Flashcards in Gastro - Vomiting and Regurgitation Deck (64)
What are the three most common causes of esophageal disease?
Esophagitis, esophageal foreign body, and mega-esophagus
What anatomic abnormalities lead to esophageal disease?
Vascular ring anomaly, cricopharyngeal disease, hiatal hernia, and diverticulum
What type of obstructions lead to esophageal disease?
Mural, luminal, or extraluminal obstruction
What can cause esophagitis?
trauma, foreign bodies, reflux (anesthesia), and irritation
What motility disorders lead to esophageal disease?
megaesophagous, neuropathy, and myopathy
Esophageal disorders are characterized by what?
Failure of transport and/or reflux
What are some clinical signs of regurgitation?
Hypersalivation, odynophagia, anorexia, dysphagia, nasal discharge, and coughing
Vomiting and regurgitation are two very different processes but often get confused. Describe vomiting.
Vomiting is an abdominal effort, there is prodromal nausea, usually digested food, no swallowing pain
Vomiting and regurgitation are two very different processes but often get confused. Describe regurgitation.
Passive event, no prodromal nausea, undigested food, possibly painful
What are the 'right' questions to ask in regards to vomiting or regurgitation?
Is there abdominal effort? Is it digested food that is brought up? What is the relation to eating? Are there swallowing difficulties? Pain on eating?
What should be done during physical examination when you are trying to determine the cause of vomiting and/or regurgitation?
Esophageal palpation, lung asucultation, determine underlying or concurrent disease, and determine body condition
What diagnostic tests are important for esophageal disease diagnosis?
Hematology and biochemistry, diagnostic imaging and endoscopy
What are the common causes for mega-esophagus?
Idiopathic megaesophagus, myasthenia gravis, thymoma, and hypoadrenocorticism
What are the rare causes of mega-esophagus?
Polyneuritis, polymyositis, dysautonomia, CNS disease, botulism/tetanus, systemic lupus erythematosus, lead/thallium toxicity, and hypothyroidism
Why is aspiration pneumonia a common complication of regurgitation?
Because regurgitation is not associated with reflex closure of the larynx leaving the airway unprotected
What chemical irritants can cause esophagitis?
corrosive agents and medications like doxycycline
Gastroesophageal reflux can lead to esophagitis. What can cause gastroesophageal reflux?
general anesthesia, hiatal hernia, persistent vomiting, and poorly positioned feeding tubes
How is esophagitis treated?
Dietary modifications, sucralfate liquid, and inhibit gastric acid secretion
What dietary modifications need to be made for treatment of esophagitis?
small meals, high protein-low fat food to minimize reflux +/- a gastric feeding tube
What gastric acid secretion inhibitors are most useful in cases of esophagitis?
proton pump inhibitors - omeprazole
What is a possible, serious complication, of esophagitis treatment?
Where do esophageal foreign bodies like to lodge themselves?
At the thoracic inlet, heart base, or hiatus
How are esophageal foreign bodies treated?
endoscopic retrieval or push into the stomach
Are esophageal foreign bodies considered emergencies?
yes - there is a potential for mucosal damage/perforation
What three pathophysiologic things can induce vomiting?
the chemoreceptor trigger zone, vagal and sympathetic afferents in the stomach acting on the brainstem, and the cortex acting on the brainstem
What can act on the chemoreceptor trigger zone to cause vomiting?
drugs, toxins, uremia, infections, and motion sickness
What are some primary acute causes of (GI) vomiting?
Dietary, infection, obstruction, and motility disorders/gastric volvulus
What are some primary chronic causes of vomiting?
Inflammatory disease and neoplasia
What primary causes of vomiting are the most common?
Dietary, infection (parasites), inflammatory disease, obstruction (foreign body)