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56 Cards in this Set
- Front
- Back
Describe the term "mega-colon"
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Accumulation of feces in the intestine that is unable to pass
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Signs of toxic megacolon
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Fever, acute abdominal pain, abdominal distention
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Pathophysiology of Hirshprungs Disease
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Absence of ganglionic cells in portions of the intestine
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Why does fecal material accumulate in the intestine with Hirshprungs disease
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Absence of peristalsis
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What 3 disorders are most commonly found in pt's with Downs Syndrome
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Diabetes, hirshprungs, atrioventricular canal defect (AV canal)
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What is the leading cause of death in children with Hirshprungs
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Entericolitis
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What is a major concern with enterocolitis
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Perforation
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What disorder is synonymous with a tight anal sphincter that fails to relax
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Hirshprungs
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4 s&s's of newborns suffering from hirshprungs
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1-Failure to pass meconium w/in 24hrs
2-Reluctant to ingest fluids 3-Bile-stained vomitus 4-Abdominal distention |
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6 s&s's during infancy of pt's suffering from hirsphrungs
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1-Failure to trhive
2-Constipation 3-D/V 4-Abdominal distention 5-Fever 6-Exhaustion |
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A pt comes in complaining of constipation and ribbon-like bowels; upon assessment you you notice the child is poorly nourished and has a distended abdomen. What disorder are they likely suffering from and what else do you expect to find?
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Hirshprungs; palpable fecal masses & visible peristalsis proximal to megacolon
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When performing a rectal exam on a pt with hirshprungs what do you expect to find
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Tight internal sphincter & absence of stool
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What is an anorectal manometry
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Insert a catheter beyond internal sphincter, inflate balloon; normal response is for anal sphincter to relax
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At what point can a child undergo surgical procedures for hirshprungs
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Adequately nourished, 9kg
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What therapeutic measurement is used until an infant is ready to undergo surgery for hirshprungs
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Temporary ostomy
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2 surgical procedures for hirshprungs
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Immediate resection of intestine; resection of intestine after megacolon has shrunk in size
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Define enterocolitis
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Inflammation of intestine & colon
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When assessing for enterocolitis what would we expect to find r/t VS's?
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Increased HR, increased RR, decreased BP
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In children, which is typically the last VS to change
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BP
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When assessing the abdomen of a pt with enterocolitis what do we expect to find
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Absence of bowel signs, distention and tenderness
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When assessing for enterocolitis what is it important that we check for r/t VS
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s&s's of shock
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A pt comes in with a fever and a possible diagnosis of enterocolitis; it is suspected that this pt's intestine has perforated. Should we administer a rectal temp?
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No
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At what point can we remove the NPO diet restriction from a post-op pt for enterocolitis
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Presence of bowel sounds, passing of flatulence
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Is gastric emptying delayed with GERD?
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Yes
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What is the most common cause of GERD
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Underdeveloped esophagus
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What are the peak ages we see GERD in children
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1-4mos
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At what age in children does GERD tend to resolve
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6-12mos
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Describe Sandifer's Syndrome
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Post-feed the infant or child turns head to one side to alleviate discomfort from GERD; often mistaken for seizure
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Is respiratory illness associated with GERD
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Yes
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When is the only time it is recommended to add rice cereal when bottle-feeding
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Infant with GERD
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NG tube and surgery are considerations for what pt's diagnosed with GERD
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Failure to thrive, anatomical abnormalities, respiratory illness, non-responsive to medical therapy
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What is the term Nissen Fundoplication
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It is a surgical procedure to treat gastroesophageal reflux disease (GERD) and hiatus hernia
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Complications of Nissan Fundoplication
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Too tight; bowel obstruction, gas-bloat syndrome
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When should meds be administered for pt's diagnosed with GERD
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Around feedings; 30 min prior
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What classifications of drugs are used for medical therapy r/t GERD
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Antacids, proton pump inhibitors, prokinetics
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Commonly used drugs more medical therapy r/t GERD
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Prilosec, prevacid, pepsid, tagamet, others
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What disorder is described as chronic inflammatory disease
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Crohn's
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What disorder is Crohn's often misdiagnosed as
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Appendicitis
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What "triggers" are commonly associated with Crohn's disease
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Stress, viral&infectious agents, food allergies, increased intestinal permeability, immunological dysfunction
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What is Erythema Nosdosum and what disorder is it associated with
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Large, painful nodules on the legs; crohn's
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s&s's of Crohn's disease
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Abdominal pain, cramps, diarrhea, weight loss, poor growth, fever, anorexia, rectal bleeding, perianal discomfort&fissures, and fistulas through other loops of bowel
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Why might we find elevated levels WBC and ESR with Crohn's disease
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Due to inflammatory response r/t dysfunctional immunology
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Uveitis and large jt arthritis are associated with what disorder, why?
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Crohn's disease
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When do we expect to find pANCA levels elevated?
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Enterocolitis, not with Crohn's
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What lab data would we expect to see elevated in a pt with Crohn's disease r/t inflammation
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CBC, ESR, CRP
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What lab data would we expect to see elvated in a pt with Crohn's disease r/t nutritional status
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Zinc, mg++, B12
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Will protein be in elevated or decreased levels in Crohn's
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Elevated
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What do we expect to find in stool of pt's with Crohn's disease
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Blood, leukocytes, infectious agents
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What drugs are commonly administered to treat Crohn's
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Corticosteroids, aminosalicylates, immunodulators, antibiotics
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What function do Aminosalicylates serve?
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Anti-inflammatory
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What is important concerning a pt who is consistently taking Corticosteroids
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Adrenal gland works via negative feedback so it is not producing cortisol on it's own; important for surgery because will need to implement stress doses of corticosteroids
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What dos Zinc do r/t treating Crohn's disease
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Helps remove free radicals from the body
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Why are pt's with Crohn's disease at risk for Enterocolitis
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Inflammation + Ulceration can lead to = Perforation
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Can you cure Crohn's disease
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No
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What is a long-term concern for pt's with Crohn's disease
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Colon cancer
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Why should pt's with Crohn's disease receive frequent colonoscopies
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At risk for colon cancer
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