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Chapter 33: The Child with Gastrointestinal Dysfunction

Open Book Quizzes


QUIZ QUESTIONS
1. The three parts of the gastrointestinal (GI) tract are the _fore gut_, consisting of the
esophagus, stomach, and proximal duodenum; the _mid gut_, consisting of the distal
duodenum, jejunum, ileum, cecum, and proximal colon; and the _hind gut_, made up of
the distal colon and rectum.
2. _Meconium__ consists of epithelial cells, digestive tract secretions, and residue of
swallowed amniotic fluid.
3. Evidence of _patency_ of the GI tract is demonstrated by the passage of meconium.
4. Swallowing is an automatic reflex action for the first _3__ months of life and then comes
under voluntary control starting at 6 months after cerebral connections develop.
5. The young childs stomach is round in shape until about _2__ years of age and then it
gradually elongates until approximately _7_ years, when it approximates the adults shape
and position.
6. The three processes needed for the body to convert nutrients are _digestion__,
_absorption__, and _metabolism__.
7. Nutrients_ are composed of carbohydrates, proteins, fats, vitamins, minerals, and water.
8. _Chemical_ digestion involves five types of GI secretions: enzymes, hormones,
hydrochloric acid; mucus; and water and electrolytes.
9. The major part of chemical digestion occurs in the _mouth__.
10. Four pancreatic enzymes that aid in digestion are _amylase_, _trypsin___,
_chymotrypsin__, and _lipase_.
11. Bile is needed for the absorption of _Fat soluble___ vitamins A, D, E, and K; its absence
causes increased amounts of ingested fats in the feces and a deficiency of these vitamins.
12. The principal site for the absorption of nutrients in the GI tract is the _small intestine__.
13. Mechanisms of absorption of nutrients include passive _diffusion_ (osmosis), _carriermediated_ diffusion, active _energy driven__ transport, and _engulfment_.

14. The most common consequences of GI disease in children include _malabsorption_,


_fluid and electrolyte_ disturbances, _malnutrition__, and poor _growth_.
15. An eating disorder characterized by compulsive and excessive ingestion of ordinary or
unprepared food (e.g., coffee grounds) and nonfood substances (e.g., clay, soil, stones,
starch, paint chips, hair, feces) is called _PICA__.
16. Two theories about the cause of pica include _psychotic__ theories and _nutritional_
theories.
17. Pica has been associated with nutritional deficiencies in minerals including _iron_ and
_zinc_.
18. Pica for dirt is the principal risk factor for visceral _larva migrans_.
19. A test for _ova and parasites_ (O&P) examines stool contents for parasites or their eggs
and obtaining three samples improves the probability of detecting the organism.
20. A biopsy of the _liver__ may be done to evaluate children for biliary obstruction,
hepatitis, metabolic disease, and response to treatment interventions.
21. _Esophageal pH monitoring__ is used to determine the frequency and duration of
gastric acid refluxed into the esophagus to assess for gastroesophageal reflux (GER).
22. A noninvasive test used to assess for carbohydrate intolerance is the _Breath Hydrogen_
test, which requires the patient to remain NPO 12 hours before the test and to have meat,
rice, and water only for the previous nights dinner.
23. The leading cause of accidental death in children less than 6 years of age is _foreign
bodies_.
24. Although most foreign bodies in the stomach and intestine usually pass without
intervention, if objects do become impacted, the impaction usually occurs at the
_ileocecal valve_.
25. A history of choking followed by an acute episode of _coughing_ is the most common
presentation of foreign body ingestion.
26. If disc batteries become lodged in the esophagus, this is considered a medical emergency
because if both poles of the battery come in contact with the esophageal wall, it may
result in _liquidifaction_, _necrosis_, and _perforation_ of the esophagus.
27. The best approach for removing a foreign object in the esophagus, stomach, or duodenum
is with _flexible endoscopy_.
28. _Bougienage_ is a procedure sometimes used to push objects into the stomach.

