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
What will ABG show in vomitng
Metabolic alkalosis from loss of gastric content
26
What do you do for suspected obstruction
AXR
27
What do you do for persistent or haeamtemesis
Upper GI endoscopy
28
What do you do for cycle
Clinical Pregnancy test Routine blood to exclude
29
What is good for gastric stasis
Pro-kinetic | Esp if DM
30
What anti-emetic used in GORD
Metoclopramide
31
What do you do for cyclical vomiting
Avoid trigger Amitryptiline Propranol Anti-emetic in acute
32
What severe vomiting
Mallory Weiss Tear | Borehavve
33
What is Boerhavve
``` Oesophageal rupture Alcohol Hx CHest pain Subcut emphysema Severe sepsis 2 mediastinitis ```
34
What is metocloproimde CI in
Bowel obstruction Parkinsons May cause rupture or extra-pyramidal SE
35
What causes osmotic diarrhoea
Osmotically active particles in lumen draw fluid in
36
Example
Pancreatitis Lactose intolerance Coeliac Malabosrption
37
What causes secretory diarrhoea
Cells that line gut secrete ions which leads to water flowing in
38
Examples
``` Gastroenteritis IBD Hyperthyroid Senna abuse Ax associated ```
39
how do you Differentiate
If stops when NBM = osmotic Large osmolar gap = osmotic High electrolyte and pH = secretory