GI Concerns in the Primary Care Setting Flashcards
What is nausea?
an ill-defined and unpleasant, although not painful, sensation generally perceived in the pharynx and upper abdomen. It is usually accompanied by hypersalivation and the desire to vomit, o the feeling that vomiting is imminent.
What is vomiting?
the forceful expulsion of gastric contents through the mouth.
What should you think when a 25 year old pt presents with 2 days of nausea and vomiting?
- Acute infectious diseases (any bacterial, viral, parasitic infection…)
- Acute abdominal emergencies (appendicitis)
- Drugs and toxins
- Intracranial disease
- Pregnancy
- Psychogenic
- Gastric retention
- Metabolic and endocrine disorders
- Chronic indigestion (gastritis)
- Labyrinthine disorders
- GI bleeding
- Cardiac disease (MI)
- Pain (bone fracture…)
What do nausea and vomiting common symptoms of in children?
systemic infections outside of the GI tract.
What are some acute abdominal emergencies related to nausea and vomiting?
- Perforation
- Peritonitis
- Intestinal obstruction
- Ischemia
- Visceral inflammation
- Appendicitis
- Pancreatitis
- Cholecystitis
What drugs and toxins can cause nausea and vomiting?
ETOH, NSAIDs, digoxin, morphine, antibiotics (augmentin= amoxicillin + clavulonic acid), enterotoxins
What CNS disorders can cause nausea and vomiting?
- Increased CNS pressure: neoplasms, encephalitis, hydrocephalus
- Migraine headaches
- Acute meningitis
When does pregnancy most often cause nausea and vomiting?
Usually only in the first trimester, but may continue into the next trimester
What psychogenic problems can cause nausea and vomiting?
- Anorexia Nervosa
- Bulimia
- Emotional upset
What are some gastric retention disorders that can cause nausea and vomiting?
- Dysmotility (diabetic stomachs don’t empty as well; gastroparesis).
- Pyloric Obstruction
What are some metabolic and endocrine disorders that cause nausea and vomiting?
- Diabetic Ketoacidosis (DKA)
- Adrenal Insufficiency
- Thyrotoxicosis
- Acute Renal Failure
- Uremia
- Hypercalcemia
What are chronic indigestion problems that can cause nausea and vomiting?
- Peptic ulcer disease
- Aerophagia - air swallowing
What are some labyrinthine disorders that can cause nausea and vomiting?
- acute labyrinthitis (balance centers).
- Meniere’s disease
What GI bleeds cause nausea and vomiting?
- blood in the stomach
What cardiac diseases can cause nausea and vomiting?
- MI
- CHF
What is the most important thing you should do when a person comes into your office?
form a differential in your head.
What are the 8 attributes of a symptom?
- Onset
- Location
- Duration
- Character (sharp, dull, burning…)
- Alleviating/Aggravating factors
- Radiation
- Timing
- Severity
With what does early morning vomiting often correlate?
pregnancy, alcoholic gastritis, or uremia
What what does feculent (smells like poop) vomitus often correlate?
- gastrocolic fistula or distal obstruction
With what does projectile vomiting often correlate?
- increased intracranial pressure or pyloric stenosis
With what does bilious vomiting often correlate?
- increased bile may indicate obstruction below ampulla of Vater
With what does bloody vomitus often correlate?
- GI bleeding
What are some associated symptoms with nausea and vomiting?
- Vertigo and Tinnitus: Meniere’s disease, labyrinthitis
- Relief of abdominal pain with vomiting: peptic ulcer disease (PUD)
- Early satiety: gastroparesis
- Weight loss: malignancy
Is vomiting during or soon after eating usually due to a potential toxin?
NO. Usually this soon is due to a psychogenic cause.
