GI and GU- Pediatrics Practice Exam
Questions and Correct Answers
Impact of pediatric differences in the GI system: ✅- Small stomach capacity
- Increased peristalsis (everything runs through quickly, not uncommon for a bowel
movement with each feeding)
- Relaxed cardiac sphincter
- Decreased enzymes (do not digest as well, especially proteins)
- Distention from gas (main cause of colicky babies- can be gas from mom passed or
baby's gas)
- Immature liver (causes decreased enzymes)
Pediatric assessment for GI disorders: ✅- Abdomen (should be soft, good bowel
sounds, should not be any areas of tenderness- sometimes guarding can be mistaken
as rigidity)
- Mouth and esophagus (alterations of the mouth, teeth, spitting, reflux)
- Nutrition/feedings (what are they eating? how are they tolerating it? enough fluids?
NICU- any emesis or residual?)
- Stools (stools reflect nutrition, iron rich stools will be dark, pale without iron, beets will
be red, may need education on fluids if stool is hard)
- Family history
- Labs (check stool for OVA and parasites
Clinical manifestations in relation to pathophysiology for Cleft Lips and Palates: ✅Cleft
Lip and Palate:
- Can occur together or separately
- Cleft lip can be unilateral or bilateral
- Cleft lip= opening in the lip
- Both can cause: feeding difficulties, dental deformities, speech problems, otitis media,
hearing problems
- Cleft lip causing difficulty latching and forming mouth around a nipple
- Cleft palate causes inability to compress the nipple and inability to properly suction
- Cleft palate can cause speech problems as the tongue is pressed against the palate
and teeth to speak, so deformities affect speech
- Cleft palate can cause a shortened eustachian tube causing otitis media
- Infections secondary to a shortened eustachian tube with a cleft palate can cause
hearing problems
- More bony growth means less to repair for a cleft palate, so they are done at 6-18
months to allow for that bony growth
Pre and Post-Operative care of a Cleft lip and Palate: ✅Pre-Operative Care:
- Modified feeing or NPO
, - Age-appropriate preoperative education (we do not need to teach the infant or young
toddler much)
- Cleft palate generally fixed by 18 months
- Cleft lip generally fixed within a few months
- Discuss surgical expectations (how many surgeries may need to occur, etc.)
- Interdisciplinary team: nurses, doctors, speech therapists, dentists, plastic surgeon
- Special feeders that cover the cleft palate and allow for compression while feeding, or
that we can squeeze milk/formula through
- Encourage breast feeding (however not recommended with a significant cleft palate)
- Encourage pumping if mother cannot breast feed
- Allow extra feeding time
- Burp frequently (defect allows for extra air intake that is swallowed)
- Upright position for 30 minutes
Post-Operative Care:
- Pain management (NIPS [not generally a priority in the NICU as things such as
respiratory function etc. are more important], *FLACC most common)
- Maintain suture line (lip- can't suck so do syringe or dropper feed to maintain proper
nutrition; palate- no straw or metal utensils in the mouth; keep clean and dry)
- Nutritional support (sit upright, feed slowly, maintain adequate nutrition)
- Home care teaching (teach how to maintain suture line, how to feed baby, signs and
symptoms of infection)
Clinical manifestations in relation to pathophysiology for Pyloric Stenosis: ✅Pyloric
Stenosis:
- The pyloris is the same as the pyloric muscle(will be used interchangeably on the test)
- Hypertrophy of the pyloric muscle and the opening starts to close, so the stomach is
pushing harder to push the food through, the food then goes to the area of least
resistance which cause projectile vomiting
- Causes lose of acid so pH cause metabolic alkalosis (blood gas will have basic pH)
- Not getting enough calories so they become fussy, hungry, tired
- Lots of vomiting causes inadequate nutrition
Symptoms:
- Starts as occasional emesis that reaches projectile vomiting
- Palpable olive-sized mass (can be physically palpated)
- Visible peristaltic waves
- Hyperactive bowel sounds (due to trying to get food moving through)
- Dehydration from vomiting
- Electrolyte imbalances from vomiting and stomach acid loss
Pre and Post-Operative care of Pyloric Stenosis: ✅Pre-Operative Care:
- NPO pre-op
- Correct dehydration and any electrolyte imbalances
Post-Operative Care:
Questions and Correct Answers
Impact of pediatric differences in the GI system: ✅- Small stomach capacity
- Increased peristalsis (everything runs through quickly, not uncommon for a bowel
movement with each feeding)
- Relaxed cardiac sphincter
- Decreased enzymes (do not digest as well, especially proteins)
- Distention from gas (main cause of colicky babies- can be gas from mom passed or
baby's gas)
- Immature liver (causes decreased enzymes)
Pediatric assessment for GI disorders: ✅- Abdomen (should be soft, good bowel
sounds, should not be any areas of tenderness- sometimes guarding can be mistaken
as rigidity)
- Mouth and esophagus (alterations of the mouth, teeth, spitting, reflux)
- Nutrition/feedings (what are they eating? how are they tolerating it? enough fluids?
