Brainscape's Knowledge GenomeTM

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


See full index

GI Exam 3 > Nausea, Vomiting, Diarrrhea > Flashcards

Nausea, Vomiting, Diarrrhea Flashcards

1
Q

______: Unpleasant sensation that may,
but not necessarily, precede vomiting

A

Nausea

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

Emesis (vomiting)

A

Forceful oral expulsion of gastric contents
* Can allow for removal of toxins/poison
* Mechanism: Stimulation of multiple
pathways (see next slide)

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

Nausea mechanism

A

Gastric rhythm disturbance
* Gastric myoelectrical activity = 3
cycle/min
* ↑ (tachygastria) or ↓ (bradygastria)
frequency = NAUSEA

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

Nausea can cause autonomic changes:

A
  • Increased (↑): salivation, heart rate,
    respiratory rate
  • Decreased (↓): gastric tone, mucosal
    blood flow
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

The physiological mechanisms of vomiting (Prepartory and expulsion steps)

A

Preparatory Steps
➢ The pyloric sphincter relaxes to allow entry of contents from the intestines
➢ The glottis closes
➢ Contractions begin in the duodenum and stomach
Expulsion Steps
➢ The lower esophageal sphincter relaxes
➢ Vomitus can move into the esophagus.
➢ Inspiratory (diaphragm, intercostals) and abdominal muscles contract
➢ The pylorus closes
➢ Vomitus is expelled into the mouth

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

DDx for causes of N&V

A

● Infectious Causes
● GI Disorders
● Endocrine Causes
● Misc. Causes
● Medications
● CNS Causes

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

Diarrhea

A

Passage of loose or watery stools:
* At least three times in a 24-hour period
* >200 g/day (difficult to measure)

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

Diarrhea pathophysiology

A

↑ water content of the stool
due to:
* Impaired water absorption
* Active water secretion by the bowel
* Acute
* Persistent
* Chronic

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

Diarrhea can generally be classified as:

A
  1. Infectious or noninfectious
  2. Inflammatory or noninflammatory
  3. Acute or chronic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Inflammatory Diarrhea

A
  • Can be due to infectious (Invasive infections) and noninfectious causes.
  • Symptoms include:
  • Diarrhea with visible blood or mucus (invading tissue). Dysentery = bloody diarrhea
  • Frequent, small-volume, and bloody stools
  • May be accompanied by tenesmus, fever, or severe abdominal pain
  • Stool will often contain leukocytes or leukocyte proteins
  • If chronic, it is likely Inflammatory Bowel Disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Non-inflammatory Diarrhea:

A

Most often caused by enterotoxin-producing organisms such as Vibrio cholerae and E.
coli, or by viruses that adhere to the mucosa and disrupt the absorptive and/or
secretory processes without causing acute inflammation or mucosal destruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Symptoms of Non-inflammatory Diarrhea

A
  • Watery
  • No blood/pus (symptoms are due to osmotic and secretory effect)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Acute diarrhea:

A

<14 days

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

Persistent diarrhea duration

A

14-29 days

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

Chronic diarrhea duration

A

> 30 days

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

Diarrhea - Risk Factors

A
  • Person to person exposure (ill contacts, daycare or senior-care centers)
  • Exposure to contaminated food or water
  • Exposure to animals (birds, reptiles often harbor salmonella)
  • Medications
  • Iatrogenic: Recent hospitalization within the last 3 months
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Diarrhea - Emergent/Urgent Risk Factors

A
  • Signs of inflammatory diarrhea: Fever, ↑ WBC, Bloody diarrhea, Severe abdominal pain
  • Passage of > 6 unformed stools/24h
  • Profuse watery diarrhea & dehydration
  • Frail older patient (> 65 yrs)
  • Immunocompromised pts
  • HIV, DM
  • Recent exposure to antibiotics
  • Weight loss
  • Pregnancy
  • Sx > 7 days
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Acute Diarrhea - Etiology

A
  • Lasts < 2 weeks (~5-7 days)
  • Acute onset
  • Most commonly caused by:
  • Infectious agents
  • Medications
  • Can be non-inflammatory or
    inflammatory diarrhea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Acute Diarrhea - non inflammatory

A
  • Watery, Non-bloody
  • Caused by virus or non-invasive bacteria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

S/S non-inflammatory acute diarrhea

A
  • Periumbilical cramping
  • Bloating
  • Nausea
  • Vomiting
  • Prominent
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Enterotoxigenic E Coli
(traveler’s diarrhea) is a common cause of ___

