Gastrointestinal Snippets

Cynthia Jensen RNC-NIC, MS, CNS

Adrienne McIntyre RNC-NIC, MS, CNS

Normal Function

• Conduit from the oral cavity to the rectum and anus.

• Prone to a variety of congenital anomalies due to unique embryonic features and pattern of development

• Anomalies may occur at any point from the mouth to the anus

http://www.aboutgimotility.org/site/about-gi-motility/digestive-tract/

Function of GI Tract

• Absorption and digestion of nutrients

• Elimination of waste products

• Maintenance of fluid and electrolyte balance

• Protection of host from toxins and pathogens

Verklan, M.T. and Walden, M. (2010). Core Curriculum for Neonatal Intensive Care. 4thEd.

Quiz: Quiz: Quiz: Quiz: Maturation of GI Tract

Meconium is rarely present in amniotic fluid before 34 weeks because:

A. Preterm babies do not produce it

B. Fetuses do not swallow amniotic fluid until later in gestation

C. The anal sphincter does not relax before 34 weeks

D. Peristalsis is slow and disorganized before 34 weeks

Obstructions of the GI Tract :Obstructions of the GI Tract :Obstructions of the GI Tract :Obstructions of the GI Tract :Common Associations and Early ManagementCommon Associations and Early ManagementCommon Associations and Early ManagementCommon Associations and Early Management

• History of polyhydramnios (proximal)

• Failure to pass meconium in 24 to 48 hours

• Abdominal distension (distal)

• Bilious emesis

• Management:

• NPO

• Replogle to low suction

• Radiographic studies

• Surgical consultation

What is it?

A. Pyloric atresia

B. Malrotation with mid-gut volvulous

C. Pyloric stenosis

D. Duodenal atresia

http://wiki-pediatric-surgery.wikispaces.com/

What is it?

What is it?

Specific Conditions: RefluxSpecific Conditions: RefluxSpecific Conditions: RefluxSpecific Conditions: Reflux

• Gastroesophageal reflux (GER) is defined as the involuntary retrograde passage of gastric contents into the esophagus with or without regurgitation or vomiting

• Gastroesophageal reflux disease (GERD) pathologic causing apnea, feeding and sleeping problems, failure to thrive etc

• 70-85% of newborns have some form of reflux for first 2 months of life

• Lower esophageal sphincter relaxation responsible

• Resolves in 90-95% of infants by one year of age

Quiz: Quiz: Quiz: Quiz: You are teaching a mother to care for her baby with GERD

Which of the following is most important to help with symptoms?

A. Add rice cereal to thicken milk

B. Large volume feeds to promote better sleep

C. Prone positioning

D. Burping every few ounces

Quiz: Quiz: Quiz: Quiz: You should suspect Hirschsprung’sDisease in an Infant with:

A. Acholic stools

B. Failure to pass meconium in first 48 hours

C. Projectile vomiting

D. Bilious emesis and thrombocytopenia

Specific Conditions: Specific Conditions: Specific Conditions: Specific Conditions: Spontaneous Intestinal Perforation (SIP)Spontaneous Intestinal Perforation (SIP)Spontaneous Intestinal Perforation (SIP)Spontaneous Intestinal Perforation (SIP)

Specific Conditions: Necrotizing Enterocolitis

Quiz: NECQuiz: NECQuiz: NECQuiz: NEC

Your patient with necrotizing enterocolitis has gone to the operating room for exploratory laparotomy and resection. You anticipate that the area of bowel that is most likely affected is the:

A. Jejunum, ileum and colon

B. The ileocecal valve

C. The duodenum

D. Descending colon

NEC: Clinical PresentationNEC: Clinical PresentationNEC: Clinical PresentationNEC: Clinical Presentation

• Abdominal distension (70-98% of cases)

• Residuals and emesis (>70%)

• Heme positive stools

• Lethargy

• Abdominal tenderness

• A’s and B’s

• Hypoperfusion

• Hypotension

• Temperature instability

When NEC Occurs When NEC Occurs When NEC Occurs When NEC Occurs

Gestational age Average Onset (Day of life)

<32 weeks 20.2 days

32-36 wks 13.8 days

36-40 wks 5.4 days

>40 weeks 2 days

Quiz: Which has been shown to prevent NEC? Quiz: Which has been shown to prevent NEC? Quiz: Which has been shown to prevent NEC? Quiz: Which has been shown to prevent NEC?

A. Transpyloric feedings

B. Maternal breast milk feedings

C. Formula feedings

D. Donor breast milk feedings

NEC PreventionNEC PreventionNEC PreventionNEC Prevention

• Only sure way to prevent is to prevent prematurity

• Antenatal corticosteroids

• Feed with mother’s own milk

• Oral care with breast milk

• Use donor milk if mother’s milk unavailable

• Avoid enteral fasting

• Advance feeds by 15-35 ml/kg/day

Necrotizing Necrotizing Necrotizing Necrotizing EnterocolitisEnterocolitisEnterocolitisEnterocolitis----Bell’s StagingBell’s StagingBell’s StagingBell’s Staging

Specific Conditions: Short Gut SyndromeSpecific Conditions: Short Gut SyndromeSpecific Conditions: Short Gut SyndromeSpecific Conditions: Short Gut Syndrome

Amin, S. C., Pappas, C., Iyengar, H., & Maheshwari, A. (2013). Short Bowel Syndrome in the Nicu. Clinics in Perinatology, 40(1), 10.1016/j.clp.2012.12.003.

http://doi.org/10.1016/j.clp.2012.12.003

Complications of Short Gut SyndromeComplications of Short Gut SyndromeComplications of Short Gut SyndromeComplications of Short Gut Syndrome

Amin, S. C., Pappas, C., Iyengar, H., & Maheshwari, A. (2013). Short Bowel Syndrome in the Nicu. Clinics in Perinatology, 40(1), 10.1016/j.clp.2012.12.003.

http://doi.org/10.1016/j.clp.2012.12.003

Quiz: Quiz: Quiz: Quiz: A baby with gastroschisis has dusky bowel…

What is the best position to promote reperfusion of the bowel?

A. Supine

B. Lateral to the right

C. Lateral to the left

D. Head of bed up 30 degrees

Quiz: Quiz: Quiz: Quiz: Which GI defect has ≥60% association with other anomalies?

A. Omphalocele

B. Gastroschisis

C. Malrotation

D. Ileal atresia

Quiz: Quiz: Quiz: Quiz: What type of TEF/EA is the most common?What type of TEF/EA is the most common?What type of TEF/EA is the most common?What type of TEF/EA is the most common?

A. EA without TEF

B. EA with distal TEF

C. EA with proximal TEF

D. TEF without EA