29. Coins are sometimes removed from the esophagus using the _penny pincher_ technique,
which involves passing forceps through a NG tube under fluoroscopic guidance and
grasping the object.
30. Sharp objects (e.g., long pins, chicken bones, fish bones) should be removed
_endoscopically_ rather than risk perforation by allowing them to pass spontaneously.
31. Signs of a GI perforation include _chest_or _abdominal__ pain and evidence of bleeding
in the _vomitus_ or _stool_, or a lower hematocrit, or change in vital signs.
32. Signs that an object might be lodged in the esophagus include increased_salivation_,
drooling, gagging, or difficulty _swallowing_.
33. Signs that an object might be lodged in the pharynx include discomfort in the _throat_ or
_chest_.
34. _Constipation_ is a symptom defined as a decrease in bowel movement frequency or
trouble defecating for more than 2 weeks.
35. Children sometimes withhold stool because of the development of painful _anal_ fissures.
36. The passage of stool can be facilitated by irrigating with a hypertonic solution or watersoluble enema such as _Gastrografin_ or _Hypague_.
37. A new laxative that is well tolerated by children is polyethylene glycol 3350 without
electrolytes, called _Polyethylene_.
38. Hirschsprung disease is a congenital anomaly that results in mechanical obstruction of the
bowel from inadequate motility of part of the intestine because of the absence of
_ganglion__ in the affected bowel.
39. Hirschsprung disease is also called _congenital aganglionic megacolon_.
40. The failure to pass meconium ileus within the first 24 to 48 hours after birth is often the
initial manifestation of _Hirschsprung Disease _.
41. A diagnosis of Hirschsprung disease is confirmed by a surgical biopsy of the _full
thickness biopsy specimen_ or by _suction_ biopsy for evidence of missing ganglion
cells.
42. Surgical management of Hirschsprung disease is primarily the surgical removal of the
_aganglionic_ portion of the bowel with a pull-through procedure and temporary
colostomy.

43. Children being prepared for surgery for Hirschsprung disease may need repeated _saline_
enemas, treatment with oral or systemic _antibiotics_, and colonic irrigation with an
_antibiotic__ solution.
44. After surgery for Hirschsprung disease, repeated measurements of abdominal
_circumference_ are usually done at the level of the umbilicus or the widest part of the
abdomen, and the point of measurement should be marked with a pen to ensure
consistency in where subsequent measurements are taken.
45. _Gastoresophageal Reflux_ (GER) is the transfer of gastric contents into the esophagus;
_ Gastoresophageal Reflux Disease_ (GERD) represents symptoms or tissue damage
that results from GER.
46. The most common clinical manifestations of GER in infancy are _passive regurgitation_
and _emesis__.
47. A potential complication of GERD is _Barrett Mucosa_ characterized by metaplastic
changes in the distal esophageal mucosa and potentially malignant epithelium.
48. The gold standard in the diagnosis of GER is the _24 hour intraesophageal ph
monitoring_ study.
49. _Thickened_ feedings with 1 tsp to 1 tbsp of rice cereal per ounce of formula can reduce
regurgitation severity in infants.
50. _Nissen Fundoplication_ is the most common surgical procedure for GER.
51. _Irritable Bowel Syndrome_ (IBS) is a functional GI disorder that has been found to be
a cause of recurrent abdominal pain in school-age children.
52. _Vermiform__, the inflammation of the blind sac at the end of the cecum, is the most
common cause of emergency abdominal surgery in childhood.
53. The first symptom of appendicitis is colicky, cramping _abdominal pain_, followed by
nausea, right lower quadrant pain, and later vomiting with fever.
54. Complications of _appendiceal perforation_ of the appendix include major abscess,
inflammation of subcutaneous connective tissue, enterocutaneous fistula, peritonitis, and
partial bowel obstruction.
55. Causes of appendicitis include an obstruction of the _lumen_ of the appendix by a
fecalith, by swollen lymphoid tissue following a viral infection, or by pinworms.
56. In appendicitis, the outflow of _mucus secretions_ is blocked, increasing pressure within
the lumen, which compresses blood vessels, causing ischemia and possible perforation.

57. _Peritonitis_ is an inflammation that spreads throughout the abdomen.


