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GI2 E1 > nausea and vomiting > Flashcards

nausea and vomiting Flashcards

clin med

1
Q

define rumination

A

regurge, rechew, + reswallow

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2
Q

what general complications are associated with N/V

A 
dehydration
malnutrition
dental caries
metabolic alkalosis+hypokalemia
aspiration
pneumonia
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3
Q

what is the trx for N/V secondary to inner ear dysfunction

A

antihistamines

meclizine

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4
Q

what is the trx for gastroparesis

A

metoclopromide + erythromycin

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5
Q

what is the trx for N/V secondary to motion sickness

A

anticholinergic scopolamine

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6
Q

what is the trx for N/V secondary to chemotherapy

A

ondonsetron, SSRI, glucocorticoid

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7
Q

what is the clinical presentation of gastroparesis

A

intermittant, worsening, waxing + waning, early satiety, N/V 1-3 hours after meals

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8
Q

what are common causes of gastroparesis

A

DM

hypothyoid, post-surgery complication, parkinson/MS, postvital/chagas, amyloidosis

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9
Q

how do you diagnose gastroparesis

A

gastric scintigraphy= gastric content retention 60% after 2 hours, >10% after 4 hours is abn

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10
Q

what is the treatment for gastroparesis

A

eat small meals with decreased fiber, milk, and fat

avoid opioids/ antichol
give meds to increase gastric emptying (metoclopromide, erythromycin)

electric stimulation

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11
Q

what is the trx for an acute exacerbation of gastroparesis

A

nasogastric suction and IV fluids

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12
Q

what is the clinical presentation of acute paralytic ileus

A

n/v, obstipation, distention, decrease bowel sounds

post surgery patients w electrolyte abn, severe illness

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13
Q

how do you diagnose an acute paralytic ileus

A

plain abd radiography/ CT scan w gas, fluid distension in bowels

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14
Q

what is the trx for acute paralytic ileus

A

restrict oral intake w slow liberalization of diet, control analgesics + avoid opioids

in severe/prolonged ileus= need nasogastric suction, parenteral administration of fluids+electrolytes

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15
Q

what is the etiology acute small bowel obstruction

A

caused by adhesion, (abd surgeries, diverticulitis, crohn’s)

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16
Q

what is the clinical presentation of acute small bowel obstruction

A

n/v can be feculent, obstipation, distension, HIGH PITCHED TINKLING BS, no BM or flatus

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17
Q

how do you diagnose of acute small bowel obstruction

A

KUB/abd radiography, CT showing dilated loops of small bowel and air fluid levels

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18
Q

what is the trx for acute small bowel obstruction

A

nasogastric tub to suction, suppurative

if persist, surgery

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19
Q

define functional dyspepsia

A

> 3 months of dyspepsia w/o an organic cause

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20
Q

define pyrosis and describe the etiology that leads to it

A

heartburn/indigestion + waterbrash (bad taste in mouth from acid)

=result of acid reflux into esophagus from stomach, gastric motor dysfunction, visceral afferent hypersensitivity

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21
Q

pyrosis is worsened by ____

A

increased gastric contents, lying down/bending over, obesity/pregnancy/ascites, tight clothes, hiatal hernia decreased LES tone (smoking, scleroderma…)

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22
Q

what sx are present with pyrosis

A

30-60 min after eating, N/V/dysphagia –> asthma, cough, aspiration/pneumonia, chronic bronchitis, dental caries, sleep apnea

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23
Q

what are complications that can develop from pyrosis

A

laryngopharyngeal reflux (LPR), esophagitis, barrett’s esophagus

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24
Q 
what are the two types of gastritis and differentiate between their
location
inflammatory infiltrate
acid production
gastrin produciton
histology
Ab type
associated CA
A

