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Z Year3 Clinical Presentations > Nausea and Vomiting 2 > Flashcards

Nausea and Vomiting 2 Flashcards

1
Q

What would chronic (>1month) nausea and vomiting with weight loss suggest?

A
  1. Upper GI obstruction: mechanical or functional

2. Coeliac disease

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2
Q

What would chronic (>1month) nausea and vomiting without weight loss suggest?

A
  1. Oesophagitis

2. Pharyngeal Pouch

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3
Q

What are the worrying signs and symptoms in nausea and vomiting?

A
  1. Motionless patient, rigid abdomen, absent bowel signs
  2. Bilious or faeculent vomiting, distended abdomen, absolute constipation, abdominal pain
  3. Very high fever (>38.5 degrees)
  4. Early morning vomiting, headache worsen when lying now, nerve VI palsy
  5. Central, crushing pain
  6. Meningism (stiff neck, photophobia, headache) conciousness
  7. Haematemesis
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4
Q

What does a motionless patient, rigid abdomen, absent bowel signs with nausea and vomiting suggest?

A

peritonitis (any cause)

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5
Q

What does bilious or faeculent vomiting, distended abdomen, absolute constipation, abdominal pain with nausea and vomiting suggest?

A

bowel obstruction

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6
Q

What does a very high fever with nausea and vomiting suggest?

A

infection

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7
Q

What would early morning vomiting, headache worsen when lying down, nerve VI palsy suggest?

A

raised ICP

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8
Q

What would central crushing pain with nausea and vomiting suggest?

A

MI

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9
Q

What would meningism (stiff neck, photophobia, headache) with nausea and vomiting suggest?

A

meningitis

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10
Q

What would reduced consciousness with nausea and vomiting suggest?

A
  1. diabetic ketoacidosis
  2. menigitis
  3. . raised ICP
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11
Q

What would haematemesis with nausea and vomiting suggest?

A
  1. bleeding peptic ulcer

2. oesophageal varices

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12
Q

What do you look for in inspection with nausea and vomiting?

A
  1. Hydration status
  2. Abdominal distention
  3. Scars
  4. Hernias
  5. Jaundice
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13
Q

How do you look for hydration status?

A

dry mucous membranes, cold peripheries, delayed cap refill time

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14
Q

What are causes for abdominal distention?

A

fetus, fat, fucking big tumour, flatus, feaces, fluid

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15
Q

Why do you look for scars?

A

previous surgery - adhesions

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16
Q

Why type of hernias do you look for?

A

irreducable ones (could contain trapped bowel and cause obstruction)

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17
Q

What would jaundice suggest?

A

hepatobiliary cause

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18
Q

What would a tender abdomen with nausea and vomiting suggest?

A

inflammation somewhere in peritoneal cavity

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19
Q

Why do you look for masses with nausea and vomiting?

A

could be cause of an obstruction

20
Q

What would guarding and rigidity on palpation suggest?

A

peritonitis

21
Q

What would absent bowel sounds suggest?

A

ileus (due to peritonitis)

22
Q

What would high pitched or tickling bowel sounds suggest?

A

mechanical obstruction

23
Q

What bloods do you investigate for nausea and vomiting?

A
  1. FBC and CRP
  2. U+Es
  3. VBG
  4. Liver enzymes
  5. Amylase
  6. Group and save
24
Q

Why do you do fbc and crp?

A

raised CRP + WCC indicates infection or inflammation

25
Why do you do U+Es?
in severe vomiting electrolyte imbalance, baseline before surgery, urea may be raised due to dehydration with subsequent renal hypoperfusion
26
Why do you carry out a VBG?
pH and lactate, Na+ and K+ give indication how critical patient is
27
What would a biliary cause show up as in liver enzymes?
raised ALP and GGT
28
What would a raise in ALT and AST suggest
hepatitis
29
Why do you measure amylase?
confirm or exclude pancreatitis
30
Why do you carry out a group and save?
incase surgery needed
31
What imaging do you do in nausea and vomiting?
1. Supine abdominal radiograph | 2. Erect chest radiograph
32
Why do you do a ABX?
looking for signs of bowel obstruction (e.g. foreign body and toxic megacolon)
33
Why do you do a CXR?
look for air under diaphragm if bowel has perforated (sit up for 10 mins before image taken)
34
What other potential X-rays could you do for nausea and vomiting?
1. Preg test 2. Toxicology screen 3. Contrast studies 4. Abdominal CT 5. Head CT
35
Why would you do a tox screen in nausea and vomiting?
for paracetemol or aspirin OD (accidental or not)
36
What contrast studies do you do for nausea and vomiting?
e.g. small bowel follow through, looking for obstruction if cant see from ABX
37
Why do you do a abdominal CT in nausea and vomiting?
intraperitoneal pathology
38
What do you do a head CT in nausea and vomiting?
look for intracranial pathology e.g. dilated ventricles or mass lesions (if history suggest raised ICP
39
What is the management of small bowel obstruction (SBO) acutely?
1. ABC 2. Nil by mouth 3. Drip and suck 4. Analgesia 5. Antiemetics
40
What is drip and suck?
IV fluids and aspiration of GI contents via an NG tube
41
What analgesia can you not give for SOB?
- opiates can cause nausea and constipation | - NSAIDs are nephrotoxic so should be avoided if AKI and dehydrated
42
What antiemetics can you not use in SBO?
- metoclopramide is prokinetic and can make obstruction worse - cyclizine or ondansetron better options
43
What is the management plan for SBO?
1. Trial of conservative management 2. CT scan 3. Surgery if needed e.g. lapartomtomy
44
What is conservative management for SBO?
1. Fluids 2. NG aspiration 3. See if obstruction resolves on itself 4. Reviewed regularly to ensure not deteriorate (e.g. bowel strangulation)
45
Why do you do a CT scan for SBO?
1. demonstrate exact level or obstruction 2. establish whether closed loop obstruction, ischaemic bowel or a cause for obstruction other than adhesions (intussusception or a mass lesion)
46
When is surgery used in SBO?
If: 1. signs of strangulation or peritonism 2. after around 48hr the obstruction not resolved or 3. no history of abdominal surgery, making adhesions less likely and more sinister causes more lik

Z Year3 Clinical Presentations (37 decks)

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