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Gastrointestinal Module > Vomiting Diarrhea And Constipation > Flashcards

Vomiting Diarrhea And Constipation Flashcards

1
Q

Nausea

A

Uneasiness of stomach that often comes before vomiting

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2
Q

Vomiting

A

Forcible voluntary or involuntary emptying of stomach contents through the mouth

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3
Q

Are nausea and vomiting diseases ?

A

No mostly symptoms

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4
Q

Causes of vomiting and nausea

A 
Motion sickness 
Early stages of pregnancy 
Medication induced vomiting 
Intense pain 
Emotional stress 
Gallbladder diseases
Food poisoning
Infections 
Overeating
 Rxn to certain smells or odeurs 
Heart attack
Concussion / brain injury 
Brain tumor 
Ulcers 
Some forms of cancer 
Bulimia 
Gastroparesis / slow stomach emptying 
Ingestion of toxins or alcohol
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5
Q

Most common cause of vomiting in children

A 
Viral infections 
Milk allergy
Motion sickness 
Overeating 
Coughing
Blocked intestines 
Illness with high fever
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6
Q

Possible cause of vomiting if happens after eating

A

Food poisoning
Gastritis
Ulcer
Bulimia

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7
Q

4 pathways of vomiting

A

CNS :
Stimuli ( high intracranial pressure, irritation of meninges, emotional trigger) activate part of CNS with cerebral cortex and limbic system by serotonin, neurokinin, dopamin and GABA

CTZ : blood borne emetics
Triggers ( metaboli abnormalities, toxins, medications) activate CTZ by dopamin , serotonin, neurokinin receptors

Vestibular system : inner ear motion
Trigger ( vestibular apparatus disturbance in inner ear due to motion sickness , dizziness) activate inner ear with histamine (H1)and acetylcholine receptors

Solitary tract nucleus : peripheral pathways
Vagal , sympathetic, glossopharyngeal afférents triggers which act on solitary tract nucleus by serotonin , dopamin , acetylcholine, histamine, neurokinin and CB. Receptors

All act on emetic center in the medulla by neurokinin which induces vomiting

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8
Q

Medication of diarrhea and nausea

A

Dehydration -> oral electrolytes or IV rehydration if severe

Motion sickness and vertigo -$ antiH1, antiM (meclizine, scopolamine )

When migraine , headaches -> antid2 ( metocloprzmide, prochlorperazine, chlorpromazine)

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9
Q

Medical complications of vomiting in chemotherapy induced vomiting

A

Dehydration
Electrolyte imbalance
Aspiration pneumonia

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10
Q

Types of CINV

A 
Acute 
Delayed 
Breakthrough 
Anticipatory
Refractory
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11
Q

Acute CINV

A

Within 24h of chemotherapy

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12
Q

Delayed CINV

A

Within 24h- 5 days

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13
Q

Breakthrough CONV

A

Occur despite prophylactic

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14
Q

Anticipatory CINV

A

Triggered by taste, odour, memories, visions, anxiety

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15
Q

Refractory CINV

A

Occur in subsequent cycles when antiemetics have failed before

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16
Q

High emetogénic agent

A 
Cisplatin
Dacarbazine
Cyclophosphamide
Carmustine 
Mechlorethamine
Streptozocin
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17
Q

Moderate emetogenic

A 
Carboplztin
Methotrexate
Docetaxel
Paclitaxel
Etoposide
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18
Q

Risk factors that out patients at risk of CINV

A 
Type of chemotherapeutic 
Female sex
Âge (under 55)
History of light alcohol abuse
History of previous CINV
History of N+V during pregnancy 
History of motion sickness
Anxiety / depression
Anticipation of CINV
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19
Q

Pathophysiology of CINV

A

Emesis as defense mechanism by area postrema of medulla oblongata

Triggers Lead to substance P which activates NK1

Vagal and ENS activated serotonin receptors

Direct activation of serotonin receptors

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20
Q

Treatment of CINV

A

5HT3 antagonists -> do laser Ron, ondansetron, granisetron, palonosetron
Per os, IV , transdermal patch

NK1 inhibitors -> aprepitant, netupitant,

Metoclopramide ( D2 antagonist)
Diphenhydramine, meclizine in rescue treatment
Cannabinoids

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21
Q

Best drug cocktail for CINV

A

Serotonin antagonist + NK1 inhibitor + dexamethasone

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22
Q

Diarrhea

A

Common. And usually not serious Bowel movement that is loose and watery at least 3 times in 24h

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23
Q

Pathology of diarrhea

A

Decreased electrolyte and water absorption
Increased secretion by intestinal mucosa
Increased luminal osmotic load
Inflammation of mucosa and exudation into lumen