A

Acute non-inflammatory diarrhea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Inflammatory acute diarrhea etiology

A
  • Fever
  • Bloody (dysentery)
  • Small volume < 1L/day
  • B/C predominantly involves the colon
  • Caused by virus or invasive bacteria: Shigella, Salmonella, Campylobacter, Amebiasis, C. diff, Enterohemorrhagic E. coli
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

S/S Inflammatory acute diarrhea

A
  • LLQ cramping
  • Urgency
  • Tenesmus
  • Fever
    • fecal leukocytes present
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Infectious dysentery MUST be distinguished from _____

A

acute ulcerative colitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

the Initial goal of the practitioner evaluating diarrhea is to Distinguish between _____

A

mild disease & those with serious disease
* >90% of pts = mild/self-limited

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

If diarrhea worsens & lasts > 7 days, labs:

A
  • Fecal leukocyte
  • Bacterial cx
  • Obtain THREE samples of O&P
  • > 10 days
  • Hx of fairly recent travel
  • HIV positive
  • Oral-anal sex
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

General Nausea, Vomiting, & Diarrhea -
Treatment

A
  1. Diet
  2. Rehydration
  3. Antiemetics
  4. Antidiarrheal Agents
  5. Antibiotic Therapy
  6. Admit
28
Q

Diet in treating N/V/D

A
  1. Generally, diet should consist of softer,
    more easily digested foods, given in smaller
    amounts (BRAT diet)
  2. Bowel rest (i.e. - avoid):
    * Large meals
    * High-fiber food
    * Fats
    * Milk products
    * Caffeine
    * Alcohol
29
Q

1st line rehydration treatment in N/V/D

A

Oral rehydration
* If feasible the solution should contain
the following:
* Glucose, Na+, K+, Cl-, HCO3
, Citrate
* Oral electrolyte solutions:
* Pedialyte, Gatorade, Oral
rehydration tablets
* Ice chips
* IV fluids – SEVERE dehydration (1 liter Normal Saline (NS) or Ringer’s
Lactate (RL) IV over 60-90 min)

30
Q

The most critical therapy in diarrheal illness is

A

Hydration

31
Q

Antimicrobial Therapy

A
  • NOT warranted for all patients
  • Administered either empirically (based on likely causes) or targeted (based on
    testing)
32
Q

Targeted abx treatments for giardia

A

metronidazole

33
Q

Targeted abx treatments for amebiasis

A

metronidazole

34
Q

Targeted abx treatments for travelers diarrhea

A

Cipro or azithromycin

35
Q

Targeted abx treatments for E. coli

A

Supportive

36
Q

Targeted abx treatments for C. Diff

A

Metronidazole or vancomycin

37
Q

Chronic Diarrhea

A
  • Diarrhea present > 4 weeks
38
Q

Most common causes of chronic diarrhea

A
  • Medications
  • Lactose Intolerance
  • Irritable bowel syndrome
39
Q

Chronic Diarrhea - labs

A
  • CBC, TSH, CMP (albumin, calcium, LFT’s) TSH, vitamin A & D, INR, ESR, CRP, celiac serologic testing
40
Q

Routine stool studies:

A
  • O&P
  • Fecal Electrolytes (osmotic gap- secretory)
  • Qualitative staining for fat (sudan stain)
  • Occult blood (FOBT)
  • Leukocytes
  • Stool culture: routine identifies
    Salmonella, shigella, campylobacter
41
Q

Staphylococcus aureus

A

Gram positive cocci in clusters (grapes)
● Facultative anaerobe (ATP via O2
or fermentation)
● Can cause many infections including gastroenteritis
● Can grow in food
● Produces Enterotoxin
● Ingested toxin → 12-24 hours of:
● Abdominal pain
● Nausea
● Vomiting (Q15-30 min X 12-24hrs)
● Diarrhea

42
Q

Bacillus cereus

A

Gram positive rods
* Aerobic, spore forming, toxin-producing
* Deposits spores in food which survive initial cooking
* Heat activates the spores → causes bacteria
dump their enterotoxin into the food (the
bacteria are killed by the heat)
* Ingested toxin = nausea, vomiting,
abdominal pain, & diarrhea
* Lasts 12-24 hours usually, self-limited
* Fried rice is an important cause of Bacillus cereus