NICU- any emesis or residual?)
- Stools (stools reflect nutrition, iron rich stools will be dark, pale without iron, beets will
be red, may need education on fluids if stool is hard)
- Family history
- Labs (check stool for OVA and parasites
Clinical manifestations in relation to pathophysiology for Cleft Lips and Palates: ✅Cleft
Lip and Palate:
- Can occur together or separately
- Cleft lip can be unilateral or bilateral
- Cleft lip= opening in the lip
- Both can cause: feeding difficulties, dental deformities, speech problems, otitis media,
hearing problems
- Cleft lip causing difficulty latching and forming mouth around a nipple
- Cleft palate causes inability to compress the nipple and inability to properly suction
- Cleft palate can cause speech problems as the tongue is pressed against the palate
and teeth to speak, so deformities affect speech
- Cleft palate can cause a shortened eustachian tube causing otitis media
- Infections secondary to a shortened eustachian tube with a cleft palate can cause
hearing problems
- More bony growth means less to repair for a cleft palate, so they are done at 6-18
months to allow for that bony growth
Pre and Post-Operative care of a Cleft lip and Palate: ✅Pre-Operative Care:
- Modified feeing or NPO
, - Age-appropriate preoperative education (we do not need to teach the infant or young
toddler much)
- Cleft palate generally fixed by 18 months
- Cleft lip generally fixed within a few months
- Discuss surgical expectations (how many surgeries may need to occur, etc.)
- Interdisciplinary team: nurses, doctors, speech therapists, dentists, plastic surgeon
- Special feeders that cover the cleft palate and allow for compression while feeding, or
that we can squeeze milk/formula through
- Encourage breast feeding (however not recommended with a significant cleft palate)
- Encourage pumping if mother cannot breast feed
- Allow extra feeding time
- Burp frequently (defect allows for extra air intake that is swallowed)
- Upright position for 30 minutes
Post-Operative Care:
- Pain management (NIPS [not generally a priority in the NICU as things such as
respiratory function etc. are more important], *FLACC most common)
- Maintain suture line (lip- can't suck so do syringe or dropper feed to maintain proper
nutrition; palate- no straw or metal utensils in the mouth; keep clean and dry)
- Nutritional support (sit upright, feed slowly, maintain adequate nutrition)
- Home care teaching (teach how to maintain suture line, how to feed baby, signs and
symptoms of infection)
Clinical manifestations in relation to pathophysiology for Pyloric Stenosis: ✅Pyloric
Stenosis:
- The pyloris is the same as the pyloric muscle(will be used interchangeably on the test)
- Hypertrophy of the pyloric muscle and the opening starts to close, so the stomach is
pushing harder to push the food through, the food then goes to the area of least
resistance which cause projectile vomiting
- Causes lose of acid so pH cause metabolic alkalosis (blood gas will have basic pH)
- Not getting enough calories so they become fussy, hungry, tired
- Lots of vomiting causes inadequate nutrition
Symptoms:
- Starts as occasional emesis that reaches projectile vomiting
- Palpable olive-sized mass (can be physically palpated)
- Visible peristaltic waves
- Hyperactive bowel sounds (due to trying to get food moving through)
- Dehydration from vomiting
- Electrolyte imbalances from vomiting and stomach acid loss
Pre and Post-Operative care of Pyloric Stenosis: ✅Pre-Operative Care:
- NPO pre-op
- Correct dehydration and any electrolyte imbalances
Post-Operative Care:
