Term
| What are the major risk factors and pathogenesis of Surgical necrotizing enterocolitis? |
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Definition
Cause of pediatric intestinal failure where 1:3 infants require surgery that can cause short gut syndrome and the need for parenteral nutrition
1) Prematurity, low birth weight, formula feeding, CVD
2) Functional/structural immaturity contributing to excessive inflammatory response to bacterial colonization. |
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Term
| What are the common causes of short gut syndrome and pediatric intestinal failure? |
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Definition
1) Surgical nec enterocolitis
2) Gastroschisis
- Developing instestine exposed to external abdominal wall to the right of umbilicus
- Similar to Omphalocele where abdominal contents are contained in membranous sac outside body (more common but less commonly surgical)
3) Malrotation/midgut volvulus (10-12 weeks)
- May involve SMA
4) Intestinal atresia
- Surgery depends on number and size of atresia(s) |
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Term
| What disorders of motility can lead to pediatric intestinal failure? |
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Definition
1) Hirschsprung (aganglionosis)
2) MMIH syndrome (smooth muscle)
3) Pseudoobstruction. |
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Term
| How might the small and distal intestines become separated and what symptoms might this produce? |
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Definition
1) Proximal (duodenum and jejunum) is net secretion and distal (illeum and colon) is net absorption
2) Separation occurs in short gut syndrome and may cause diarrhea |
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Term
| What are the 4 major components of fluid balance monitoring in a patient with short gut syndrome? |
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Definition
1) Clinical assessment
- Membranes, skin turgor, capillary refill, tachycardia, behavior
2) Vitals
- HR, RR, BP
3) Weights
- MOST sensitive indicator of volume status in children
- Growth vs. hydration
4) Intake/output (fluid balance)
- Objective measurement of fluid balance. |
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Term
| How does the intestine normally maintain fluid homeostasis? |
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Definition
Osmosis over semi-permeable barrier (intestinal epithelium) exchanging electrolytes and nutrients).
1) Leaky epithelium in small intestine (Jejunum) for secretion
2) Tight epithelia (active >> passive) in stomach, illeum and colon, for absorption |
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Term
| What are the basic components of TPN used in pediatric intestinal failure? |
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Definition
Dextrose, protein, fat, electrolytes, macronutrients (vitamins/trace elements)
Use TPN while waiting for adaptation to occur after surgery. |
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Term
True or False:
Short gut syndrome is a functional disease |
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Definition
| True! Even though many involve anatomical abnormalities. |
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