Approach to GI Patient: Nausea & Vomiting

Question 1

Acute small bowel obstruction etiology?

Answer 1

Caused by adhesions due to multiple abdominal surgeries, diverticulitis, or chrons disease

Question 2

History of SBO?

Answer 2

-N/V often feculent -Intermittent crampy periumbilical pain - Obstipation

Question 3

PE for SBO?

Answer 3

-Abdominal pain and distension ***High pitch tinkling bowel sounds

Question 4

Diagnosis and Treatment of SBO?

Answer 4

Diagnosis: -Plain KUB Xray/ Abdominal series XR or CT -XR shows dilated loops of small bowel or air fluid levels Treatment: -Nasogastric tube to suction -Surgery if nasogastric unhelpful

Question 5

Gastroparesis possible etiologies?

Answer 5

Diabetes Mellitus

Question 6

History of those with gastropariesis?

Answer 6

Intermittent waxing and waning symptoms -chronic or intermittent symptoms of postprandial fullness -N/V 1-3 hours post meal

Question 7

Diagnosing gastroparesis?

Answer 7

Gastric emptying study using a low fat solid meal such as eggs -gastric retention of 60% after 2 hours or more than 10% after 4 hrs is abnormal

Question 8

Tx of gastroparesis?

Answer 8

Supportive:

• eat small frequent low fiber, milk, gas forming foods and fat
• Avoid opioids and anticholinergics bc they decrease GI motility

Acute exacerbations:

• Nasogastric suction
• IV fluids

Medications:

• Metoclopramide
• Erythromycin

Last resort:

• Gastric electrical stimulation