H PYLORI TYPE=TYPE A

antrum
neutrophils+subepithelial plasma cells
increased acid production, 
gastrin normal to low
polyps
anti-H. Pylori Ab
B cell lymphoma, adenocarcinoma (low), MALTOma
AUTOIMMUNE= TYPE B
fundus+body
lymphocytes and Mø
decreased acid production
increased gastric production --> achlorhydria
neuroendocrine hyperplasia
Ab to parietal cells
carcinoid tumor, adenocarcinoma (high)
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25
Q

how do you detect h pylori

A

fecal ag test
urea breath test
warthin starry stain

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26
Q

what is the trx of h pylori gastritis

A

none unless they have PUD or MALToma, which you would trx that

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27
Q

what are the diagnostic measures for autoimmune gastritis

A

cbc
serum Vit B12,
acid assays
IF Ab/parietal cell Ab

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28
Q

what is the trx of autoimmune gastritis

A

parenteralB12

if extensive damage, do periodic surveillance

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29
Q

use of what medication will increase risk of H Pylori

A

prednisone

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30
Q

what is the clinical presentation of PUD

A

nausea, dyspepsia, burning pain

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31
Q

what complication of PUD is a surgery emergency

A

perforated viscus= a hollowed out organ perforates

cxr shows free air under the diaphragm or in the mediastrinum

32
Q

what are the two types of stress ulcers (PUD)

A

curling= peptic ulcers in patients with severe burns

cushings= peptic ulcers s/p TBI or CNS lesion

33
Q

when do you want to eradication H Pylori

what is the abx trx

A

in the setting of MALToma

omeprazole/lansoprazole
clarithromycin
metronidzaole
amoxicillin

34
Q

what are the risk factors for gastric adenocarcinoma

A 
increased risk with smoked fish+meat
pickled veggies
nitrosamines
benxpyrenes
decreased fruits and veg
H Pylori
smoking
blood type A
menetriere ds
35
Q

what physical exam findings are indicative of gastric adenocarcinoma

A

virchows node is showing in the neck about the clavicle as having a metastasis
linitis plastica= diffuse stomach CA
signet-ring cells
krukenburg tumors of the ovary

36
Q

most gall bladder stones are what time

A

cholesterol

20% pigment stones

37
Q

what are the risk factors for cholelithiasis

A

Fat
Female
Fertile
Fair

uncontrolled DM, increased carbs/TG
males w cirrhosis or Help C
biliary sludge with prolonged fasting

38
Q

clinical presentation of cholelithiasis

A

obstruction of the cystic or common bile duct

biliary colick= severe, steady, RUQ age starting 30-90 minutes after a meal, radiate to the R scapula or back

white, clay like stools (bilirubin is blocked), tea colored urine

39
Q

what are the physical exam findings associated with cholecystitis

A

RUQ and epigastric pain w (+) Murphy’s sign
guarding +rebound tenderness
palpable GB, jaundice

40
Q

what are the test findings with acute vs chronic cholecystitis

A

acute= bilirubinemia, increase liver enzymes+serum amylase, US shows increased wall thickness, pericholecystic fluid,

chronic= test are normal, US shows stones and contracted GB

41
Q

what are some complications of acute cholecystitis

A

gangrene s/p vasoconstriction
perforation+necrosis
emphysematous GB secondary to DM
fistula

42
Q

what are some complications of chronic cholecystitis

A

porcelain GB–>incidental calcified lesion, poor prognosis w increased risk of CA

43
Q

what are the main causes of pancreatitis

A

gallstones in the biliary tract
heavy EtOH use

also hyperTG, celiac ds, vasculitis, mumps, CMV.. cystic fibrosis

44
Q

PE findings with pancreatitis

A

boring epigastric pain going straight to the back,
(+) cullen sign= periumbilical echymosis
grey turner sign= flank echymosis
(+) chvostek and trousseau sign for hypocalcemia

xray= sentinal loop, conol cutoff sign

45
Q

what are the diagnostic criterion for pancreatitis

A

at least 2= epigatric pain, lipase/amylase>3x ULN, CT changes consistent w pancreatitis

46
Q

how do you quantify the severity of pancreatitis

A 
ranson criterion
apache II criterion > 8= high mortality
HAPS
BISAP 0-5= < 1% mortalirt, 
=BUN, Impaired mental status, Sirs, Age >60yo, Pleural effusion
47
Q

what is the trx for pancreatitis

A

mild case= npo, rest, increased fluids (LR or NS), opioids, resume food with improvement

severe case= surgery consult, hemodynamic monitoring, Ca gluconate IV, serum albumin infusion, pressors if hypovolemic, start enteral feeding w/n 48 hours of administration

48
Q

what are potential complications of pancreatitis

A

3rd spacing, ileus, pre-renal azotemia, pleural effusion, necrosis w infection -> need debridement, pseudocysts, ascites

