Nausea and vomiting Flashcards
Whata re 4 things to think about as causes of N&V
Problems in the brain
Problems with heart and abdomen
Vertigo
Things in the blood
What does undigested food suggest about N&V
Oesophageal disorder- achalasia, pharyngeal pouch
What does slightly digested food suggest about cause of N&V
Gastric outflow obstruction- cancer, pyloric, stenosis and pancreatic pseudocyst
Gastroparesis
What is gastroparesis
Delayed gastric emptying
Who is gastroparesis seen in
Diabetics
What does bilous vomit suggest about cause
Bowel obstruction distal to ampulla of vater
What 2 things can cause feculent vomit
Distal bowel obstruction
Gastrocolonic fistula
Why is timing of vomit relevant
In morning suggests raised ICP
What does vomiting within an hour of eating suggest about cause of N&V
Obstruction proximal to gastric outlet
Why is peptic ulcer history relevant in N&V history
Can lead to scarring and ultimatly pyloric stenosis
What does vomiting a long time after eating suggest about cause of N&V
Small bowel obstruction
What symptoms tend to present with gastroparesis and gastric outflow obstruction
Early satiety
Bloating
Abdo discomfort
What does early satiety suggest about vomiting cause
Gastric outflow obstruction
What does fever suggest with nausea and vomiting cause
Any inflammation or infection of abdo organ
Why is focal neurology relevant with nausea and vomiting
Migraine
Meningitis
Encephalitis
Motility disorder
What questions to ask about for exposure to pathogens in suspected gastroenteritis
Travel
Living in close quarters
Close contacts have something similair
Unusual meals recently
First thing to think about with cause of nausea and vomiting
Is it acute (under 1 month)
Or chronic
If acute vomiting what symptoms help narrow down differentials
Vertigo
Abdo pain
Headache
What are categories of acute N&V differentials
Vertigo Abdo pain Headache Shortly after food None of these symptoms
Causes of vertigo and nausea and vomiting
Menieres
Vestibular neuritis
BPPV
Acoustic neuroma
Causes of headache nausea and vomiting
ICP SOL
Meningitis
Encephalitis
Migraine
Causes of abdo pain with fever and nausea and vomiting
Appendicits Cholecystitis Hepatitis Mesenteric adenitis Pancreatitis Food poisoning
Causes of abdo pain with no fever and nausea and vomiting
UTC MI SBO DKA LBO Mesenteric ischaemia Testicular torsion Drug overdose
Causes of chronic nausea and vomiting
Upper GI obstruction- mechanical and functional
Coeliac disease
Oesophagitis
Pharyngeal pouch
Problems in brain leading to nausea and vomiting
SOL
Migraine
Meningitis
Encephalitis
Things in blood leading to nausea and vomiting
Drug overdose
Uraemia from renal failure
Excess of hormones
Electrolyte abnormalities
Reduced consciousness with nausea and vomiting
DKA
Meningitis
ICP
What looking for on inspection of nausea and vomiting
Hydration status- vomiting loses fluids Abdo distension- SBO Scars- SBO Jaundice- hepatobiliary cause Hernias- SBO
Bloods ordered nausea and vomiting
FBC- infective cause U&Es- electrolyte abnormalities from those lost VBG- lactate and electrolytes Amylase- exclude pancreatitis Liver enzymes- hepatobiliary picture Group and save- off to surgery
How long must patient be sat up before erect CXR
10mins
Investigations for nausea and vomiting if young woman
Pregnancy
What analgesia shouldnt be given in dehydrated patients
NSAIDS
What anti-emetic shouldnt be given in context of SBO
Metoclopramide
Cyclizine or ondensatron are better options
Managment plan for SBO
NBM Drip and suck Analgesia Antiemetics Trial conservative management provided no strangulation signs If hasnt resolved go to surgery
What would make you definetely go to surgery in SBO
Strangulation or peritonism signs
Conservative trial hasnt worked
No history of abdo surgery meaning sinister causes more likely
Patient is in a lot of pain
Main clinical sign is gastroenteritis not food poisoning
Food poisoning lasts less than 24 hours generally
What does ketonuria suggest in gastroenteritis
In state of starvation as not eating
Why would patient with DKA have hyponatraemia
Pseudohyponatraemia from high glucose
In DKA how is insulin given
Infusion
If have burst appendix what is done in surgery
Appendicectomy and wash out of any contents
