N+V Flashcards
define vomiting?
uncontrolled reflex that expels the contents of the stomach through the mouth
define nausea?
feeling like you want to be sick – no physical vomiting
define retching?
reverse movements (peristalsis) of stomach/ oesophagus and but not actually vomiting
what is a mallor weiss tear?
- Excessive retching and vomiting can cause a tear/ laceration of stomach/ oesophagus
- Often found near gastro-oesophageal border (near fundus of stomach)
- Mallory – Weiss tear – small amounts of fresh blood sicked up – need history of previous recent vomiting/ retching
what is boehaaves syndrome?
oesophagus is ruptured during severe retching/ vomiting
stomach contents goes through tear and into mediastinum
? can prolonged severe vomiting cause metabolic alkalosis
fluid depletion/ dehydration can cause a metabolic alkalosis
what does nausea but no vomiting indicate?
increased intracranial pressure
what would sudden onset of vomiting with/without diarrhoea prompt?
prompt isolation (barrier nursing) – need infection caution and avoid dissemination to other patients irrespective of exposure history
what is included on history of vomiting?
- Drinking fluids – ask about nappies/ nappies etc
- What does vomit look like – green (bile from stomach), red – other issues, undigested food oesophageal pouch – regurgitation (no heaving, slightly rotted and undigested food coming up). Gastric juices – gastric outlet obstruction. Vomiting of faecal material colointestinal/ cologastric fistulae
- Volume/ amount
- Does it contain blood – what type (RED FLAG)
what type of conditions is prolonged nausea/ vomiting associated to?
- Prolonged nausea and vomiting is usually linked to chronic conditions such as CKD, liver disease, cancers (physical cause or treatment) , pregnancy, GORD (usually resolves after eating), diabetes
what are repeated acute episodes of V/N linked to?
- Can be repeated episodes of acute causes such as migraine, motion sickness
what would nausea and central niggling pain that moves to iliac fossa indicate?
appendicitis
what would colickly pain then moves to constant pain and then N/V indicate
obstruction
what type of pain would biliary pathology present with?
colicky pain
how would pancreatitis present?
V+N
central pain then referred back pain
alcohol history
how would renal stones pain present?
back pain then refers to groin
what type of pain would be seen in pyelonephritis?
back pain - need urine dip to see WCC elevation and inflammation
what is pyelonephritis?
kidney infection
what CVS conditions may present as N+V?
MI
angina/ aneurysm
what neurological conditions may present with N+V?
headache (menigitis, encephalitis, sub arachnoid sub dural bleeds), migraine, raised intra cranial pressure and glaucoma
what is history is needed with potential infectious cause of N+V?
- Ask about recent illnesses (gastroenteritis) in family members, places of work, schools etc
- Recent travel
- Diarrhoea associated? Blood/ mucus in stool
- Recent food history – takeaway, undercooked, out of date etc
- Food poisoning and infectious bloody diarrhoea (this requires been notified to PHE?)
what would early morning sick and alcohol link?
shows alcohol dependence
alcohol excess
when would vomiting occur in diabetics?
- Diabetes type 1: acute vomiting seen in DKA
- Diabetes T1/T2: chronic vomiting – gastroparesis
why do you need a surgical and medical history within N+V?
- Particularly abdo surgery and IBS
- At risk of adhesions: inflammation and scarring torsion risk causes by gut mobility
- Any associated vertigo, gait instability, nystagmus (repetitive, involuntary movement of the eyes) – labyrinth disorders eg vestibular neuronitis as the cause of vomiting
what other general symptoms may present with N+V?
General symptoms: dehydration ( decreased skin turgor, sunken eyes, no/ low urine output, dark yellow urine, decreased cap refill, dizzy, confused, lack of tears/ sweat, falls/ difficulty walking, low BP, rapid HR, abnormal labs/ electrolytes
what would reveal tenderness, guarding and rebound in abdo exam?
acute abdo - need surgical review asap
what would you look for a neuro exam with a patient presenting with V+N?
- Look for any cranial nerve or gait deficits
- Nystagmus: disorder of labyrinth system
- Fundoscopy to assess for papilledema
- Enlarged discs: increased intracranial pressure and this will stimulate brainstem emesis centres
in gastroparesis what would indicate diabetic autonomic neuropathy?
orthostatic hypotension, orthostatic tachycardia, abnormal sweating, delayed bladder emptying
what dental sign would indicate bulimia as cause of V+N?
loss of dental enamel - flat teeth
