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CSI > vomiting, diarrhea, constipation > Flashcards

vomiting, diarrhea, constipation Flashcards

1
Q

chronic nausea/vomiting, think what conditions??

A

gastroparesis: DM neuropathy, unable to digest
dx with a radio labeled egg that is undigested

tx: Reglan, metoclopromide (prokinetic)
erythromycin (but tachyphylaxis? effect: tolerance, stops working after several doses)
FYI can put in gastric pacemakers

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2
Q

with excessive vomiting, watch out for ??

A

rupture of esophageal varicose: can rupture

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3
Q

if drink drano, don’t induce vomiting because ??

A

will corrode esophagus 2x!!

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4
Q

induced vomiting can b ??

A

medication/iatrogenic in the hospital

on purpose

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5
Q

N/V mediated by

A

Brainstem mediated in medulla

stimulated by: 4 next cards

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6
Q

Afferent vagal fibers from GI viscera 5-HT3 receptors due to ??

A

biliary or GI distention, mucosal or peritoneal irritation, or infections. (pre-formed toxins)

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7
Q

Vestibular system, ??

A

H1 and muscarinic cholinergic receptors

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8
Q

Amygdala, ??

A

sights/smells/emotion

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9
Q

Chemoreceptor trigger zone (outside blood brain barrier)

A

Rich in opioid, serotonin 5-HT3, dopamine D2 receptors

effected by meds

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10
Q

mechanical obstructions

A

gastric outlet obstruction, PUD, Ca, gastric volvulus

small int. obstruction, adhesions, hernias, volulus Crohn’s, Ca

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11
Q

dysmotility

A

gastroparesis, DM, postviral, post vagotomy

sm. int: scleroderma, amyloidosis, chronic intestinal pseudo obstruction

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12
Q

peritoneal irritation

A

peritonitis: perforated viscus, appendicitis,(rebound tenderness) spontaneous bacterial peritonitis (bac from gut into peritoneal cavity: if cirrhotic, dec. immune system)

viral gastroenteritis: Norwalk, rotavirus

“food poisoning”: Bacillus cereus, S. aureus, C. perfringes

Hepatitis A, B
acute systemic infections

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13
Q

hepatobiliary or pancreatic disorders

A

acute pancreatitis

cholecystitis (inflamed GB) or choledocholithiasis (stone in common bile duct)

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14
Q

topical GI irritants

A

etOH, NSAIDs, oral abx (tetras)

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15
Q

postop

A

due to anesthesia

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16
Q

other causes of N/V

A

cardiac disease: acute MI, HF

urologic disease: stones, pyelonephritis

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17
Q

vestibular disorders

A

labyrinthitis, Menieres, motion sickness

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18
Q

CNS disorders

A

inc. ICP: CNS tumors (morning), subdural, SAH
migraine
infections: meningitis, encephalitis
psychogenic

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19
Q

irritation of CRTZ

A 
antitumor chemo
meds/drugs?? (nicotine gum misuse)
radiation tx
systemic disorders 
DKA
pregnancy
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20
Q

morning vomiting

A

Pregnancy, alcohol, increased ICP

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21
Q

after meals

A

biliary, GB issue

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22
Q

undigested foods?

A

Gastroparesis or gastric outlet obstruction

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23
Q

Green Emesis

A

Bowel obstruction, biliary emesis

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24
Q

examination

A

Rebound?
RUQ Pain? Murphy’s?
Pelvic Pain in Woman? (think gyne, ovarian pathology) PID, ovarian torsion

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25
Q

vomiting CMP

A

Hypochloremic, hypokalemic, metabolic alkalosis (prolonged emesis

26
Q

other testing

A 
KUB, Obstructive Series 
NM Gastric Emptying Study
Barium Upper GI Study
EGD
CT w or w/o, RARELY w and w/on (note that is 2 scans) (pick ONE typically)
Head CT? (check for tumor)
27
Q

slide 12 on left

A

stool seen on right on pt

28
Q

slide 12 on right

A

see air bubbles: small bowel obstruction

29
Q

most common dx

A 
Viral Gastroenteritis
Bacterial Gastroenteritis
Ileus
Small Bowel Obstruction
Opiate Induced
Gastroparesis 
Pregnancy 
Chemotherapy 
Anesthesia 
Gallstone
Pancreatitis 
*Ascites (from inc. pressure)
30
Q

complications of vomiting

A

Dehydration, electrolytes
aspiration (into lungs: chemical inflammation, if have fever start on anaerobic abx coverage)
Boerhaave’s Syndrome (rupture esophagus, emergency, rare, v. painful)
Mallory Weiss Tears (more common, less serious, smaller tears from force of vomiting)

31
Q

vomiting tx

A

Symptomatic management
-Clear liquids to full liquids to soft diet
Admit patient?
NG tube? (swallow when going down to ensure not in lungs, XR to figure out in lungs, listen for gurgling sound with sterile saline)
Antiemetic Medications

32
Q

serotonin 5-HT3 antagonists

A

ondansetron (zofran) IV, oral
granisetron (chemo?)
dolasetron
Palonosetron (chemo)