58. A progressive peritoneal inflammation results in functional intestinal obstruction of the
small bowel, called an _ileus_.
59. The most common point of focal tenderness in the abdomen in appendicitis is located
about two thirds the distance along a line between the umbilicus and the anterosuperior
iliac spine termed _The McBurney Point_.
60. Tenderness that occurs during palpation or percussion of other abdominal quadrants is
referred to as _Rousing_ sign.
61. Diagnosis of appendicitis includes urinalysis to rule out a _urinary tract infection__ and,
in females, serum human chorionic gonadotropin to rule out an _etopic pregnancy_.
62. In a child with appendicitis, the CBC may show a elevated percentage of bands, often
referred to as a _shift to the left_, indicating the presence of an inflammatory process.
63. Complications of a simple appendectomy include _wound infection_ and
_intraabdominal abcess_.
64. Younger, nonverbal children may assume a rigid, side-lying position with the knees flexed
and have decreased range of motion of the _right__ hip.
65. _Omphalomesenteric fistula/ Meckel Diverticulum_ is a fibrous band connecting the
small intestine to the umbilicus as a result the failure of a fetal duct to close characterized
by abdominal pain, rectal bleeding, and bloody stools, and sometimes severe anemia and
shock.
66. _Inflammatory Bowel Disease_ (IBD) is chronic intestinal inflammation that refers to
Crohn disease (CD) and ulcerative colitis (UC).
67. One of the earliest signs of UC may be growth failure likely due to chronic _poor dietary
intake_ from anorexia related to GI symptoms.
68. Common presenting symptoms of CD are _diarrhea_, abdominal pain with cramps,
_fever_, weight loss, and growth _problems_.
69. For individuals who do not respond to medical or nutritional therapy for ulcerative colitis,
_subtotal colectomy_ and _ileostomy_ surgery is indicated.
70. A long-term complication of inflammatory bowel disease is the development of
_colerectal_ cancer.
71. The condition of chronic ulcers affecting the stomach or duodenum is called _peptic
ulcer disease_ (PUD).

72. Most _primary__ ulcers occur in the absence of a predisposing factor, tend to be chronic,
and occur more in the duodenum.
73. _Stress_ ulcers result from the stress of a severe underlying disease or injury.
74. Primary ulcers occur more often in children older than _6__ years; stress ulcers occur
more often in infants younger than __6___ months.
75. There is a significant relationship between the bacterium _H pylori__ and ulcers; the
bacterium may cause disease by weakening the gastric mucosal barrier and allowing acid
to damage the mucosa.
76. The pathologic condition in PUD is likely an _imbalance__ between toxic mechanisms
(cytotoxic factors) and defensive factors (cytoprotective factors).
77. The primary mechanism that prevents the development of peptic ulcer is the secretion of
_mucus__ by the epithelial and mucous glands throughout the stomach.
78. The chronic abdominal pain associated with PUD tends to be _chronic_ when the
stomach is empty and at night.
79. When taking a history for suspected PUD, the nurse should ask about the use of
potentially causative substances such as _caffine_, _alcohol_, _tobacco_, and
_ulcerogenic drugs_.
80. Medications called _Proton Pump Inhibitors__ (PPIs) such as omeprazole (Prilosec)
and lansoprazole (Prevacid) are used in PUD to block the production of acid.
81. In children with PUD in need of an analgesic-antipyretic, _acetaminophen_ should be
used instead of aspirin or NSAIDs.
82. GI tract obstruction can be either _congenital__ or _acquired_., with the former usually
occurring in the newborn period.
83. Acute intestinal obstruction is characterized by abdominal pain, nausea, vomiting,
abdominal distention, and a change in _stooling patterns_.
84. Vomiting of _gastric_ contents is often the first sign of a high obstruction; vomiting of
_bile-stained_ material is a sign of obstruction of the small intestine.
85. _Hypertrophic pyloric stenosis_ (HPS) occurs when the muscle encircling the pyloric
sphincter becomes thickened and causes an elongation and narrowing of the pyloric canal.
86. The hypertrophied pylorus may be palpable as an _olive like mass_ in the upper
abdomen.

87. The vomiting associated with pyloric stenosis usually begins at _3__ weeks of age but can
start as early as 1 week and as late as 5 months.
88. Infants with pyloric stenosis are prone to _metabolic__ alkalosis from loss of hydrogen
ions and depletion of potassium, sodium, and chloride.
89. Following surgery for pyloric stenosis, feedings are usually started within _4-6_ hours
postoperatively beginning with clear fluids containing glucose and electrolytes.
90. The most common cause of intestinal obstruction in children between the ages of 3
months and 3 years is _intussusception_ often caused by hypertrophy of intestinal
lymphoid tissue following a viral infection.
91. Intussusception occurs when a proximal segment of the bowel _telescopes__ into a more
distal segment, pulling the mesentery with it, which causes lymphatic and venous
obstruction.
92. The stools in intussusception are characteristically _jelly like_.
93. The classic triad of intussusception symptoms include _abdominal pain_, _abdominal
mass_, and _bloody stools_ although they are present in only 29% to 33% of children.
94. The definitive diagnosis of intussusception is made based on findings of a _barium
enema_.
95. First line of treatment of intussusception consists of nonsurgical reduction using a
pneumoenema with or without water-soluble contrast or ultrasound-guided hydrostatic
(saline) enema performed by a _radiologist_.
96. The passage of a _normal brown_ stool usually indicates that the intussusception has
reduced itself and should be reported to the practitioner.
97. Malrotation of the intestine occurs as a result of the abnormal rotation of the intestine
around the superior _mesenteric artery_ during embryologic development.
98. _Complete volvulus_ occurs when the intestine twists around itself, causing intestinal
necrosis, peritonitis, perforation, and death if there is no surgical intervention.
99. Malabsorption syndromes are characterized by chronic _diarrhea__ and
_malabsorption_ of nutrients.
100. _Celiac disease _ is characterized by steatorrhea, general malnutrition, abdominal
distention, and secondary vitamin deficiencies.

