Week 2- Dr. Smoot Flashcards
what things about the history suggest GI origin
Diarrhea
– Abdominal discomfort
– Prior abdominal surgery
– Recent ingestion of an enterotoxic pathogen
• shellfish, poultry, raw fish, home canned foods
• recent international travel or cruise ship voyage
– History of peptic ulcer disease
– Early satiety
– Timing of vomiting
what things about the physical exam suggest gi origin
Abdominal distention – Surgical scar – High pitched bowel sounds – Tenderness to palpation – Palpable mass – Succussion splash
what things about the history suggest non gi origin
– Pregnancy – True vertigo – Weight fluctuations – Presence of a chronic illness • Chronic kidney disease • Metabolic disorders – Head injury – Flank pain – Recovery from surgery
what things about the exam suggest non gi origin
Palpable gravid uterus – Focal neurologic signs – Confusion, delirium – Papilledema – Nystagmus – Flank tenderness – Glaucoma-Narrow angle /acute onset
what about the history suggests a functional disease
Gastroparesis-like nausea
and vomiting with normal
gastric emptying time
what about the exam suggest a functional disease
■ No visible abnormalities
what is gastroparesis
the food stays too long in the stomach. the churning and breaking down of the food doesnt happen properly so the food stays in the stomach longer. this can cause nausea and vomiting
a person has a small bowel obsturction what does the vomit look like
bloody
bilious
undigested food
what does the inspection look like on a small bowel obstruction
distension
peristalsis
ecchymosis
what does the auscilation sound like with a small bowel obstruction
rushes and tinkles
absent bowel sounds
what is percussion like with small bowel obstructions
tenderness
tympani
sucession splash
what is cyclic vomiting? What are the phases
■ Stereotypical episodes of vomiting specifically regarding onset (acute)
and duration (less than one week)
■ Three or more discrete episodes in the prior year and two episodes in the
past six months, occurring at least one week apart
■ Absence of nausea and vomiting between episodes
■ Severe abdominal pain initially in the epigastrium, radiating diffusely
and beginning with the onset of nausea and vomiting
■ Well phase- where the person is essentially without
symptoms.
■ Pre-emetic (prior to vomiting) phase characterized by pallor,
intense sweating and intense nausea.
■ Intense vomiting- up to 20-30 vomiting episodes essentially
retching and dry heaving per day which can lasting usually
from 1-4 days or, in some cases, up to a week.
■ Recovery phase where the patient’s vomiting decreases, the
nausea improves, and the patient is able to take in liquids by
mouth.
describe what cannabinoid hyperemesis syndrome is
■ Stereotypical episodic vomiting resembling cyclic vomiting syndrome (CVS)
in terms of onset, duration, and frequency.
■ Presentation after prolonged excessive cannabis use (>5 years of daily use
of Marijuana).
■ Relief of vomiting episodes by sustained cessation of cannabis use.
Supportive remarks:
■ May be associated with pathologic bathing behavior to help relieve
symptoms (prolonged hot baths or showers will relieve symptoms).
what is rumination syndrome
■ Effortless, fountain – like, and repetitive regurgitation of
gastric contents within 5 to 30 minutes of ingestion with
either re-swallowing or spitting up of the contents
■ Occurs for solids and liquids
■ Often preceded by belching or belch sensation
■ The regurgitant consists of recognizable just ingested food
and may have a pleasant taste
■ Nausea and wretching do not precede the regurgitation
■ “meal in, meal out, day in, day out” setting
what is early satiey
Becoming full after eating much less food than normal
■ This must be consistent lasting for several days to weeks
■ Important to distinguish from loss of appetite
– Patient is hungry when starting to eat, but feels full after eating
less food, which may be progressive.
■ Most commonly associated with Stomach Cancer
– Patient with cancer will over time develop a loss of appetite
making it more difficult to distinguish one from the other.
– Cancer patients will also have weight loss
