Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

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

A
  1. Oesophagitis

2. Pharyngeal Pouch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

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

A

peritonitis (any cause)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

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

A

bowel obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

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

A

infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

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

A

raised ICP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What would central crushing pain with nausea and vomiting suggest?

A

MI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

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

A

meningitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What would reduced consciousness with nausea and vomiting suggest?

A
  1. diabetic ketoacidosis
  2. menigitis
  3. . raised ICP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What would haematemesis with nausea and vomiting suggest?

A
  1. bleeding peptic ulcer

2. oesophageal varices

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How do you look for hydration status?

A

dry mucous membranes, cold peripheries, delayed cap refill time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are causes for abdominal distention?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Why do you look for scars?

A

previous surgery - adhesions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Why type of hernias do you look for?

A

irreducable ones (could contain trapped bowel and cause obstruction)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What would jaundice suggest?

A

hepatobiliary cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What would a tender abdomen with nausea and vomiting suggest?

A

inflammation somewhere in peritoneal cavity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
Q

Why do you do U+Es?

A

in severe vomiting electrolyte imbalance, baseline before surgery, urea may be raised due to dehydration with subsequent renal hypoperfusion

26
Q

Why do you carry out a VBG?

A

pH and lactate, Na+ and K+ give indication how critical patient is

27
Q

What would a biliary cause show up as in liver enzymes?

A

raised ALP and GGT

28
Q

What would a raise in ALT and AST suggest

A

hepatitis

29
Q

Why do you measure amylase?

A

confirm or exclude pancreatitis

30
Q

Why do you carry out a group and save?

A

incase surgery needed

31
Q

What imaging do you do in nausea and vomiting?

A
  1. Supine abdominal radiograph

2. Erect chest radiograph

32
Q

Why do you do a ABX?

A

looking for signs of bowel obstruction (e.g. foreign body and toxic megacolon)

33
Q

Why do you do a CXR?

A

look for air under diaphragm if bowel has perforated (sit up for 10 mins before image taken)

34
Q

What other potential X-rays could you do for nausea and vomiting?

A
  1. Preg test
  2. Toxicology screen
  3. Contrast studies
  4. Abdominal CT
  5. Head CT
35
Q

Why would you do a tox screen in nausea and vomiting?

A

for paracetemol or aspirin OD (accidental or not)

36
Q

What contrast studies do you do for nausea and vomiting?

A

e.g. small bowel follow through, looking for obstruction if cant see from ABX

37
Q

Why do you do a abdominal CT in nausea and vomiting?

A

intraperitoneal pathology

38
Q

What do you do a head CT in nausea and vomiting?

A

look for intracranial pathology e.g. dilated ventricles or mass lesions (if history suggest raised ICP

39
Q

What is the management of small bowel obstruction (SBO) acutely?

A
  1. ABC
  2. Nil by mouth
  3. Drip and suck
  4. Analgesia
  5. Antiemetics
40
Q

What is drip and suck?

A

IV fluids and aspiration of GI contents via an NG tube

41
Q

What analgesia can you not give for SOB?

A
  • opiates can cause nausea and constipation

- NSAIDs are nephrotoxic so should be avoided if AKI and dehydrated

42
Q

What antiemetics can you not use in SBO?

A
  • metoclopramide is prokinetic and can make obstruction worse
  • cyclizine or ondansetron better options
43
Q

What is the management plan for SBO?

A
  1. Trial of conservative management
  2. CT scan
  3. Surgery if needed e.g. lapartomtomy
44
Q

What is conservative management for SBO?

A
  1. Fluids
  2. NG aspiration
  3. See if obstruction resolves on itself
  4. Reviewed regularly to ensure not deteriorate (e.g. bowel strangulation)
45
Q

Why do you do a CT scan for SBO?

A
  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
Q

When is surgery used in SBO?

A

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)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions