Questions and Correct Answers
A&P - GI ✅- Mouth: highly vascular, common entry point for infections (as noted in first
lecture)
- Esophagus: lower esophageal sphincter not developed until 1 month allowing
regurgitation. May continue this until one year
- Stomach: capacity 10-20 mL in newborns vs. adults 2000ml-3000ml. Hydrochloric acid
levels reach adult levels at 6 months age.
- Intestines: 250 cm vs. 600 cm. small intestine.
- Biliary system: liver is large at birth (5% weight), Enzymes reach adult levels at 2 years
of age.
- Larger proportion of body water. Require greater amounts of water vs. weight and lose
greater amounts of water/urine in proportion to weight.
Health History: GI ✅- previous illness/surgery
- past family history
- present illness: when did symptoms begin, how does it differ from previous illness
- how have you managed these symptoms
- growth patterns
-allergies, bowel disease, IBS family history
Inspection GI ✅Colour - skin, eyes, lip colour (pale in anemia/dehydration) (jaundiced
with liver dysfunction and high bilirubin levels), assess abdomen for signs of distended
veins
- Normal "pot belly" in toddlers.
- Altered mental status with increased ammonia levels (liver failure, hepatic
encephalopathy-abnormal brain function), altered electrolytes, dehydration,
anaphylactic reaction to foods/meds. Early sign irritability and restlessness.
Auscultation GI ✅What causes hyperactive bowel sounds: diarrhea, gastroenteritis
Hypoactive: obstructive process: emergent
How long do you have to listen to state absent? 5 minutes
Percussion GI ✅- You will hear dullness over bladder that is full which may initially
seem like an ominous finding - but it is a full bladder! You will note tympany everywhere
else. Dullness is heard in the RUQ over the liver.
Palpation GI ✅- tenderness is not a normal finding. Right upper quadrant: liver
enlargement or cholecystitis
RLQ with rebound tenderness: appendicitis and EMERGENT
Assess for hernias in inguinal canals (cough)
, Lab and Dx tests - GI ✅- Stool samples (scrape from diaper, collect in a 'hat' in toilet)
- Abdominal X-ray (pregnancy tests pre x-ray for active teens
- Electrolytes: determine level of dehydration (increase NA, K) (increased BUN with
normal Creatinine)
- Endoscopy: visualizes GI tract (upper) Small bowel series (done in conjunction with
upper GI to visualize small intestine
Oral Candidiasis (Thrush) cause ✅Children on immunosuppressive meds, chemo and
antibiotics cause this. Thrush can be passed back and forth between mother and infant
if breastfed.
Hernias ✅The hernia sacs that develop most often contain:
Females: Fallopian tubes or ovaries.
Males: Bowels.
- Inguinal hernias should be able to be reduced or "pushed back in" or notify a
physician. Unless causing discomfort won't reduce them.
- Umbilical hernias are quite common and should resolve by age 5.
- Hernias that won't reduce and cause pain/discomfort require surgical correction to
avoid organ compromise.
Diarrhea patho ✅Caused by viruses most commonly, but can be related to bacteria or
parasites
Injure the villi preventing fluid absorption.
Could be related to antibiotic use, undercooked meat, travel, day care attendance, well
water.
Chronic diarrhea ✅greater than 2 weeks: food intolerance, nutrient malabsorption,
tumours (secondary diarrhea), ulcerative collitis, IBD, appendiceal abscesses.
Health history - diarrhea ✅number and frequency, duration, volume, associated
symptoms, presence of blood or mucous. Where they live, day care, diet, travel,
antibiotics. (c.diff)
Inspection - diarrhea ✅Dehydration!
(Inspection: colour of skin, eyes, lip colour (pale in anemia/dehydration) (jaundiced with
liver disfunction and high biliruben levels), assess abd for signs of distended veins,
altered mental status irritability and restlessness, lethargy and listlessness)
Assess anal area for redness/ excoriation.
Auscultation - diarrhea ✅Hypoactive: obstruction/ peritonitis. Hyperactive: diarrhea,
gastroenteritis
Palpation: tender lower: gasto, rebound could be appendicitis, peritonitis.
Diarrhea: Nursing management ✅- Restoring fluid and electrolyte balance
- Providing family education