Week 9 Special Populations N / V

Question 1

N / V in preg happen when and stops when and how to TX

Answer 1

1. After 6 weeks
2. 16week -18weeks
3. Small frequent meals, low fat, high carbs
   Ginger, Vit B6 can help, avoid medications

Question 2

Hyperemisis gravidarum

What is it and lab findings

Answer 2

Severe V persistent in pregnant women = WL, and hypervolemia , dehydration
= elevated liver enzymes
= high hCG
= more common in more then 1 fetus OR Hydatidiform mole
= can be associated with hyperthyroidism**

Question 3

Hyperemisis gravidarum imagining

Answer 3

None do not image

Question 4

Preg women N/V after 10 weeks

Answer 4

Look at dx that have nothing to do with preg
= all things we talked about + 
= acute fatty liver of preg
= preeclampsia
= ovarian torsion

Question 5

N with no V preg tx

Answer 5

Treat with diets and ginger and B6

Question 6

N and V preg tx

Answer 6

IF Hypovolemia +Tachy + orthostatic hypotension = urine ketones, elevated specific gravity, electrolyte abnormalitities ——> more serious (they are in gluconeogenesis)

Question 7

D and preg

Answer 7

Not associated with preg
= avoid meds
= Flexible sigmoidoscopy preferred imaging **(to see IBD)
= US is also fine

Question 8

D and preg DONOT

Answer 8

= radiation on imaging
= Bismuth Subsalicylate (you can give Loperamide if needed)
= AB dont give flouriquinones and tetracyclines

Question 9

2 most common GI problems in neonate and how to SX and DX

Answer 9

1. Pyloric Stenosis : progressive gastric outlet obstruction (non-bile V, Dehydration, US muscle ring is more then 4mm thick, Barium swallow
2. Hirshsprung’s Disease : Cant poop, V, ABD distention, constipation, KUB x ray no gas in pelvic colon and dial aged proximal colon

Question 10

Congenital atresia + Stenosis

Inborn errors of metabolism

Answer 10

1. In utero seen, dilated loops SI, no colon gas, barium can see narrowing at atresia in colon, V
2. Rare only very serious, hyperammonemia, hypoglycemia, Metabolic acidosis,

Question 11

Childhood and infancy 2 most common problems

Answer 11

1. Intussusception : V/ hematochezia, palpable mass, US dx and Barium enema tx/dx, drawing up knees
2. Malrotation : error in 10 weeks, SBO sx, V, barium swallow looking at SI*

Question 12

Adolescents and children most common GI problem

Answer 12

Incarcerated hernia 
= painless ,mass
= indirect inguinal most common
= coughing, standing for long can hurt
= surgery

Question 13

Increased intracranial p 3 causes

Answer 13

Bad CNS sx, RR abnormal, bradycardia, can be from trauma

1. Hydrocephalus : NO LUMBAR PUNCTURE, MRI, US see size of ventricles
2. Subdural hematoma : MRI, CT
3. Tumor : MRI , CT

Question 14

3 causes of N/V not thought of always

Answer 14

1. Infection : Otitis media, UTI, strep pharyngitis
2. Preg
3. Cannabis : looks for many hot showers

Question 15

GI obstruction in children SX

Answer 15

1. projectile vomiting (stenosis or SBO)

2. Hematemisis

Question 16

bulding frontanelle infants

Answer 16

hydrocephalus or meningitis

Question 17

headache and no N, Vomiting

Answer 17

increased intracraninal P, mass

Question 18

adrenal crisis sx in children

Answer 18

hypotension, hyponatremia, hyperkalemia