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GI SYSTEM

At birth the resistance of the newborns

intestinal tract to bacterial and viral

infection is incompletely developed.

As children grow the have higher

nutritional, metabolic and energy needs

The infants stomach is small and emptiesrapidly

New borns produce little saliva until three

months of age

Swallowing is reflex for the first 3 months

Hepatic efficiency in the new born is

immature, sometimes causing jaundice

Fat Absorption is poor

Esophageal Atresia (Tracheoesophageal Fistula)

Caused by a failure of the GI tract to

separate properly from the respiratory

tract early in the prenatal life.

The earliest signs occurs prenatally when the

mother develops

Poly hydramnios

o When the upper esophagus ends

in a blind pouch, the fetus cannotswallow the amniotic fluid,

resulting in an accumulation of

fluid in the amniotic sac

(polyhydramnios)

At birth the infant will vomit and choke

when the first feeding is introduced.

Drooling

because the upper of the esophagus ends

in a blind pouch (unable to swallow

accumulated secretions)

o Drooling in newborn Is

pathological and is related to

atresia (drooling after 3 months

is related to teething)

o Drooling in the newborn is

pathological because the salivary

glands do not develop for severalmonths

If the upper esophagus enters the trachea,

the first feeding will enter the trachea

(coughing, choking, cyanosis and apnea)

If the lower end of the esophagus (from the

stomach) enters the trachea, air will enter

the stomach each time the infant breathes

(abdominal distention)

Treatment and Nursing CareNursing Goal

Prevent pneumonia, chocking and apnea in

the newborn

Assessment of newborn during the first

feeding is essential

o First feeding usually consists of

clear water or colostrums to

minimize the seriousness of

aspiration should it occur.

If symptoms are noted, placed on NPO

status, suction to clear the airway, position

to drain mucus form the nose and throat.

Surgical repair is essential for survival.

Pyloric Stenosis

Pyloric stenosis (narrowing) is the

obstruction at the lower end of the

stomach (pylorus) caused by an

overgrowth (hypertrophy) of the circular

muscle of the pylorus or by spasms of the

sphincter

Commonly classified as congenital anomaly;

however, the symptoms do not appear

until the infant is 2 or 3 weeks old.

Most common surgical condition of the

digestive tract in infancy.

Incidence: higher in boys than in girls, and it

has a tendency to be inherited.

Manifestations

Vomiting

outstanding symptom of the disorder.

Contains mucus and ingested milk.

Projectile Vomiting

force progresses until most of the food is

ejected to a considerable distance from the

mouth; occurs immediately after feeding.

o Vomitus usually smells sour

because it has a reached the

stomach and has been in contact

with stomach enzymes.

No Bile in the Vomiting

of pyloric stenosis because the feeding

does not reach the duodenum to become

mixed with bile.

Constant Hunger

and will eat again immediately after

vomiting

Assessment

Diagnosis is primarily made from history:

o Vomiting or spitting up, be

certain to get full description:

What is the duration?

What is the intensity?

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What is the frequency?

What is the description

of the vomitus?

Is the infant ill in other

way?

Manifestations Dehydration

evidenced by sunken fontanels, inelastic

skin, and decreased urination, as well as

malnutrition

o Lack of tears, dry mucus

membranes of the mouth, fever.

Decreased urine output, weight

loss.

Alkalosis

because of the excessive loss of CI-ions

from the stomacho Hypopnea

Slowed respirations occurs as the

body attempts to compensate for

the alkalosis

Definitive diagnosis

by watching the infant drink:

o Before the child drinks, attempt

to palpate the right upper

quadrant of the abdomen for a

pyloric mass.

o If one is present, it feels round an

d firm, approximately the size of

the olive (Pathognomonic sign

Olive Shape)

Olive-Shaped Mass

may be felt in the right upper quadrant of

the abdomen

UTz are commonly used for diagnostic

purposes (noninvasive and accurate)

In severe cases the outline of the distended

and peristaltic waves are visible during

feeding

Tetany may occur with alkalosis because the

increased HCO3 ions may combine with

calcium ions, trying to effect homeostasis

and thereby lowering the level of ionized

calcium (low serum calcium leads totetany)

Therapeutic Management

Treatment

surgical laparoscopic correction (a

pyloromyotomy), performed before

electrolyte imbalance form vomiting or

hypoglycemia from the lack of food

occurs

Incision is made in the pyloric

muscle to enlarge the opening sofood may easily pass through it

again.