49
Q

define an acute upper GI bleed

A

bleeding from a source proximal to the ligament of trietzw

50
Q

describe a possible hx of someone with an acute upper GI bleed

A

anemia/hypovolemia, hematemesis, melena, hematochezia

hx of aoritc stenosis, renal ds
portal HTN
EtOH use
NSAID use
ASA (salicylate use), glucocorticosteroids, anticoag, peptobismol
51
Q

what are the diagnostic measures for an acute upper GI bleed

A
  1. check volumete status, fitals
52
Q

what are the risk factors for an acute uper gi bleed

A

> 60 yo

SBP>90, P>90blood of nasogastric or rectal exam.. admit to ICU

53
Q

what is the trx for a GI bleed (upper or lower)

A

first, stabilize the patient with 2 large bore 18 gauge or bigger IV lines
check their blood type for possible transfusion
get an endoscopy within 24 hours

if secondary to PUD, give PPI
octreotide if have portal HTN

54
Q

what increases the risk of bleeding with esophageal varices

A

increase with increased size, presence of dilated venules (Red whale markings), severity of liver ds, active EtOH abuse

55
Q

how do you diagnose esophageal varices

A

EGD

56
Q

how do you trx esophageal varices

A
  1. acute resuscitation, get an 18 gauge IV in for fluids and blood
    emergent upper endoscopy w variceal bonding
    prophylactic abx
    balloom tamponade, TIPS, liver transplant
57
Q

what can be done to prevent rebleeding of esophageal varices

A

non-selective B blockers (propranolol, nadolol)

band ligation

58
Q

what are the sx of hemorrhagic gastropathy/gastritis

A 
upper GI bleed is the most common
coffee ground emesis
epigastric discomfort
nausea
melena
increased bowel sounds
59
Q

how do you diagnose hemorrhagic gastropathy/gastritis

A

EGD w biopsy, subepithelial hemorrhage, petechiae, erosion

60
Q

trx of hemorrhagic gastropathy/gastritis

A

remove offending agent, O2 + blood volume,
hourly oral antacids
enteral nutrition (to lower the risk of stress related bleeding)
if have portal HTN, use b blockers
give a PPI to prevent stress ulcers

61
Q

compare and contrast zollinger ellison syndrome and menetriere ds

location

A

ZES=
duodenum, pancreas, fundus

MD= body and fundus

62
Q

zollinger ellison syndrome is a primary ____, and secretes ____

A

gastrinoma, gastrin

63
Q

giant, thickened gastric folds in the body and fundus of the stomach, mostly mucous cells, limited lymphocyte infiltrate

A

menetriere ds

64
Q

what syndrome is a risk factor for zollinger ellison syndrome

A

MEN 1= hyperparathyroidism, increased Ca, gigantism,

65
Q

2/3 of zollinger ellison gastrinomas are ___ and will go to the ____

A

malignant

liver

66
Q

where are gastrinomas most commonly located

A

duodenim (45%)

pancreas (25%)

67
Q

diagnostic measures for zollinger ellison syndrome

A

age ~ 50
hypertrophic mucosal folds
fastring serum gastrin > 100= CONFIRMATORY
(+) secretin stimulant test

68
Q

how do you diagnose menetriere ds

A

endoscopy w biopsy

hypoproteinemia + weight loss +diarrhea

69
Q

what is the trx for zollinger ellison syndrome

A

PPI, laparatomy w resection

70
Q

increased PTH –> increased Ca –> ___

A

constipation

71
Q

what is the trx for menetriere ds

A

cetuximab
gastric resection in severe cases
increased risk of adenocarcinoma

72
Q

fried rice –> vomiting

A

bacillus cereus

73
Q

what is the treatment of mallory weiss tear

A

usually stops bleeding spontaneously, can give epi, clipping, or catheterization therapy

74
Q

PE findings with boerhave syndrome

A

CXR with air in the mediastinum
subQ emphysema
subQ crepitus

75
Q

what is the trx of boerhaave syndrome

A

NPO, parenteral abx, surgery, endoscopic stenting

76
Q

what is the most common cause of food poisoning and what kinds of foods do you get it from

A

staph aureus

mayo and eggs

77
Q

what foods can give you shigella caused food poisoning

A

lettus

GI2 E1 (19 decks)

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