43
Q

Clostridium difficile

A

“C Diff” or Pseudomembranous Enterocolitis
* Small amount normally found in the intestine (controlled)
* Gram stain: Gram Positive Rod
* Anaerobic bacteria, spore-forming, toxin-producing
* Spores are often found in hospitals & nursing homes
* Fecal-oral ingestion of spores → intestinal colonization

44
Q

Escherichia coli

A
  • Part of normal colon flora
  • If it gains virulence factor (mutation, plasmid exchange, etc), E coli can cause
    human disease.
  • Diarrhea, UTIs, neonatal meningitis, Gram negative sepsis
  • Outbreaks can occur with fecal contamination of water
45
Q

3 important strains of E. Coli

A
  • Enterotoxigenic: Non-invasive, toxin induces watery diarrhea (travelers diarrhea)
  • Enterohemorrhagic Escherichia coli (EHEC) : Invasive diarrhea due to Shiga-like toxin.
  • Enteroinvasive: Invasive diarrhea
46
Q

HUS triad (hemolytic uremic syndrome)

A

Hemolytic anemia
Acute renal failure
Thrombocytopenia

Triad is life
Threatening
1% in adults
3% in children

47
Q

Vibrio cholerae (Cholera)

A

● Similar action to E. Coli but much more severe
● Influx of Na+
into lumen pulls water with it
● Copious watery diarrhea (up to 1 L / hr)
● “Rice Water Diarrhea”
● Fishy odor

48
Q

Treatment for cholera

A

Cipro® or azithromycin

49
Q

Salmonella

A
  • Salmonella Gastroenteritis-
  • Most common form of Salmonella
  • Sx - occur 8-48 hr post ingestion:
  • Fever
  • Abdominal pain
  • Mucous
  • Bloody diarrhea
50
Q

Treatment of Salmonella

A
  • Supportive
  • Abx do NOT shorten dz course
51
Q

Severe form of salmonella

A

Typhoid Fever
* Rx: Cipro (1st line), azithromycin,
cephalosporins or
trimethoprim/sulfamethoxazole

52
Q

A MAJOR complication of Salmonellosis = _____

A

Enteric fever (Typhoid fever)

53
Q

Symptoms of typhoid fever

A

○ SYSTEMIC - gets into the bloodstream
■ Meningitis
■ Endocarditis
■ Osteomyelitis
○ Weight loss
○ Rose spots (transient rash on abd/back)
● Culprits are Salmonella typhi & Salmonella paratyphi

54
Q

Shigella

A

“Shigella dysenteriae”
* NEVER found in normal GI flora
* Shiga toxin: Cytotoxic to intestinal
epithelium

55
Q

S/S shigella

A
  • HIGH Fever
  • Bloody/mucoid diarrhea (invasive)
  • Purulent
  • Abdominal cramping
  • Tenesmus & rectal spasms
56
Q

Treatment of shigella

A
  • Supportive treatment
  • Severe = Ciprofloxacin or TMP-SMX
57
Q

Intestinal Complications of Shigella

A
  • Proctitis
  • Rectal Prolapse
  • Toxic Megacolon
  • Intestinal obstruction
  • Colonic perforation
58
Q

Campylobacter Jejuni S/S

A
  • Fever
  • Bloody diarrhea
  • Possible association with Guillain-Barre Syndrome
  • Caution - can mimic appendicitis: often severe abdominal pain
    occurs PRIOR to onset of diarrhea
  • Key = Rebound/guarding usually absent
  • Can mimic inflammatory bowel disease colitis: starts in jejunum &
    progresses to cecum & colon.
  • Acute colitis & bloody diarrhea
59
Q

How do differentiate campylobacter jejuni from appendicitis

A

Rebound/guarding usually absent

60
Q

The two most common GI viruses are:

A
  • Rotaviruses
  • Norwalk Virus
61
Q

Leading cause of dehydrating
gastroenteritis in children worldwide

A

Rotaviruses

62
Q

= Most Common
Sources of Transmission for norovirus

A

Food handlers

63
Q

Treatment of CMV

A
  • Antiretrovirals (in HIV pts)
  • Ganciclovir
  • Prophylaxis in HIV pts when
    CD4 < 50
64
Q

Amebiasis Tx:

A
  • Metronidazole + Iodoquinol
65
Q

Giardiasis Tx

A

metronidazole

GI Exam 3 (5 decks)

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