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24
Q

Goal diarrhea treatment

A

Restore the fluid / electrolytes balance

Treat the cause of the diarrhea

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25
Types of diarrhea
Acute | Chronic
26
Acute diarrhea characteristics
Sudden onset Last less than 2 weeks Mostly infectious in etiology 90% Some due to medications , toxins and ischemia 10% Could be action of laxatives and diuretics
27
Chronic diarrhea
Last more than 4 weeks Mostly non infection Seen in IBS, Colorectal cancer
28
Dysentery
Stools with blood or mucus
29
Persistent diarrhea
Diarrhea present for more than 14 days
30
Signs and symptoms of diarrhea
``` Abdominal bloating Thin or loose stools Watery loose Sense of urgency to have bowel movement Nausea Vomiting If severe -> blood, mucus, un digestedfood in stools , Weight loss, Fever ```
31
Common form of diarrheas
Rotavirus -> in children less than 2yearz old Cholera, E. coli, shigellosis -> children aged 2-5yo E. coli, campylobacter -> all ages Amebiasis , cryptosporidium -> immunocompromised
32
Main cause of acute diarrhea
``` Viral Bacterial Drug induced Nutritional Protozoan ```
33
Chronic diarrhea causes
``` Tumors Diabetes IBS Addison’s disease Hyperthyroidism ```
34
Nutritional causes of diarrhea
``` Alcohol Caffeine Food causing gas like beams Nicotine Spicy foods Foods high in acids like oranges Fatty foods like sausage Dairy products In lactose intolerant ```
35
Bacteria that causes diarrhea
``` E. coli Salmonella Shigella Campylobacter Vibrio Yersini C. Difficile S. Aureus B. Cereus C. Botinilum ```
36
Virus that can cause diarrhea
``` Adenovirus Rotavirus Calicivorus Astrobirus Norwalk virus ```
37
Fungi that can cause diarrhea
Fungi | Yeast
38
Parasite that can cause diarrhea
E histolytica Gardia lamblia Cryptosporidium Isospora
39
Pathogenesis of diarrhea due to microbes
Transmission mostly feco oral ( rota by air, shigella by person to person )
40
Different form of diarrhea based on pathophysiology
``` Osmotic Malabsorption Secretory Inflammatory Abnormal motility ```
41
Osmotic diarrhea
A substance draws water from body into bowel
42
Secretory diarrhea
Body secretes water into the bowel ( like in infections, drugs. ) Abnormal ion transported into intestinal epithelial cells
43
Exudation diarrhea
Diarrhea with pus and blood in stool | Seen in IBS like CD and UC
44
Osmotic mechanism
Accumulation of non absorbable water soluble | Retain water in bowel
45
Causes of osmotic diarrhea a
``` Magnesium sulfate Excess sorbitol and mannitol Diasaccharids intolerance Generalized malabsorption Lactose intolerance ```
46
Malabsorption. Diarrhea
``` Luminal phase (intraluminal digestion ) Mucosal phase (mucosal disease and loss ) Transport phase -> steatorrhea ```
47
Causes of malabsorption diarrhea
Bacteria outgrowth Pancreatic insufficiency Mucosal disease ( CD, Celiac spruce )
48
Celiac sprue
Gluten sensitive enteropathy Reaction against gluten from diet Seen in the whites
49
Drugs Causes of malabsorption
Luminal effect -> neomycin, cholestyramine, alcohol Mucosal effect-> methotrexate, colchicine Stricture -> NSAID Enterocyte -> alcohol Brush border enzyme effect -> neomycin, alcohol Intracellukar effect -> laxatives, colcichime, biguanides
50
Secretory diarrhea causes
Cholera enterotoxin E. coli enterotoxin Vernier Morrison syndrome vasoactibe intestinal peptide Bile salts in colon after ileal resection Laxatives Carcinoid tumors
51
Inflammatory diarrhea
``` Damage to intestinal mucosa cell leading to loss of fluids and blood Pain Fever Bleeding Inflammation ```
52
Causes of inflammatory diarrhea causes
Shigella dysentery UC CD
53
Abnormal motility diarrhea
``` Underlying disease leading to increased frequency of defecation Large volume Malabsorption (steatorrhea) Diarrhea diarrhea Bloating Gas ```
54
Abnormal motility diarrhea causes
Diabetes mellitus neuropathy Post vagotomy Hyperthyroid IBS
55
Non specific Treatment of diarrhea
``` Hydration Absorption -> kaopectate Bismuth Anti peristaltic/ opiates derivatives Fiber supplementation ORS -> oral rehydration solution ```
56
Constipation
Infrequent bowel movement , usually less than 3 movement per week
57
Obstipation
Severe constipation with no passage of stool or gas
58
Signs and symptoms of constipation
``` Desire to defecate Pain and intestinal discomfort Swelling in abdomen, cramps, and colic Several days without being able to defecate Hemorrhoids, appendicitis, acne Hard stool after straining in toilets Excess gas and bloatinG Vomiting Headaches Intestinal obstruction Loss of appetite Offensive breath Bad taste in mouth ```
59
When are you considered constipayed
If you have 2 of more of these over 3 months Straining during bowel movement more than 25% of time Hard stool more than 25% of time Incomplete evacuation ore than 25% of time Two or fewer bowel movement in a week
60
Type of stools
Type 1 -> sepearte hard lumps like nuts Type 2-> sausage shaped but lumpy Type 3 -> sausage like with cracks on surface Type 4-> sausage like smooth and soft Type 5-> soft blobs with clear cut edges Type 6 -> fluffy pieces with ragged edges m mushy stool Type 7 -> entirely liquid
61
Type of stools that indicate condtipation
Type 1 and 2
62
Ideal type of stools
Type 3 and 4
63
Type of stools tending towards diarrhea
Type 5-7
64
Causes of constipation
``` Diet Lack of excercise Age Irregular bowel habits Drug induced Disease states Spasm of sigmoid colon Dysfunction of myenteric plexus Travel Painkillers Drugs Environmental changes Pregnancy ```
65
Causes of constipation during pregnancy
1st trimester -> progesterone slows down intestinal activity Late stage -> pressure of uterus on intestines and rectum , iron supplement, stress , sedentary lifestyle
66
Management of constipation k
Lifestyle changes (exercise, hydration, fibers diet, vegetables , fruits, milk etc ) Laxatives Surgical removal if very severe and needed

Gastrointestinal Module (15 decks)

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