33
Q

ondansetron

A

oral or IV

postop N/V

34
Q

granisetron

A

IV for chemo

35
Q

dopamine receptor antagonists

A

metoclopramide IV, oral
*prochlorperazine IV, IM, oral, rectum
*promethazine IV, oral, rectum
trimethobenzamide oral, IV
SEs: dyskinesias

36
Q

marijuana: used as tx and causes vomiting

A

THC active ingredient, available by Rx as dronabinol
Helps with nausea of chemo, has CNS side effects

NOTE: some have paradoxical reaction, Cyclic Vomiting Syndrome, Canabis Hyperemesis Syndrome:
Classic History: Improvement of symptoms of N/V with taking a hot shower

37
Q

2nd Case: traveller’s diarrhea

A

pepto bismol

Postinchain doesn’t like cipro: risk of C. diff

38
Q

Diarrhea

A

Range from acute self limiting to fatal (cholera)
10L approximately entering duodenum, all but 1.5 L absorbed, colon absorbs rest less than 200ml in stool lost

Definition: 200-300g in 24 hour period
Alternate Definition: more than 3 bowel movements per day (may be norm) or liquidity

39
Q

acute diarrhea

A 
less than 2 weeks
-Non inflammatory:
Watery, non bloody 
Self limited
Virus or noninvasive bacteria 
-Inflammatory:
Blood, pus or fever
Invasive organism or toxin producing 
Clostridium difficile, E coli O157:H7
40
Q

risk for acute diarrhea

A

Pregnancy? Higher risk of listeriosis (avoid soft cheese)
Day care? Hiking? Higher risk Giardia or Cryptosporidium
Traveler’s diarrhea
Antibiotics? C diff colitis (metronidazole, vanco SLD) (can have without C. diff)
HIV? ie: CMV

41
Q

med risk for acute diarrhea ??

A

Do NOT give immodium (loperimide) or diphenoxylate with atropine, risk of increased contact time with gut

42
Q

virus causing diarrhea on cruiseship

A

norovirus

slide 24

43
Q

slide 25

A

causes

44
Q

slide 26

A 
algorithm
send for fecal leaks
routine stoll cx
C. diff assay
o/p
more
45
Q

med Good for traveler’s

A

Bismuth subsalicylate

46
Q

opioid receptor agaonist

A

Loperamide

47
Q

IBD??

A

UC or Crohn’s: affects terminal ileum

48
Q

chronic diarrhea time

A

> 4 wks

49
Q

slide 29, 30

A

types/causes
laxatives
malabsorption: lactase deficiency, malfuncitoning pancreas

50
Q

case 3: constipation

A

can add metamucil
prune juice

10-15% of adults
More common in women, elderly
If bed bound, may be due to inability to get to toilet

51
Q

dx constipation

A

History is key
Physical examination: rectal exam, FOBT
Labs: BMP, Mag, TSH
? Colonoscopy (only if thinking tumor)

52
Q

slide 34 more causes

A 
inadequate fluid
hypothyroidism
*hyperthyroidism: can lead to hyperCa2+ and cause constipation*
neuro disorders
CCBs
53
Q

primary constipation

A

Normal transit time is 35 hours, more than 72 hours is abnormal
Impaired relaxation of anal sphincter and/or pelvic floor muscles
Irritable Bowel Syndrome (IBS) (pain relieved with bowel movement, can fluctuate C/D)

54
Q

secondary constipation

A

Systemic disorders, medications, obstructing colonic lesions:
Hypercalcemia, hypokalemia, hypothyroidism, calcium channel blockers (amlodipine/nifedipine)

55
Q

secondary constipation: cancer: Warning signs:

A

Age >50 with: hematochezia, weight loss, anemia, FOBT +, family history of colon CA, IBD patients

56
Q

constipation tx

A

Lifestyle measures
Dietary changes
Mineral oil
Laxatives, Osmotic laxatives, Stimulant laxatives
Magnesium citrate – AKA “liquid TNT” – Magnesium Mg “makes you go”
Prune juice
Opioid Induced Constipation: Methylnaltrexone (Relistor), subcutaneous injection
Enema or Suppository
Fecal Impaction
Manual disimpaction
OMT: colonic milking

57
Q

most common

A

polyethylene glycol (miralax, golytely)

stimulant lax: senna: ExLax, may cause cramps add with docusate (1st line)

Lactulose: prevents buildup of ammonium, good for liver pts

58
Q

Ogilvie syndrome

A

AKA Acute Colonic Pseudo-obstruction (ACPO)
massive dilation of large intestine

put tube in colon, suck air out, stop opiates, get pt to walk around

59
Q

FA facts

A

Projective vomiting in 2-6 week old = palpable “olive” mass: Congenital pyloric stenosis
Achalasia – bird’s beak on barium swallow, ? (pic) If from Chagas disease
Boerhaave syndrome – esophageal rupture

60
Q

FA facts 2

A

Diverticulosis vs. Diverticulitis (when it becomes INFECTED) (LLQ Pain, fever, leukocytosis)
Intussusception – “currant jelly” stools

CSI (75 decks)

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