Chronic Vomiting

Question 1

What signs are indicative of vomiting?

Answer 1

Abdominal contraction
vomitus may contain bile
nausea or salivation- careful with this.

Question 2

T/F Chronic vomiting is a symptom, not a diagnosis.

Answer 2

True

Question 3

What are some common differentials for chronic vomiting?

Answer 3

Primary gastrointestinal-inflammatory bowel disease, neoplasia, parasitism, idiopathic gastritis, chronic FB

Extra-GI/systemic: hyperthyroidism, chronic pancreatitis, hepatobiliary disease, chronic kidney disease, hypercalcemia

Question 4

What tests are common to rule out causes of chronic vomiting?

Answer 4

Blood chem, CBC, UA, T4 (hyperthyroidism),
GI parasitism: Zinc sulfate fecal

Question 5

When would you consider a hypoallergenic diet?

Answer 5

Stable patient. It is strict for 3 weeks.

Question 6

If a diet trial is performed and no improvement is seen what are generally the next diagnostic steps?

Answer 6

Radiographs, ultrasound (assess bowel layering, focal masses foreign material)

Question 7

What are the two types of gastrointestinal biopsies?

Answer 7

Surgical- invasive with more complications but are full thickness. Access to all portions of the small intestines

Endoscopic- less invasive, less risk of dehiscence, biopsies usually include mucosa +/- submucosa. Access to stomach, duodenum, and ileum. Cant get to all of the sections of intestines

Question 8

What is the treatment for inflammatory bowel disease?

Answer 8

Prednisone (prednisolone) with a recheck in 2 weeks. once CS are well controlled and albumin in within normal range for at least 2 weeks start the pred taper. Taper 25% every 2-3 weeks to lowest effective dose.