Gastrointestinal dysfunction
Dehydration
- Severity assessed on % of body weight lost. Mild 2-5 %. Mod 6-9% severe >10%.
- S/S: dry skin/mucous membranes, lack of tears, sunken fontanels, irritability, LOC changes.
Tachycardia, intense thirst, infants are greater risk.
- TX: Depends on cause and how severe. Oral intake, IV fluids, MONITOR I&Os and DAILY
WEIGHTS at the same time, same place, same scale and infants should be naked or have DRY
diaper. Vomiting is not a contraindication for oral rehydration unless severe! Give Oral
rehydration solution (ORS) = Pedialyte.
- Reintroduce bland foods slowly, let parents know they will poop a lot once they start eating
again.
Daily intake should be: (ML per day)
- 0-10 kg 100mL/kg/day of body weight
- 11-20 kg 1000mL + 50mL /kg/day for each kg >10
- >20 kg 1500mL + 20mL/kg/day for each kg >20
So if they weight 8 kg = 8 x 100 ml = 800 ml per day
If they weigh 12 kg = 2 more kg over 10 so add 50ml/kg for each kg over 10. 2 X 50 = 100 + 1000 =
1,100.
15 kg = 5 X 50 = 250 + 1000 = 1,250 mL /day
25 kg = (5kg over 20) so 5 x 20 = 100 + 1500 = 1,600 ML/day.
28 kg = 8 x 20 = 160 + 1500 = 1,660 mL/day
Hourly output should be 1-3 ml /kg/hr
Ex) 36 kg x 1 = 36ml/hr 36 kg x 3= 108ml/hr if child had 195 ml output in 12 hours it would be too low.
Diarrhea
- Get a good history of a child who comes in with diarrhea to find out cause
- Types of diarrheal disturbances:
- Gastroenteritis
- Enteritis/ enterocolitis
- Colitis
, Hirschsprung Disease (aganglionic megacolon)
- Lack of ganglion cells in colon
- causes feces back up into colon because anal sphincter doesn’t relax.
S/S in Newborns: Failure to pass meconium stool with 24-48 hours after birth, Feeding
intolerance, Bilious vomiting d/t obstruction, abdominal distention.
- S/S in Infants: Failure to thrive, Constipation, Abdominal distention, Diarrhea and vomiting,
Enterocolitis S/S: explosive diarrhea, fever = (SEPSIS from perforation)!!!! (KNOW)
- S/S in Childhood: Constipation, ribbon- like foul-smelling stools (could be earlier on In infancy
as well), Abdominal distention, Visible peristalsis, palpable fecal mass, Undernourished.
Dx: Rectal biopsy to see if ganglion cells are missing
- TX: typically temporary colostomy.
Pre op: Bowel clean out
Post op: educate and help parents with colostomy care, show child colostomy equipment and
play with it If old enough. Rectal dilation may be needed.
It is mostly important to Monitor for abdominal distention and temperature for fever!!(sepsis)
Gastroesophageal Reflux (GER)
- Becomes the disease (GERD) when complications are added
- Can occur throughout the day, but most frequently after meals and at night
- Peak incidence occurs at 4 mos of age, Mostly outgrown by 12 months
- S/S: Excessive crying, irritability, arching of back, pushing the bottle away from them, stiffening,
Respiratory problems (cough, wheeze, gagging, choking with feedings.) blood in spit up, weight
loss, failure to thrive (FTT).
- TX: small frequent feedings, sitting upright for feedings and sitting them up for 30 mins after
feeding, adding baby cereal to formula.
Meds: ranitidine, famotidine, PPIs
- Surgical management is rare: Nissen fundoplication. (last resort)
Dehydration
- Severity assessed on % of body weight lost. Mild 2-5 %. Mod 6-9% severe >10%.
- S/S: dry skin/mucous membranes, lack of tears, sunken fontanels, irritability, LOC changes.
Tachycardia, intense thirst, infants are greater risk.
- TX: Depends on cause and how severe. Oral intake, IV fluids, MONITOR I&Os and DAILY
WEIGHTS at the same time, same place, same scale and infants should be naked or have DRY
diaper. Vomiting is not a contraindication for oral rehydration unless severe! Give Oral
rehydration solution (ORS) = Pedialyte.
- Reintroduce bland foods slowly, let parents know they will poop a lot once they start eating
again.
Daily intake should be: (ML per day)
- 0-10 kg 100mL/kg/day of body weight
- 11-20 kg 1000mL + 50mL /kg/day for each kg >10
- >20 kg 1500mL + 20mL/kg/day for each kg >20
So if they weight 8 kg = 8 x 100 ml = 800 ml per day
If they weigh 12 kg = 2 more kg over 10 so add 50ml/kg for each kg over 10. 2 X 50 = 100 + 1000 =
1,100.
15 kg = 5 X 50 = 250 + 1000 = 1,250 mL /day
25 kg = (5kg over 20) so 5 x 20 = 100 + 1500 = 1,600 ML/day.
28 kg = 8 x 20 = 160 + 1500 = 1,660 mL/day
Hourly output should be 1-3 ml /kg/hr
Ex) 36 kg x 1 = 36ml/hr 36 kg x 3= 108ml/hr if child had 195 ml output in 12 hours it would be too low.
Diarrhea
- Get a good history of a child who comes in with diarrhea to find out cause
- Types of diarrheal disturbances:
- Gastroenteritis
- Enteritis/ enterocolitis
- Colitis
, Hirschsprung Disease (aganglionic megacolon)
- Lack of ganglion cells in colon
- causes feces back up into colon because anal sphincter doesn’t relax.
S/S in Newborns: Failure to pass meconium stool with 24-48 hours after birth, Feeding
intolerance, Bilious vomiting d/t obstruction, abdominal distention.
- S/S in Infants: Failure to thrive, Constipation, Abdominal distention, Diarrhea and vomiting,
Enterocolitis S/S: explosive diarrhea, fever = (SEPSIS from perforation)!!!! (KNOW)
- S/S in Childhood: Constipation, ribbon- like foul-smelling stools (could be earlier on In infancy
as well), Abdominal distention, Visible peristalsis, palpable fecal mass, Undernourished.
Dx: Rectal biopsy to see if ganglion cells are missing
- TX: typically temporary colostomy.
Pre op: Bowel clean out
Post op: educate and help parents with colostomy care, show child colostomy equipment and
play with it If old enough. Rectal dilation may be needed.
It is mostly important to Monitor for abdominal distention and temperature for fever!!(sepsis)
Gastroesophageal Reflux (GER)
- Becomes the disease (GERD) when complications are added
- Can occur throughout the day, but most frequently after meals and at night
- Peak incidence occurs at 4 mos of age, Mostly outgrown by 12 months
- S/S: Excessive crying, irritability, arching of back, pushing the bottle away from them, stiffening,
Respiratory problems (cough, wheeze, gagging, choking with feedings.) blood in spit up, weight
loss, failure to thrive (FTT).
- TX: small frequent feedings, sitting upright for feedings and sitting them up for 30 mins after
feeding, adding baby cereal to formula.
Meds: ranitidine, famotidine, PPIs
- Surgical management is rare: Nissen fundoplication. (last resort)
