nausea and vomiting Flashcards
clin med
define rumination
regurge, rechew, + reswallow
what general complications are associated with N/V
dehydration malnutrition dental caries metabolic alkalosis+hypokalemia aspiration pneumonia
what is the trx for N/V secondary to inner ear dysfunction
antihistamines
meclizine
what is the trx for gastroparesis
metoclopromide + erythromycin
what is the trx for N/V secondary to motion sickness
anticholinergic scopolamine
what is the trx for N/V secondary to chemotherapy
ondonsetron, SSRI, glucocorticoid
what is the clinical presentation of gastroparesis
intermittant, worsening, waxing + waning, early satiety, N/V 1-3 hours after meals
what are common causes of gastroparesis
DM
hypothyoid, post-surgery complication, parkinson/MS, postvital/chagas, amyloidosis
how do you diagnose gastroparesis
gastric scintigraphy= gastric content retention 60% after 2 hours, >10% after 4 hours is abn
what is the treatment for gastroparesis
eat small meals with decreased fiber, milk, and fat
avoid opioids/ antichol
give meds to increase gastric emptying (metoclopromide, erythromycin)
electric stimulation
what is the trx for an acute exacerbation of gastroparesis
nasogastric suction and IV fluids
what is the clinical presentation of acute paralytic ileus
n/v, obstipation, distention, decrease bowel sounds
post surgery patients w electrolyte abn, severe illness
how do you diagnose an acute paralytic ileus
plain abd radiography/ CT scan w gas, fluid distension in bowels
what is the trx for acute paralytic ileus
restrict oral intake w slow liberalization of diet, control analgesics + avoid opioids
in severe/prolonged ileus= need nasogastric suction, parenteral administration of fluids+electrolytes
what is the etiology acute small bowel obstruction
caused by adhesion, (abd surgeries, diverticulitis, crohn’s)
what is the clinical presentation of acute small bowel obstruction
n/v can be feculent, obstipation, distension, HIGH PITCHED TINKLING BS, no BM or flatus
how do you diagnose of acute small bowel obstruction
KUB/abd radiography, CT showing dilated loops of small bowel and air fluid levels
what is the trx for acute small bowel obstruction
nasogastric tub to suction, suppurative
if persist, surgery
define functional dyspepsia
> 3 months of dyspepsia w/o an organic cause
define pyrosis and describe the etiology that leads to it
heartburn/indigestion + waterbrash (bad taste in mouth from acid)
=result of acid reflux into esophagus from stomach, gastric motor dysfunction, visceral afferent hypersensitivity
pyrosis is worsened by ____
increased gastric contents, lying down/bending over, obesity/pregnancy/ascites, tight clothes, hiatal hernia decreased LES tone (smoking, scleroderma…)
what sx are present with pyrosis
30-60 min after eating, N/V/dysphagia –> asthma, cough, aspiration/pneumonia, chronic bronchitis, dental caries, sleep apnea
what are complications that can develop from pyrosis
laryngopharyngeal reflux (LPR), esophagitis, barrett’s esophagus
what are the two types of gastritis and differentiate between their location inflammatory infiltrate acid production gastrin produciton histology Ab type associated CA
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)
how do you detect h pylori
fecal ag test
urea breath test
warthin starry stain
what is the trx of h pylori gastritis
none unless they have PUD or MALToma, which you would trx that
what are the diagnostic measures for autoimmune gastritis
cbc
serum Vit B12,
acid assays
IF Ab/parietal cell Ab
what is the trx of autoimmune gastritis
parenteralB12
if extensive damage, do periodic surveillance
use of what medication will increase risk of H Pylori
prednisone
what is the clinical presentation of PUD
nausea, dyspepsia, burning pain
what complication of PUD is a surgery emergency
perforated viscus= a hollowed out organ perforates
cxr shows free air under the diaphragm or in the mediastrinum
what are the two types of stress ulcers (PUD)
curling= peptic ulcers in patients with severe burns
cushings= peptic ulcers s/p TBI or CNS lesion
when do you want to eradication H Pylori
what is the abx trx
in the setting of MALToma
omeprazole/lansoprazole
clarithromycin
metronidzaole
amoxicillin
what are the risk factors for gastric adenocarcinoma
increased risk with smoked fish+meat pickled veggies nitrosamines benxpyrenes decreased fruits and veg H Pylori smoking blood type A menetriere ds
what physical exam findings are indicative of gastric adenocarcinoma
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
most gall bladder stones are what time
cholesterol
20% pigment stones
what are the risk factors for cholelithiasis
Fat
Female
Fertile
Fair
uncontrolled DM, increased carbs/TG
males w cirrhosis or Help C
