysiology: Failure of lip/palate fusion during embryonic development (5–12 weeks
gestation).
• Risk Factors: Genetics, maternal smoking, alcohol, folic acid deficiency, anticonvulsants.
• Clinical Manifestations: Visible split in lip/palate, feeding difficulties, recurrent otitis media.
• Diagnosis: Prenatal ultrasound, physical exam at birth.
• Therapeutic Management:
o Surgery: lip repair at 2–3 months, palate repair at 6–12 months.
o Post-op considerations: Protect suture line (avoid straws/spoons), pain management,
elbow restraints.
• Patient Education: Special feeding techniques, importance of follow-up surgeries,
speech/hearing monitoring.
Hirschsprung’s Disease
• Pathophysiology: Congenital absence of ganglion cells in distal bowel → no peristalsis →
obstruction.
• Clinical Manifestations: Newborn—failure to pass meconium, abdominal distension, bilious
vomiting. Older child—constipation, ribbon-like stools, poor growth.
• Main Complication: Enterocolitis (life-threatening).
Elimination: Gastric
Dehydration
• Classifications
1. Isotonic – equal fluid and sodium loss; most common.
2. Hypotonic – more sodium lost than water; risk for shock.
3. Hypertonic – more water lost than sodium; neurological symptoms more likely. (most
dangerous)
• Clinical Manifestations
o Weight loss, dry mucous membranes, poor skin turgor, sunken eyes/fontanel, lethargy,
tachycardia, decreased urine output.
• Therapeutic Management
o Assess severity, restore fluids and electrolytes orally or IV (oral rehydration solution for
mild/moderate; IV isotonic fluids for severe), monitor I&O, parent education.
• Maintenance Fluid (Holliday-Segar method):
o 8 kg → 800 mL/day
o 10 kg → 1,000 mL/day
o 15 kg → 1,250 mL/day
o 25 kg → 1,500 mL + (5×20) = 1,600 mL/day
o 40 kg → 1,500 mL + (20×20) = 1,900 mL/day
• Normal Urine Output:
o Infants: 2–3 mL/kg/hr
o Toddlers/Preschoolers: 2 mL/kg/hr
o School-age: 1–2 mL/kg/hr
o Adolescents: 0.5–1 mL/kg/hr
Diarrhea
• Acute Diarrhea
o Definition: Sudden increase in watery stools lasting <14 days.
o Causes: Viral (rotavirus, norovirus), bacterial, parasites, antibiotic use, food intolerance.
o Diagnosis: Stool cultures, O&P, blood work, hydration status.
, o Prevention: Handwashing, safe food/water prep, rotavirus vaccine.
o Therapeutic Management: Oral rehydration therapy, continued feeding, IV fluids if
severe.
o Priority Goal: Prevent dehydration and electrolyte imbalance.
• Chronic Diarrhea
o Definition: Lasts >14 days.
o Causes: Malabsorption (celiac disease, lactose intolerance), inflammatory bowel disease,
chronic infection.
o Clinical Manifestations: Frequent watery stools, weight loss, growth failure, fatigue.
o Diagnosis: Stool studies, blood tests, growth monitoring, endoscopy.
o Prevention: Treat underlying cause, proper nutrition, education.
o Therapeutic Management: Correct dehydration, treat cause, dietary modifications.
Cleft Lip and Palate
• Pathophysiology: Failure of lip/palate fusion during embryonic development (5–12 weeks
gestation).
• Risk Factors: Genetics, maternal smoking, alcohol, folic acid deficiency, anticonvulsants.
• Clinical Manifestations: Visible split in lip/palate, feeding difficulties, recurrent otitis media.
• Diagnosis: Prenatal ultrasound, physical exam at birth.
• Therapeutic Management:
o Surgery: lip repair at 2–3 months, palate repair at 6–12 months.
o Post-op considerations: Protect suture line (avoid straws/spoons), pain management,
elbow restraints.
• Patient Education: Special feeding techniques, importance of follow-up surgeries,
speech/hearing monitoring.
Hirschsprung’s Disease
• Pathophysiology: Congenital absence of ganglion cells in distal bowel → no peristalsis →
obstruction.
• Clinical Manifestations: Newborn—failure to pass meconium, abdominal distension, bilious
vomiting. Older child—constipation, ribbon-like stools, poor growth.
• Main Complication: Enterocolitis (life-threatening).
