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GI > D+V > Flashcards

D+V Flashcards

1
Q

What does early morning vomiting suggest

A

Pregnancy

Raised ICP

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2
Q

What does vomiting 1h post food suggest

A

Gastric stasis

Gastroparesis 2 DM neuropathy

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3
Q

What does pain relieved by vomiting suggest

A

Peptic ulcer

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4
Q

What does vomiting procedded by gurgling suggest

A

Obstruction

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5
Q

What are other differentials for vomiting

A 
Gastroenteritis (pre diarrhoea)
Pancreatitis 
Malignancy - oesophagus / gastric
Coeliac 
Cyclical
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6
Q

What is important in Hx of vomit

A

ANy blood = suggest GI bleed
Any fecal material = small bowel obstruction
Signs of dehydration

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7
Q

What investigations should you do for vomiting

A

Bloods - FBC, U+E, LFT, Ca, glucose, amylase
Risk of hypokalaemia
ABG - may have alkalosis from loss of gastric content /
Plain AXR if suspected obstruction
Upper GI endoscopy if persistent / blood
Pregnancy / blood to exclude in cyclical

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8
Q

How do you treat vomiting

A

Monitor electrolytes + fluid balance
IV fluid with K replacement if severly dehydrated
Anti-emetics
Pro-kinectic for gastric stasis
Cyclical - amitryptilline / propranolol / anti-emetic

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9
Q

What anti-emetics are there and do they act on

A 
Cyclizine (acts on H1) 
Domperidone - doesn't cross BBB
Metaclopirimide (D2 also pro-kinectic) - used post surgery / GORD / gastroporesis 
Haloperidol (D2)
Ondansetron (5HT3 antagonist)
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10
Q

What are issues with D2 receptor

A

Pyramidal SE e.g. oculocyric crisis
Hyperprolactin
Tardive dyskinesia
Parkinosim

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11
Q

What can severe vomiting lead too

A

Mallory Weiss tear - haematemesis

Boerhave - oesophageal rupture (alcohol, chest pain, subcutaneous emphysema)

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12
Q

What is acute diarrhoea (>3 watery / loose stool per day) <14 days

A

Gastroenteritis
Diverticulitis
Ax use - always think due to risk of C>diff
Constipaition causing overflow

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13
Q

What are chronic causes of diarrhoea

A

IBS
IBD
Colorectal cancer
Coeliac

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14
Q

What are other causes of diarrhoea

A

Hyperthyroid
Laxative
Appendicitis
Radiation enteritis

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15
Q

What causes bile acid malabsorption

A 
Excessive production by liver or intestines can't reabsorb so extra in colon once done job of breaking down food
Chron's
Coeliac
Bacterial overgrowth
Pancreas disease 
Cholecystectomy

Thought 30% of people with IBS actually have BAM

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16
Q

What does bile acid malabsorption cause

A

Steathorrhea
Watery diarrhoea
Urgency
Bloating / pain / wind

Vit ADEK deficinecy

17
Q

How do you Dx bile acid malabsorption and Rx and how should you monitor

A

SeHCAT - swallow artificial bile and image after a week

Bile acid binder - cholestryalmine
Dietary change

Montior

  • Weight
  • Triglyeride as meds can affec
  • Meds decrease vit ADEK so monitor this
18
Q

How do you treat symptoms of diarrhoea

A

Loperamide (Imodium) - opiate antagonist so increases motility and peristalsis but doesn’t cross BBB so less SE
Opiod CI in C.diff

19
Q

What do you do for loose stool

A 
Hx - acute, chronic, extra-intestinal 
Ax use 
Bloods - FBC / U+E, CRP 
Stool culture in all loose 
Coeliac
Calprotectin
FOB
Ca
TFT
Consider colonoscopy / endoscopy
20
Q

How do you Dx C.diff

A

Need evidence of toxin and antigen

Antigen just shows exposure

21
Q

How do you treat

A

Stop Ax causing / opiod / avoid 4C’s
Oral metronidazole
Vancomycin if doesn’t work
Stool transplant

22
Q

What anti-emetic CI in bowel obstruction

A

Metaclopramide

Prokinetic so could cause perforation

23
Q

How does cyclical vomiting present

A 
Severe N+V
Weight loss 
Dizzy
Photophobia
Sweating
Nausea
Diarrhoea
Migraine
24
Q

What is major risk of vomiting

A

Electrolyte imbalances

25
Q

What will ABG show in vomitng

A

Metabolic alkalosis from loss of gastric content

26
Q

What do you do for suspected obstruction

A

AXR

27
Q

What do you do for persistent or haeamtemesis

A

Upper GI endoscopy

28
Q

What do you do for cycle

A

Clinical
Pregnancy test
Routine blood to exclude

29
Q

What is good for gastric stasis

A

Pro-kinetic

Esp if DM

30
Q

What anti-emetic used in GORD

A

Metoclopramide

31
Q

What do you do for cyclical vomiting

A

Avoid trigger
Amitryptiline
Propranol
Anti-emetic in acute

32
Q

What severe vomiting

A

Mallory Weiss Tear

Borehavve

33
Q

What is Boerhavve

A 
Oesophageal rupture
Alcohol Hx
CHest pain
Subcut emphysema
Severe sepsis 2 mediastinitis
34
Q

What is metocloproimde CI in

A

Bowel obstruction
Parkinsons
May cause rupture or extra-pyramidal SE

35
Q

What causes osmotic diarrhoea

A

Osmotically active particles in lumen draw fluid in

36
Q

Example

A

Pancreatitis
Lactose intolerance
Coeliac
Malabosrption

37
Q

What causes secretory diarrhoea

A

Cells that line gut secrete ions which leads to water flowing in

38
Q

Examples

A 
Gastroenteritis 
IBD 
Hyperthyroid
Senna abuse
Ax associated
39
Q

how do you Differentiate

A

If stops when NBM = osmotic
Large osmolar gap = osmotic
High electrolyte and pH = secretory

GI (29 decks)

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