Before surgery

o Correction of electrolyte

imbalance, dehydration and

starvation must be corrected by

IVF (usually isotonic saline or

5% glucose in saline (contains an

excess Cl-ions)

Withhold oral feedings to prevent further

electrolyte depletion.

Pacifier- to meet nonnutritive sucking needs

and be comfortable when receiving only

IVF

If tetany is present, IV calcium must be also

being administered.

May need additional potassium (but must

not be administered until it is determinedthat the childs kidneys are functioning

(voiding) otherwise potassium buildup

could cause cardiac arrhythmias.

Prognosis

excellent if the condition is discovered

before an electrolyte imbalance occurs.

Nursing Care

The dehydrated infant is given IVFpreoperatively to restore fluid and

electrolyte balance (if not, shock may

occur during surgery)

Thickened feedings

until the time of operation (in hopes that

some nutritions may be retained)

o Degree of thickness of formula is

ordered by physician given by

teaspoons or through a nipple

with large hole

The infant is burped before as well as

during feedings to remove any gas

accumulated in the stomach

o Feeding is done slowly and the

infant is handled gently and as

little as possible.

The infant is placed on the right side after

feeding to facilitate drainage into the

intestine

Fowlers position is preferred to aid gravity

in passing milk through the stomach.

Charting of the feeding includes time, type,

and amount offered; amount taken and

retained and type and amount of vomiting.

Obtain and record baseline weight and

weigh the infant at the same time each

morning

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Document the type and number of stools and

color of urine and frequency of voiding (I

and O)

Frequent position change.

After Surgery

o Careful observation of VS andIVF

o Frequent inspection of wound

site

o Infant may resume oral feeding

shortly after recovering from

anesthesia

o Small amounts of glucose water

that gradually increase until a

regular formula can be taken and

retained.

o Avoid overfeeding, and review

feeding techniques to parents.

o Diaper is placed low over the

abdomen to prevent

contamination of the wound site.

Celiac Disease (Malabsorption Syndrome; Gluten

Induced Enteropathy)

Basic problem is a sensitivity or abnormal

immunologic response to protein

particularly the gluten factor of protein

found in grains, wheat, rye, oats, and

barley

Children develop an inability to absorb fat.

Steatorrhea

Vitamins ADEK are not absorbed because

fat is not absorbed.

Ricketts may occur lack of vitamin D

Hypoprothrombinemia loss of Vitamin K

Hypochromic Anemia (iron-deficiency

anemia) and hypoalbuminemia from poor

protein absorption

Early recognition is essential so thattreatment bay me provided

Increased incidence in children with Down

syndrome

Nursing Tip

A bulky, frothy stool may indicate

malabsoprtion

Assessment

Anorectic and irritablegradually fall behind other children in

height and weight

Appear skinny, with spindly extremities and

wasted buttocks

Face may be plump and well-appearing

Symptoms

bulky stool, malnutrition, distended

abdomen and anemia noted between 6

and 18 months

Diagnosis

history, clinical symptoms, serum analysis

of antibodies against gluten (IgA

antigliadin antibodies); biopsy of the

intestinal mucosa (done by endoscopy)

o OGTT reveal poor\ absorption

o Stool examintion for fat content

(increased)

o Gluten Free diet

Therapeutic management

Gluten-free diet for life (more prone to GI

carcinoma later in life)

Water soluble forms of vitamins A and D

Iron and Folate to correct any anemiapresent