CELIAC DISEASE Definition: an autoimmune illness of the small intestine.

It affects the digestive system when food containing gluten is ingested. Gluten is found in foods like barley, rye, oats, and wheat. For someone with celiac, the bodys immune response to gluten causes inflammation in the small intestine, damaging the lining. This reduces the intestines ability to absorb dietary nutrients. etiology:unknown. Studies suggest its a familial disease found among Caucasians and reduced absorptive surface. signs ans symptoms: There are no typical signs and symptoms of celiac disease. Most people with the disease have general complaints, such as:

Intermittent diarrhea Abdominal pain Bloating Irritability or depression Anemia Stomach upset Joint pain Muscle cramps Skin rash Mouth sores Dental and bone disorders (such as osteoporosis) Tingling in the legs and feet (neuropathy) Weight loss Diarrhea Abdominal cramps, gas and bloating General weakness and fatigue Foul-smelling or grayish stools that may be fatty or oily Stunted growth (in children) Osteoporosis

Diagnostic tests: Blood tests Endoscopy pathophysiology G l u t e n i s m a i n l y f o u n d i n w h e a t , r y e , o a t s , a n d barley. When gluten is ingested, it is brokendown into peptides, particularly gliadin. It isthought that gliadin binds to antigen-pre-senting cells expressing HLA-DQ2 and HLA-DQ8. This is facilitated by the enzyme tissuet r a n s g l u t a m i n a s e . T h e p e p t i d e s a r e t h e n presented to intestinal mucosal T-lympho-c y t e s w h i c h b e c o m e a c t i v a t e d , p r o d u c i n g antibodies and cytokines, resulting in inflam-mation and intestinal mucosal injury. Smallb o w e l b i o p s y s h o w s v a r i a b l e a m o u n t s o f villous atrophy, crypt hyperplasia and inflam-mation. Treatment with a glutenfreed i e t r e s u l t s i n i m p r o v e m e n t i n i n t e s t i n a l structure and symptoms. treatment: 1. surgical management :none 2. medical management: Provide supplemental fat soluble vitamins in water soluble form (Vits. A,D,E,K) 3. nursing management which includes: Gluten Free Diet TPN for malnourished child Hypertrophic Pyloric Stenosis Definition: congenital hypertrophy of the muscles of the pylorus on the stomach, the muscles become progressively thickened, elongated, with narrowing of lumen Etiology:unknown; hereditary factors, have associated congenital defects. signs and symptoms: projectile vomiting-after 1-2 feedings during 2 nd-4th week and 2-3 months pathophysiology peristaltic waves- visible from left to right across epigastrium palpable olive shaped mass in the RUQ of the abdomen weight gain/loss scanty urine signs of metabolic alkalosis stools decrease in number/size pathophysiology:

the gastric outlet obstruction due to the hypertrophic pylorus impairs emptying of gastric contents into the duodenum. As a consequence, all ingested food and gastric secretions can only exit via vomiting, which can be of a projectile nature. The exact cause of the hypertrophy remains unknown. The vomited material does not contain bile because the pyloric obstruction prevents entry of duodenal contents (containing bile) into the stomach. This results in loss of gastric acid (hydrochloric acid). The chloride loss results in hypochloremia which impairs the kidney's ability to excrete bicarbonate. This is the significant factor that prevents correction of the alkalosis. [4] A secondary hyperaldosteronism develops due to the hypovolemia. The high aldosterone levels causes the kidneys to avidly retain Na+ (to correct the intravascular volume depletion), and excrete increased amounts of K+ into the urine (resulting in hypokalaemia). The body's compensatory response to the metabolic alkalosis is hypoventilation resulting in an elevated arterial pCO2. Diagnostic tests:

Physicalexam. Your baby's doctor may feel an olive-shaped lump the enlarged pyloric muscle when examining your baby's abdomen.

Bloodtests. The loss of electrolytes such as sodium, potassium, magnesium and calcium may be a sign of continual vomiting and dehydration.

Ultrasound.This test uses sound waves to create an image of your baby's stomach. ContrastX-ray. For this test, your baby swallows a small amount of a liquid that coats the stomach. This contrast material helps any abnormalities show up more clearly on an X-ray.

treatment: 1. surgical management Pyloromyotomy an in incision through muscle fibers of the pylorus performed by laparoscopy 2. medical management Diet Regimen IV therapy

3. nursing management which includes: pre op: Feeding instructions - Position semi upright - Right side lying or high fowlers after feeding Gastric Lavage as ordered Maintain optimum hydration Monitor Daily Weight post operative care: Monitor I/O Maintain IV Fluids Small, frequent feeding of glucose, H2O, Electrolyte solution after 4-6 hours, position in 45 degree angle, feed infant slowly, burping frequently, handle minimally after feeding Monitor abdominal distention

Achalasia so known as esophageal achalasia, achalasia cardiae, cardiospasm, and esophageal aperistalsis, is anesophageal motility disorder involving the smooth muscle layer of the esophagus and the lower esophageal sphincter (LES).It is characterized by incomplete LES relaxation, increased LES tone, and lack of peristalsis of the esophagus (inability of smooth muscle to move food down the esophagus) in the absence of other explanations like cancer or fibrosis. Etiology: A muscular ring at the point where the esophagus and stomach come together (lower esophageal sphincter) normally relaxes during swallowing. In people with achalasia, this muscle ring does not relax as well. The reason for this problem is damage to the nerves of the esophagus. Cancer of the esophagus or upper stomach and a parasite infection that causes Chagas disease may have symptoms like those of achalasia. Achalasia is a rare disorder. It may occur at any age, but is most common in middle-aged or older adults. This problem may be inherited in some people.

Symptoms

Backflow (regurgitation) of food Chest pain, which may increase after eating or may be felt in the back, neck, and arms

Cough Difficulty swallowing liquids and solids Heartburn Unintentional weight loss

Exams and Tests Physical examination may show signs of anemia or malnutrition. Tests include:

Esophageal manometry Esophagogastroduodenoscopy Upper GI x-ray

Treatment Medical The approach to treatment is to reduce the pressure at the lower esophageal sphincter. Therapy may involve:

Injection with botulinum toxin (Botox). This may help relax the sphincter muscles, but any benefit wears off within a matter of weeks or months. Medications, such as long-acting nitrates or calcium channel blockers, which can be used to relax the lower esophagus sphincter

Surgical called an esophagomyotomy), which may be needed to decrease the pressure in the lower sphincter

Widening (dilation) of the esophagus at the location of the narrowing (done during esophagogastroduodenoscopy) Possible Complications

Backflow (regurgitation) of acid or food from the stomach into the esophagus (reflux) Breathing food contents into the lungs, which can cause pneumonia Tearing (perforation) of the esophagus