Intussusception, Volvulus, Celiac disease Ricci, pp. 1523-1525; 1537-1538
Intussusception • Telescoping of bowel into itself • Usually occurs as a complication of another bowel disorder • Occurs more often in infant males
Manifestations • Sudden onset of intermittent, severe, abdominal pain • V/D—bilious vomiting indicates obstruction • Currant jelly stools • Lethargy • Dehydration • Sausage-shaped mass • Watch for peritonitis
Diagnosis and Management • Barium enema is both diagnostic and therapeutic. May reduce intussusception. • Check labs for signs of dehydration and peritonitis • IVF and antibiotics • If can’t be reduced by barium enema, must be reduced surgically. • If necrosis has occurred, bowel resection must be done. Then routine postop nsg care.
Volvulus • Twisting of bowel either in utero or after birth. • Can occur when bowel gets malrotated during during embryonic development. • Infection and necrosis can occur with resulting peritonitis and sepsis.
Manifestations • Bilious vomiting • Abdominal pain and distention • Hypoactive bowel sounds • Guarding, rebound • Hematochezia, melena • Shocky with tachycardia and hypotension • + abd x-ray or UGI shows corkscrew appearance of bowel
Management • IVF • Antibiotics, pain meds • NG tube to suction • Surgery to release or resect the bowel • Routine postop nursing care
Celiac Disease • Intolerance to gluten • Immunologic disorder—higher incidence in those with other autoimmune diseases. • Villi in intestine that normally absorb nutrients become damaged by the immune response to gluten and malnutrition results. • May have genetic component. Genetic testing may be done.
Manifestations • Diarrhea, steatorrhea, constipation • FTT, wt loss, poor muscle tone • Delay of sexual maturation • Abdominal distention • Irritability, listlessness • Nutritional deficiencies, anemia • +Antibody test to gluten • EGD with +intestinal bx
Management • Elimination of gluten from diet for life • Most gluten-containing foods are in the grain family • Educate family about foods to avoid (p. 1538) • Better if entire family adopts diet to make it easier for child to cope.