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GIR Test 4 > B5.067 Nausea and Vomiting > Flashcards

B5.067 Nausea and Vomiting Flashcards

1
Q

what are important things to ask about in the context of nausea and vomiting

A

exposure to toxins (food, sick contacts, recent radiation therapy)
duration of symptoms
associated symptoms
alleviating and exacerbating factors

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2
Q

how to determine severity of nausea/vomiting

A

vitals and hydration status

acute abdominal pain on physical exam

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3
Q

alarm signs

A 
severe abdominal pain
hematochezia
> 55 years old
unintended weight loss
progressive dysphagia
fam history of cancer
altered mental status
focal neurologic deficit
feculent vomiting
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4
Q

abdominal pain relieved by vomiting

A

bowel obstruction

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5
Q

most common cause of nausea and vomiting

A

self limited viral enteritis
179 million/year
600,000 hospitalizations
norovirus most common in adults

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6
Q

signs of dehydration

A

decreased urine output
skin tenting
dry mucous membranes

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7
Q

abdominal x-ray in nausea/vomiting

A

bowel obstructions

kidney stones

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8
Q

CT in nausea/vomiting

A

infections
bowel obstruction
kidney stones

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9
Q

RUQ US in nausea/vomiting

A

gallstones

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10
Q

chronic nausea and vomiting

A

> 1 month

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11
Q

acute nausea and vomiting

A

< 1 week

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12
Q

commonly prescribed anti-emetics

A

promethazine
metoclopramide
prochlorperazine
ondansetron

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13
Q

what works to help nausea and vomiting in pregnant women?

A

ginger

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14
Q

common causes of chronic nausea and vomiting

A

diabetic gastroparesis
GERD
gastritis
gastric ulcer

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15
Q

how to evaluate diabetic gastroparesis

A

gastric emptying study

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16
Q

acute onset vomiting

A

cholecystitis
gastroenteritis
med effects
pancreatitis

17
Q

associated with diarrhea, headache, myalgias

A

viral gastroenteritis

18
Q

bilious vomiting

A

small bowel obstruction

19
Q

continuous vomiting

A

conversion disorders

20
Q

delayed vomiting (more than 1 hour after meals)

A

gastric outlet obstruction

gastroparesis

21
Q

feculent or foul odor vomit

A

intestinal obstruction

22
Q

habitual postprandial, irregular vomiting

A

major depression

23
Q

insidious onset vomiting

A 
GERD
gastroparesis
medication
metabolic disorders
pregnancy
24
Q

regurg of undigested food

A

achalasia
esophageal stricture
Zenker

25
Q

projectile vomiting

A

intracranial disorders

increased intracranial pressure

26
Q

partly digested food or chime vomiting several hours after meals

A

gastric outlet obstruction (no bile)

gastroparesis

27
Q

4 sources of afferent input to vomiting center

A
  1. afferent vagal fibers from GI viscera stimulated by distention, irritation, or infection (5-HT3)
  2. fibers of vestibular system (H1 and muscarinic)
  3. high CNS centers, smells, emotional experiences
  4. chemoreceptor trigger zone outside BBB (opioid, 5-HT3, NK1, D2)
28
Q

vomiting pre-breakfast

A

pregnancy
uremia
alcohol
increased intracranial pressure

29
Q

lab abnormalities expected with severe vomiting

A

hypokalemia
azotemia
metabolic alkalosis

30
Q

supportive treatment for non-severe vomiting

A

clear liquids
small quantities of dry foods
ginger

31
Q

serotonin antagonists

A

-setron

32
Q

when are serotonin antagonists used

A

prevent chemo and radiation induced emesis
post-op nausea
used in combo w steroid and NK1 antagonist

33
Q

antiemetic properties of steroids

A

enhance efficacy of serotonin antagonists

34
Q

neurokinin receptor antagonists

A

-prepitant

35
Q

when are neurokinin receptor antagonists used

A

combo w corticosteroid and serotonin antagonists for nausea associated with chemo

36
Q

dopamine antagonists

A

phenothiazines
butyrophenones
benzamides (-azine)

37
Q

when are dopamine antagonists used

A

infrequently used, mainly in outpatients with minor, self limited symptoms

38
Q

antihistamines and anticholinergics

A

meclizine
dimenhydrinate
scopolamine

39
Q

when are antihistamines and anticholinergics used

A

motion sickness, vertigo, migraines

vomiting during pregnancy

GIR Test 4 (20 decks)

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