biliary sludge with prolonged fasting
clinical presentation of cholelithiasis
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
what are the physical exam findings associated with cholecystitis
RUQ and epigastric pain w (+) Murphy’s sign
guarding +rebound tenderness
palpable GB, jaundice
what are the test findings with acute vs chronic cholecystitis
acute= bilirubinemia, increase liver enzymes+serum amylase, US shows increased wall thickness, pericholecystic fluid,
chronic= test are normal, US shows stones and contracted GB
what are some complications of acute cholecystitis
gangrene s/p vasoconstriction
perforation+necrosis
emphysematous GB secondary to DM
fistula
what are some complications of chronic cholecystitis
porcelain GB–>incidental calcified lesion, poor prognosis w increased risk of CA
what are the main causes of pancreatitis
gallstones in the biliary tract
heavy EtOH use
also hyperTG, celiac ds, vasculitis, mumps, CMV.. cystic fibrosis
PE findings with pancreatitis
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
what are the diagnostic criterion for pancreatitis
at least 2= epigatric pain, lipase/amylase>3x ULN, CT changes consistent w pancreatitis
how do you quantify the severity of pancreatitis
ranson criterion apache II criterion > 8= high mortality HAPS BISAP 0-5= < 1% mortalirt, =BUN, Impaired mental status, Sirs, Age >60yo, Pleural effusion
what is the trx for pancreatitis
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
what are potential complications of pancreatitis
3rd spacing, ileus, pre-renal azotemia, pleural effusion, necrosis w infection -> need debridement, pseudocysts, ascites
define an acute upper GI bleed
bleeding from a source proximal to the ligament of trietzw
describe a possible hx of someone with an acute upper GI bleed
anemia/hypovolemia, hematemesis, melena, hematochezia
hx of aoritc stenosis, renal ds portal HTN EtOH use NSAID use ASA (salicylate use), glucocorticosteroids, anticoag, peptobismol
what are the diagnostic measures for an acute upper GI bleed
- check volumete status, fitals
what are the risk factors for an acute uper gi bleed
> 60 yo
SBP>90, P>90blood of nasogastric or rectal exam.. admit to ICU
what is the trx for a GI bleed (upper or lower)
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
what increases the risk of bleeding with esophageal varices
increase with increased size, presence of dilated venules (Red whale markings), severity of liver ds, active EtOH abuse
how do you diagnose esophageal varices
EGD
how do you trx esophageal varices
- 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
what can be done to prevent rebleeding of esophageal varices
non-selective B blockers (propranolol, nadolol)
band ligation
what are the sx of hemorrhagic gastropathy/gastritis
upper GI bleed is the most common coffee ground emesis epigastric discomfort nausea melena increased bowel sounds
how do you diagnose hemorrhagic gastropathy/gastritis
EGD w biopsy, subepithelial hemorrhage, petechiae, erosion
trx of hemorrhagic gastropathy/gastritis
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
compare and contrast zollinger ellison syndrome and menetriere ds
location
ZES=
duodenum, pancreas, fundus
MD= body and fundus
zollinger ellison syndrome is a primary ____, and secretes ____
gastrinoma, gastrin
giant, thickened gastric folds in the body and fundus of the stomach, mostly mucous cells, limited lymphocyte infiltrate
menetriere ds
what syndrome is a risk factor for zollinger ellison syndrome
MEN 1= hyperparathyroidism, increased Ca, gigantism,
2/3 of zollinger ellison gastrinomas are ___ and will go to the ____
malignant
liver
where are gastrinomas most commonly located
duodenim (45%)
pancreas (25%)
diagnostic measures for zollinger ellison syndrome
age ~ 50
hypertrophic mucosal folds
fastring serum gastrin > 100= CONFIRMATORY
(+) secretin stimulant test
how do you diagnose menetriere ds
endoscopy w biopsy
hypoproteinemia + weight loss +diarrhea
what is the trx for zollinger ellison syndrome
PPI, laparatomy w resection
increased PTH –> increased Ca –> ___
constipation
what is the trx for menetriere ds
cetuximab
gastric resection in severe cases
increased risk of adenocarcinoma
fried rice –> vomiting
bacillus cereus
what is the treatment of mallory weiss tear
usually stops bleeding spontaneously, can give epi, clipping, or catheterization therapy
PE findings with boerhave syndrome
CXR with air in the mediastinum
subQ emphysema
subQ crepitus
what is the trx of boerhaave syndrome
NPO, parenteral abx, surgery, endoscopic stenting
what is the most common cause of food poisoning and what kinds of foods do you get it from
staph aureus
mayo and eggs
what foods can give you shigella caused food poisoning
lettus
