Multiprofessional Critical Care Review: Pediatric 2024 (MCCRCP24ON)-Gastrointestinal Abnormalties

Gastrointestinal Abnormalties

Pdf Summary

The presentation on gastrointestinal (GI) abnormalities covers various aspects related to pediatric critical care, particularly in neonatal and pediatric intensive care units (PICU). Key presenter Dr. Katri Typpo lays out the learning objectives aimed at understanding relevant GI anatomy and physiology, common GI abnormalities, and their management, including Necrotizing Enterocolitis (NEC), intestinal obstruction, bleeding, pancreatitis, and intra-abdominal hypertension/Abdominal Compartment Syndrome (ACS).<br /><br />The initial sections delve into GI physiology, focusing on the structure and function of the intestinal epithelium, the processes governing small intestinal motility, and the intricate regulation of gastric emptying by hormones like ghrelin and motilin. Dysregulation in these processes can have critical implications for pediatric patients, particularly those in intensive care.<br /><br />Stress ulcer prophylaxis lacks unified guidelines for critically ill children, though risk factors like mechanical ventilation and coagulopathy are highlighted. Enteral nutrition is both protective against GI bleeds and potentially beneficial in preventing dysbiosis—disruption of the gut's microbial balance—which is frequent in critical illness.<br /><br />The presentation also includes an overview of common GI abnormalities:<br />- <strong>NEC</strong>: Seen predominantly in very low birth weight (VLBW) infants, with specific risk factors and symptoms including feeding intolerance, abdominal distension, and possible sepsis.<br />- <strong>Obstructions</strong>: Conditions like hypertrophic pyloric stenosis, esophageal and duodenal atresia are detailed with their respective clinical presentations, associated anomalies, and management protocols.<br />- <strong>Bleeding</strong>: Both upper GI (UGI) and lower GI (LGI) bleeding causes are explored alongside diagnostic and therapeutic approaches, emphasizing the importance of rapid resuscitation and potential surgical interventions.<br /><br />Pancreatitis diagnosis in children relies on clinical symptoms and specific markers such as elevated amylase or lipase levels. Management includes aggressive fluid resuscitation and, when necessary, nutritional support via enteral nutrition.<br /><br />ACS, characterized by increased intra-abdominal pressure, is under-recognized but critical in pediatric care, requiring vigilant monitoring and proactive management to prevent high mortality rates.<br /><br />In summary, the presentation aims to equip healthcare providers with comprehensive knowledge on managing GI abnormalities in pediatric critical care, enhancing their diagnostic and therapeutic skills in this complex domain.

Keywords

Gastrointestinal abnormalities

Pediatric critical care

Neonatal intensive care

Pediatric intensive care

Necrotizing Enterocolitis

Intestinal obstruction

Pancreatitis

Abdominal Compartment Syndrome

Enteral nutrition

GI bleeding

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