101. Malabsorption syndromes are caused by three types of defects: _digestive_,


_absorptive_, and _anatomic_.
102. _Celiac disease_ is also known as gluten-induced enteropathy, gluten-sensitive
enteropathy, and celiac sprue.
103. Celiac disease is characterized by _villous atrophy_ in the small bowel in response to
the protein gluten.
104. Gluten is found in _wheat_, _rye_, _barley_, and _oats_ grains.
105. When individuals are unable to digest the _gliadin_ component of gluten, a toxic
substance accumulates that is damaging to the mucosal cells.
106. One of the most serious complications of celiac disease is the development of
_lymphoma_ of the small intestine.
107. Short-bowel syndrome (SBS) results in malabsorption of nutrients due to a decreased
mucosal surface area, usually following extensive resection of the _small intestine_.
108. _Short bowel syndrome_ is characterized by decreased intestinal surface for fluid,
electrolyte, and nutrient absorption, and the child requires parenteral nutrition.
109. The most important components of nursing care for the child with short bowel syndrome
are administration and monitoring of _nutritional_ therapy, care of the central venous
access device, and care of the _central venous access_.
110. A common site of upper GI bleeding in children is the _esophagus__.
111. Bright red blood in the stool of a healthy child may be due to an _anal_ fissure.
112. _Hematemesis_ is the vomiting of bright red blood or denatured blood that looks like
coffee grounds, usually representing an upper GI source of bleeding.
113. _Hematochezia_ is the passage of bright red blood per the rectum, indicating lower GI
bleeding.
114. Bright red blood that coats the stool may be due to a hard bowel movement,
hemorrhoids, or anal fissure while blood mixed with the stool indicates a bleeding source
_proximal__ to the rectum.
115. The passage of black, tarry stools that contain denatured (digested) blood suggests an
upper GI source of bleeding and is called _melena_.
116. In older children, false positives for occult blood in stool can occur with the ingestion of
_red meats_ and _iron preparations_.

117. _Hepatitis_ is an acute or chronic inflammation of the liver due to a variety of factors,
including infection, autoimmune, chemical, hemodynamic, and idiopathic causes.
118. _Six_ of the cases of viral hepatitis are caused by hepatitis A, B, C, D, E, and G virus.
119. The incidence of hepatitis A, spread primarily via the fecal-oral route, has declined 92%
since _vaccination_ was begun.
120. Hepatitis C (HCV) is transmitted through exposure to blood and blood products from
HCV-infected persons and is the leading reason for liver _Transplantation_ in the United
States.
121. Hepatitis D (HDV) occurs in children already infected with _HBV__.
122. The fourth stage of liver disease progression is _cirrhosis_.
123. Many children with acute viral hepatitis never develop jaundice, but when it occurs, it is
often accompanied by _dark__ urine and _pale_ stools.
124. Children with _chronic_ active hepatitis commonly have nonspecific symptoms of
malaise, fatigue, lethargy, weight loss, or vague abdominal pain.
125. The primary causes of fulminant hepatitis are _HBV_ and _HCV__.
126. In children with fulminant hepatitis, changes in mental status or personality indicate
_impending liver failure_.
127. The spread of viral hepatitis in the hospital is best prevented by _proper hand
washing_ and _standard precautions_.
128. Vaccines have been developed to prevent HAV and HBV, with _HAV__ vaccination
recommended for infants starting at 12 months and _HBV_ recommended for all
newborns, high-risk groups, and all adolescents.
129. A cirrhotic liver is one that is _irreversibly_ damaged.
130. Clinical manifestations of cirrhosis include _jaundice_, _poor growth_, _anorexia_,
_muscle weakness_, and _lethargy_.
131. Indications for liver transplantation are _patency_ and _size of hepatic portal vein_.