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Gastrointestinal 2 > GI Concerns in the Primary Care Setting > Flashcards

GI Concerns in the Primary Care Setting Flashcards

1
Q

What is nausea?

A

an ill-defined and unpleasant, although not painful, sensation generally perceived in the pharynx and upper abdomen. It is usually accompanied by hypersalivation and the desire to vomit, o the feeling that vomiting is imminent.

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2
Q

What is vomiting?

A

the forceful expulsion of gastric contents through the mouth.

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3
Q

What should you think when a 25 year old pt presents with 2 days of nausea and vomiting?

A
  • Acute infectious diseases (any bacterial, viral, parasitic infection…)
  • Acute abdominal emergencies (appendicitis)
  • Drugs and toxins
  • Intracranial disease
  • Pregnancy
  • Psychogenic
  • Gastric retention
  • Metabolic and endocrine disorders
  • Chronic indigestion (gastritis)
  • Labyrinthine disorders
  • GI bleeding
  • Cardiac disease (MI)
  • Pain (bone fracture…)
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4
Q

What do nausea and vomiting common symptoms of in children?

A

systemic infections outside of the GI tract.

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5
Q

What are some acute abdominal emergencies related to nausea and vomiting?

A
  • Perforation
  • Peritonitis
  • Intestinal obstruction
  • Ischemia
  • Visceral inflammation
  • Appendicitis
  • Pancreatitis
  • Cholecystitis
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6
Q

What drugs and toxins can cause nausea and vomiting?

A

ETOH, NSAIDs, digoxin, morphine, antibiotics (augmentin= amoxicillin + clavulonic acid), enterotoxins

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7
Q

What CNS disorders can cause nausea and vomiting?

A
  • Increased CNS pressure: neoplasms, encephalitis, hydrocephalus
  • Migraine headaches
  • Acute meningitis
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8
Q

When does pregnancy most often cause nausea and vomiting?

A

Usually only in the first trimester, but may continue into the next trimester

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9
Q

What psychogenic problems can cause nausea and vomiting?

A
  • Anorexia Nervosa
  • Bulimia
  • Emotional upset
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10
Q

What are some gastric retention disorders that can cause nausea and vomiting?

A
  • Dysmotility (diabetic stomachs don’t empty as well; gastroparesis).
  • Pyloric Obstruction
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11
Q

What are some metabolic and endocrine disorders that cause nausea and vomiting?

A
  • Diabetic Ketoacidosis (DKA)
  • Adrenal Insufficiency
  • Thyrotoxicosis
  • Acute Renal Failure
  • Uremia
  • Hypercalcemia
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12
Q

What are chronic indigestion problems that can cause nausea and vomiting?

A
  • Peptic ulcer disease

- Aerophagia - air swallowing

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13
Q

What are some labyrinthine disorders that can cause nausea and vomiting?

A
  • acute labyrinthitis (balance centers).

- Meniere’s disease

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14
Q

What GI bleeds cause nausea and vomiting?

A
  • blood in the stomach
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15
Q

What cardiac diseases can cause nausea and vomiting?

A
  • MI

- CHF

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16
Q

What is the most important thing you should do when a person comes into your office?

A

form a differential in your head.

17
Q

What are the 8 attributes of a symptom?

A
  • Onset
  • Location
  • Duration
  • Character (sharp, dull, burning…)
  • Alleviating/Aggravating factors
  • Radiation
  • Timing
  • Severity
18
Q

With what does early morning vomiting often correlate?

A

pregnancy, alcoholic gastritis, or uremia

19
Q

What what does feculent (smells like poop) vomitus often correlate?

A
  • gastrocolic fistula or distal obstruction
20
Q

With what does projectile vomiting often correlate?

A
  • increased intracranial pressure or pyloric stenosis
21
Q

With what does bilious vomiting often correlate?

A
  • increased bile may indicate obstruction below ampulla of Vater
22
Q

With what does bloody vomitus often correlate?

A
  • GI bleeding
23
Q

What are some associated symptoms with nausea and vomiting?

A
  • Vertigo and Tinnitus: Meniere’s disease, labyrinthitis
  • Relief of abdominal pain with vomiting: peptic ulcer disease (PUD)
  • Early satiety: gastroparesis
  • Weight loss: malignancy
24
Q

Is vomiting during or soon after eating usually due to a potential toxin?

A

NO. Usually this soon is due to a psychogenic cause.

25
Q

What should you think if you vomit undigested food?

A
  • esophageal or Zenker’s diverticulum
26
Q

What should you look for on physical exam for nausea and vomiting?

A
  • Dental caries (anorexia or bulemia…)
  • Altered autonomic activity: diarrhea, increased perspiration, hypersalivation.
  • Anorexia, weight loss, wasting (malignancy)
  • Intravascular volume depletion: bradycardia, hypotension, skin pallor, skin “tenting” (checks hydration; turgo on FOREHEAD or CHEST), tachycardia, + tilt test.
  • Hematemesis, coffee-ground emesis, feculent emesis
  • Projectile vomiting
  • Abdominal tenderness, rebound, guarding, distention, abnormal bowel sounds (hyperactive, hypoactive, absent, high pitched tinkling).
27
Q

What tests should we consider doing to rule in or rule out things on your DDx for nausea and vomiting?

A
  • Plain X-rays: looking for intestinal obstruction (will see bright white opaqueness in intestine).
  • Upper GI Series: assesses motility and mucosa of proximal GI tract.
  • Esophagogastroduodenoscopy (EGD): obstruction, mucosal aberrations.
  • Gastric emptying scans: gastroparesis
  • CT of brain: intracranial disorders
  • Pregnancy test (must be at least 2 wks pregant for urine test to be positive).
  • Electrolytes: to assess volume and electrolyte status
  • Liver function tests (hepatiits or cholecystitis).
  • Complete blood count: infection
  • Thyroid stimulating hormone: thyrotoxicosis
28
Q

What are some management strategies?

A
  • Treat the underlying cause
  • Antiemetics for symptom relief
  • Prevention and treatment of complication development
  • Diet: NPO, BRATS diet, hard candy or popsicles
  • Patient education: explanation, sequelae, signs or symptoms that need immediate evaluation, follow up.
29
Q

What are the pearls of this lecture?

A
  • A careful history is the most important factor in determining etiology.
  • Assess volume status with history of frequent or prolonged vomiting.
  • Check stool for occult blood with history of unwitnessed hematemesis
  • Obtain pregnancy test with history of vomiting and amenorrhea.

Gastrointestinal 2 (18 decks)

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