Clinical Approach to the GI Patient: Nausea and Vomiting Flashcards
what is rumination?
refers to the regurgitation, rechewing, and reswallowing food from the stomach
what are 6 intraperitoneal causes of nausea and vomiting?
small bowel obstruction, enteric infections, inflammatory diseases, gastroparesis, gastroesophageal reflux, biliary colic
what are 4 extraperitoneal causes of nausea and vomiting?
MI, labyrinth disease, intracerebral disorders, psychiatric illness
what things outside of the GI system could be associated with nausea and vomiting?
vertigo and tinnitus, Meniere’s disease, inner ear infection (labyrinthitis); headache
what does a plain film abdominal x-ray show when evaluating nausea/vomiting?
intestinal obstruction or perforation
what does a plain film chest xray show when evaluating nausea/vomiting?
pneumomediastinum
what are gastric emptying scans used to diagnosed?
gastroparesis
what are 5 complications associated with nausea and vomiting?
rupture of the esophagus (boerhaave syndrome), hematemesis from a mucosal tear (mallory-weiss tear), dehydration, malnutrition, dental caries, and erosions, metabolic alkalosis and hypokalemia, aspiration pneumonitis
what is the etiology of small bowel obstructions?
it is commonly caused by adhesions (mechanical obstruction); multiple abdominal surgeries, diverticulitis, Crohn disease
what might the history/presentation look like in someone with a small bowel obstruction?
nausea and vomiting (can be feculent); obstipation (no BM or flatus); intermittent, crampy, periumbilical pain
what might the physical exam look like in a patient with. a small bowel obstruction?
abdominal pain and distention, decreased or absent bowel sounds sounding like high pitched tinkling bowel sounds
how do you diagnose a small bowel obstruction?
plain abdominal radiography (KUB X-ray/ abdominal serious x-ray) or CT scan
what might the radiographs show in a patient with a small bowel obstruction?
dilated loops of small bowel and air fluid levels
what is the treatment/management for small bowel obstruction?
nasogastric tube (NGT) to suction, supportive, and sometimes surgery if NGT isn’t helpful
what are some possible etiologies of gastroparesis?
endocrine disorders: DM or hypothyroidism; postsurgical complications (gastric bypass); neurologic conditions (multiple sclerosis); medications
how can a diabetic patient prevent getting gastroparesis?
controlling blood glucose prior to gastroparesis can help to prevent it
how does gastroparesis present?
intermittent, waxing and waning symptoms, chronic or intermittent symptoms of postprandial fullness; nausea and vomiting (1-3 hours after meals)
what might the physical exam look like in a patient with gastroparesis?
abdominal distention and decreased bowel sounds
how do you diagnose gastroparesis?
gastric emptying study (scintigraphy)–> low-fat solid meal is the optimal means for assessing gastric emptying (eggs commonly used)
what results from the gastric emptying study show gastroparesis?
gastric retention of 60% after 2 hours or more than 10% after 4 hours is abnormal
what is the treatment/management for gastroparesis?
supportive; medications to enhance gastric emptying (metoclopramide and erythromycin)
what are the adverse effects associated with metoclopramide?
risk of tardive dyskinesia, which is involuntary unintentional uncontrollable movements
what is the last resort for treatment of gastroparesis?
gastric electrical stimulation with internally implanted neurostimulators
what are some possible etiologies of extraperitoneal DDx that cause nausea and vomiting?
labyrinthine disease, intracerebral disorders, psychiatric, and medications
what is labyrinthine disease?
inner ear or cranial nerve VIII dysfunction/pathology; meniere disease
what are some intracerebral disorders that could cause nausea and vomiting?
mass? subarachnoid hemorrhage= “worst headache of my life”/ thunderclap
how would you diagnose nausea and vomiting caused by an intracerebral disorder?
get a CT head (eventually MRI, but CT head without contrast is done first, as it is fast and contrast left out of orders as it would hide blood if hemorrhagic stroke)
