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Surgery EOR > GI / Nutritional Part 4 (N/V) Enoch's Deck > Flashcards

GI / Nutritional Part 4 (N/V) Enoch's Deck Flashcards

1
Q

What is emesis?

A
  • Retching
  • Follows nausea
  • Expulsion of GI contents
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2
Q

What is rumination syndrome?

A

Chewing and swallowing food that has been regurgitated

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3
Q

What are the 3 things that control the motor function of the gut?

A
  • Parasympathetic and sympathetic nervous systems
  • Enteric brain neurons
  • Smooth muscle cells
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4
Q

How many cycles occur per minute in the gastric cycle?

A

3 cycles per minute of smooth muscle contraction in the stomach.

Nausea shifts this

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5
Q

What are the two irregular rhythms of stomach motility?

A
  • Tachygastria
  • Bradygastria
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6
Q

What are the 4 sources that can stimulate vomiting?

A
  1. Afferent vagal fibers from GI viscera (GI distention
  2. Fibers of the vestibular system (sea-sickness, dizziness)
  3. Higher CNS centers (smells, sights, emotion)
  4. Chemoreceptor trigger zone (area posterna)
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7
Q

What virus is most likely implicated with vomiting 24-48 hrs post ingestion?

A

Norwalk-like viruses

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8
Q

What does acute onset of N/V w/ severe pain suggest for etiology?

A
  • Peritoneal inflammation
  • Acute gastric/intestinal obstruction
  • Pancreatobiliary disease
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9
Q

What does persistent N/V suggest for etiology?

A
  • Pregnancy
  • Gastric outlet obstruction
  • Gastroparesis
  • Intestinal dysmotility
  • Psychogenic disorders
  • CNS/Systemic disorders
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10
Q

What does morning N/V suggest for etiology?

A
  • Pregnancy
  • Uremia
  • Alcohol intake
  • Increased ICP
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11
Q

What improves cannabinoid hyperemesis syndrome usually?

A

A hot bath

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12
Q

If a person constantly vomits right after meals, what is the suspected etiology and how might you check?

A
  • Bulimia
  • Perform a TEETH exam!
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13
Q

What does feculent vomiting suggest?

A

Intestinal obstruction

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14
Q

What should abdominal XRAY show for SBO? Ileus?

A
  • SBO: Intestinal air-fluid levels with reduced colonic air.
  • Ileus: Diffusely dilated air-filled bowel loops.

Order Flat and upright XRAY if sus of mechanical obstruction.

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15
Q

How does EGD often present?

A

Normal

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16
Q

What complications should we be wary about in someone with persistent vomiting?

A
  • Volume depletion/dehydration
  • Lyte disturbances
  • Aspiration
  • Mallory-Weiss tear
  • Boerhaave syndrome (Esophageal rupture)
17
Q

What two things should we always check in someone vomiting?

A
  • Volume status
  • Lyte status
18
Q

What food type should we avoid in someone vomiting that we are attempting to PO test?

A

Lipids

Lipids delay gastric emptying

19
Q

What is the overall goal of replacement fluid therapy?

A
  • Correct volume status
  • Correct lyte abnormalities
20
Q

What is unique about replacing mild hypovolemia?

A

Positive fluid balance is preferred.

Infusing slightly more fluid than the rate of loss.

21
Q

What electrolyte abnormality should NOT be corrected fast?

A

Natremias

22
Q

What is the MOA of zofran/ondansetron?

A

Serotonin 5-HT3 receptor agonist

Blocks stimulation of vomiting center in medulla.

23
Q

When is zofran NOT used for N/V?

A
  • First trimester!!!
  • QT prolongation

Cleft palate defect could occur.

24
Q

What kind of patients should zofran use be cautionary in?

A

Hepatic impaired.

25
Q

What is the MC SE of zofran?

A

HA

26
Q

What are the preferred medications for N/V in pregnancy?

A
  • Scopolamine
  • Meclizine
  • Doxylamine

Anticholinergics/anthistamines

Any of these + vit B6 (pyridoxine) + doxylamine = recommended

27
Q

How does promethazine work?

A

1st gen H1 blocker.

Used for acute N/V only.

28
Q

What are the serious SEs of promethazine?

A
  • Respiratory depression
  • Extrapyramidal SEs
  • Bradycardia
29
Q

What are the BBWs for promethazine?

A
  • Respiratory depression
  • Tissue necrosis/injury
30
Q

Who is promethazine specifically contraindicated in?

A

Children under 2 due to risk of respiratory depression.

Gotta be a pro to take promethazine

31
Q

How does metoclopramide work and when do we use it?

A
  • Prokinetic
  • Used as adjunct for N/V, gastroparesis, and refractory GERD.

Meto makes you move

32
Q

What are the main serious SEs of metoclopramide?

A
  • Extrapyramidal SEs
  • Neuroleptic malignant syndrome
  • Lowers seizure threshold

Malignant meto

33
Q

What is the BBW of metoclopramide?

A

Tardive dyskinesia

34
Q

When is metoclopramide contraindicated?

A
  • Seizure d/o
  • GI obstruction

Taper med off.

35
Q

When is lorazepam commonly administered for N/V?

A

Prior to chemo along with zofran

36
Q

What history might preclude us from using promethazine for a N/V patient?

A

COPD

Promethazine causes respiratory depression.

37
Q

What is preferred medication therapy for N/V during pregnancy?

A

Vit B6 + doxylamine

UTD says this is the first-line therapy before the anticholinergics but u can add scopolamine or meclizine i guess

Surgery EOR (17 decks)

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