D+V Flashcards
What does early morning vomiting suggest
Pregnancy
Raised ICP
What does vomiting 1h post food suggest
Gastric stasis
Gastroparesis 2 DM neuropathy
What does pain relieved by vomiting suggest
Peptic ulcer
What does vomiting procedded by gurgling suggest
Obstruction
What are other differentials for vomiting
Gastroenteritis (pre diarrhoea) Pancreatitis Malignancy - oesophagus / gastric Coeliac Cyclical
What is important in Hx of vomit
ANy blood = suggest GI bleed
Any fecal material = small bowel obstruction
Signs of dehydration
What investigations should you do for vomiting
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
How do you treat vomiting
Monitor electrolytes + fluid balance
IV fluid with K replacement if severly dehydrated
Anti-emetics
Pro-kinectic for gastric stasis
Cyclical - amitryptilline / propranolol / anti-emetic
What anti-emetics are there and do they act on
Cyclizine (acts on H1) Domperidone - doesn't cross BBB Metaclopirimide (D2 also pro-kinectic) - used post surgery / GORD / gastroporesis Haloperidol (D2) Ondansetron (5HT3 antagonist)
What are issues with D2 receptor
Pyramidal SE e.g. oculocyric crisis
Hyperprolactin
Tardive dyskinesia
Parkinosim
What can severe vomiting lead too
Mallory Weiss tear - haematemesis
Boerhave - oesophageal rupture (alcohol, chest pain, subcutaneous emphysema)
What is acute diarrhoea (>3 watery / loose stool per day) <14 days
Gastroenteritis
Diverticulitis
Ax use - always think due to risk of C>diff
Constipaition causing overflow
What are chronic causes of diarrhoea
IBS
IBD
Colorectal cancer
Coeliac
What are other causes of diarrhoea
Hyperthyroid
Laxative
Appendicitis
Radiation enteritis
What causes bile acid malabsorption
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
What does bile acid malabsorption cause
Steathorrhea
Watery diarrhoea
Urgency
Bloating / pain / wind
Vit ADEK deficinecy
How do you Dx bile acid malabsorption and Rx and how should you monitor
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
How do you treat symptoms of diarrhoea
Loperamide (Imodium) - opiate antagonist so increases motility and peristalsis but doesn’t cross BBB so less SE
Opiod CI in C.diff
What do you do for loose stool
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
How do you Dx C.diff
Need evidence of toxin and antigen
Antigen just shows exposure
How do you treat
Stop Ax causing / opiod / avoid 4C’s
Oral metronidazole
Vancomycin if doesn’t work
Stool transplant
What anti-emetic CI in bowel obstruction
Metaclopramide
Prokinetic so could cause perforation
How does cyclical vomiting present
Severe N+V Weight loss Dizzy Photophobia Sweating Nausea Diarrhoea Migraine
What is major risk of vomiting
Electrolyte imbalances
What will ABG show in vomitng
Metabolic alkalosis from loss of gastric content
What do you do for suspected obstruction
AXR
What do you do for persistent or haeamtemesis
Upper GI endoscopy
What do you do for cycle
Clinical
Pregnancy test
Routine blood to exclude
What is good for gastric stasis
Pro-kinetic
Esp if DM
What anti-emetic used in GORD
Metoclopramide
What do you do for cyclical vomiting
Avoid trigger
Amitryptiline
Propranol
Anti-emetic in acute
What severe vomiting
Mallory Weiss Tear
Borehavve
What is Boerhavve
Oesophageal rupture Alcohol Hx CHest pain Subcut emphysema Severe sepsis 2 mediastinitis
What is metocloproimde CI in
Bowel obstruction
Parkinsons
May cause rupture or extra-pyramidal SE
What causes osmotic diarrhoea
Osmotically active particles in lumen draw fluid in
Example
Pancreatitis
Lactose intolerance
Coeliac
Malabosrption
What causes secretory diarrhoea
Cells that line gut secrete ions which leads to water flowing in
Examples
Gastroenteritis IBD Hyperthyroid Senna abuse Ax associated
how do you Differentiate
If stops when NBM = osmotic
Large osmolar gap = osmotic
High electrolyte and pH = secretory
