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Year 3 > Nausea and vomiting (oxford clin cases) > Flashcards

Nausea and vomiting (oxford clin cases) Flashcards

1
Q

What are some vestibular causes of nausea and vomitting?

A

Menieres
Motion sickness
BPPV
Labyrinthitis

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2
Q

What are some chemoreceptor trigger zone causes of nausea and vomiting?

A 
Medication
Alcohol
Hormones
Electrolytes
Toxins
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3
Q

What are some CNS causes of nausea and vomiting?

A 
Pain
Anxiety
Raised ICP
Meningitis
Encephalitis
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4
Q

What are some abdominal/cardiac causes of nausea and vomiting?

A

GI obstruction
GI infection
Inflammation of the diaphragm
Inflammation of the liver, gallbladder, pancreas, peritoneum

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5
Q

If vomit is undigested what may be the cause?

A

Oesophageal eg achalasia or pahryngeal puch

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6
Q

If vomit is partially digested what may be the cause?

A

Gastric outlet obstruction

Delayed stomach emptying

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7
Q

What patients is delayed stomach emptying seen in?

A

Those with diabetes

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8
Q

If vomit has bile in it what may be the cause?

A

Small bowel obstruction

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9
Q

If vomit is foul looking what may be the cause?

A

Distal/ colonic obstruction

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10
Q

What is the one situation you will see faeces being vomitted?

A

When someone has a gastrocolonic fistula

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11
Q

If vomit is of a very large volume what may be the cause?

A

It is not likely to be caused functionally

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12
Q

What is early morning vomiting typical of?

A

Pregnancy and raised ICP

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13
Q

If someone is vomiting for a long duration what pathology is unlikely?

A

Bowel obstruction

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14
Q

What pathology does vomiting within in hour of eating suggest? What should you ask about if this is the case?

A

Proximal obstruction of the GI tract- if this is the case ask about peptic ulcer disease as it may have caused scarring or stenosis

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15
Q

If someone feels relief after vomiting what does this suggest?

A

Obstruction

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16
Q

What pathology does vomiting after a while of eating suggest?

A

Distal GI obstruction

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17
Q

What does fever with vomitting indicate might be pathologically going on?

A

Infection or inflammation

18
Q

What neurological symptoms might you see alongside nausea and vomitting?

A 
Headache
Visual disturbance
Limb weakness
Cranial nerve palsy
Paraesthesia
19
Q

What is the likely diagnosis if someone has vertigo alongside nausea and vomiting?

A

Menieres
BPPV
Labyrinthitis

20
Q

What does a delay or absolute constipation alongside nausea and vomiting suggest?

A

Bowel obstruction

21
Q

What does diarrhoea alongside vomiting suggest?

A

Infectious gastroenteritis

22
Q

What should you ask about in terms of bowel movements when someone has nausea and vomitting?

A

Faeces and flatus
When was the last time they passed any
What did the faeces look like/ was there any change from usual

23
Q

What should you ask about to investigate if the patient has been exposed to infectious bowel pathogens?

A

Have any of their close contacts been vomiting eg family/ housemates/ friends
Have they travelled anywhere foreign recently
Do they live in close quarters eg hospitals, army barracks
Have they had any unusual meals recently

24
Q

If a young female presents with nausea and vomiting what is the first thing to consider?

A

Pregnancy

25
Q

What are differentials if someone has nausea and vomiting thats acute, abdominal pain present and fever?

A 
Gastroenteritis
Food poisoning
Appendicitis
Cholecystitis
Pancreatitis
26
Q

What are differentials if someone has nausea and vomiting thats acute, abdominal pain present but no fever?

A 
DKA
Small bowel obstruction
Side effect of drugs 
Toxins
Large bowel obstruction
Mesenteric ischaemia 
MI
Pain from kidney stones, testicular etc
27
Q

What are differentials if someone presents with chronic nausea and vomiting with weight loss?

A

Upper GI obstruction- cancer or mechanical

Coeliac disease

28
Q

What are differentials if someone presents with chronic nausea and vomiting without weight loss?

A

Oesophagitis

Pharyngeal pouch

29
Q

Why may a patient who is vomiting lots loose conciousness?

A

Due to dehydration

30
Q

What are differentials if someone presents with nausea and vomiting and has altered conciousness?

A

DKA
Meningitis
Raised ICP

31
Q

What are differentials when someone presents with nausea/vomiting and haematemesis?

A

Bleeding peptic ulcer

Oesophageal varices

32
Q

What are the 6 fs that can cause abdominal distention?

A 
Fat 
Fluid
Faeces
Fetus
Fat tumor
Flatus
33
Q

What will tenderness of the abdomen suggest as opposed to guarding/rigidity?

A 
Tenderness= inflammation somewhere
Guarding/rigidity= peritonitis
34
Q

What are some peripheral signs of dehydration?

A

Cold peripheries

Reduced cap refil time

35
Q

What happens to urea level when someone is dehydrated and why?

A

It may be raised due to hypoperfusion of the kidneys

36
Q

What must you always remember when analysing amylase levels?

A

They might not be raised even if someone does have pancreatitis, therefore it cannot be used to diagnose or rule out but it is used to support your differentials

37
Q

What may you see on chest x-ray when someone present with nausea and vomiting and why?

A

Air under the diaphragm due to perforation of bowel

38
Q

How do you do an erect chest x ray after someone presents with nausea and vomiting?

A

Sit them up for 10 mins to allow air to migrate upwards then do the x ray

39
Q

What other useful investigations might you do that aren’t first line and why

A

Pregnancy test- if the patient is female, fertile and sexually active
Contrast studies- to find the location of a bowel obstruction if not visible on x ray
Head CT- to look for dilated ventricles or fluid if raised ICP is suspected
Toxicology screen- if accidental or purposeful drug overdose is suspected (remember it has to be drug specific as there is no general toxicology screen)

40
Q

What will be seen on abdominal x ray if there is small bowel obstruction?

A

Centrally located loops of distended small bowel with vulvae conniventes

Year 3 (104 decks)

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