N/V/D + hernias Flashcards

(43 cards)

1
Q

What can cause acute N/V without abdominal pain?

A

food poisoning, infectious gastroenteritis, drugs, systemic illness

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2
Q

What can cause acute N/V WITH abdominal pain?

A

peritoneal irritation, acute gastric or intestinal obstruction, pancreaticobiliary disease

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3
Q

what can cause persistent vomiting?

A

pregnancy, gastric outlet obstruction, gastroparesis, intestinal dysmotility, psychogenic disorders, CNS disorders, systemic disorders

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4
Q

What can cause N/V before breakfast?

A

pregnancy, uremia, alcohol intake, increased ICP, cannabinoid hyperemesis syndrome

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5
Q

What can cause N/V after meals?

A

bulimia, psychogenic

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6
Q

What can cause N/V of undigested food 1+ hours later?

A

gastroparesis, gastric outlet obstruction

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7
Q

What can cause generally N/V?

A

Mechanical obstruction, dysmotility, peritoneal irritation, infections, hepatobiliary or pancreatic disorders, GI irritants, post-op, vestibular disorders, CNS disorders, irritation of chemoreceptor trigger zone

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8
Q

What should a workup include for N/V?

A

– serum electrolytes
Hypokalemia, azotemia, metabolic alkalosis
– flat + upright abdominal XR
Dilated loops
– CT of abdomen
Best for SBO
– upper endoscopy
Gastric outlet obstruction
– nuclear scintigraphy studies or C-octanoic acid breath tests
Gastroparesis, delayed gastric emptying
– liver enzymes, amylase, lipase
Pancreaticobiliary disease
– head CT or MRI
CNS

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9
Q

How do you treat N/V?

A

Clear liquids, ginger

IV saline w/ KCl
NG tube for gastric or mechanical SBO

Serotonin 5-HT3-receptor antagonists:
Ondansetron, granisetron, palonosetron (enhanced with NK1 + steroid), post-op, chemo

Steroids: dexamethasone

Neurokinin receptor antagonists: aprepitant, fosaprepitant, rolapitant (+ for chemotherapy)

Dopamine antagonists: prochlorperazine, promethazine (sedative)

Antihistamines and anticholinergics: meclizine, scopolamine, dimenhydrinate (motion sickness, vertigo, migraines)
B6 & doxylamine for pregnancy

Cannabinoids: dronabinol

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10
Q

Asymptomatic or epigastric discomfort, postprandial bloating/fullness, dysphagia, SOB, nausea/vomiting after eating, anemia, reflux symptoms

A

hiatal hernia

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11
Q

What predisposes someone to a hiatal hernia?

A

Age, obesity, power-lifting, scoliosis

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12
Q

What’s the MC type of hiatal hernia?

A

sliding (upward herniation of stomach/GE junction)

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13
Q

Type I “sliding” of upward herniation of stomach/GE junction – MCC
Type II “rolling” GE junction stays fixed with gastric fundus herniating adjacent to esophagus with risk of strangulation
Type III “mixed” both GE junction AND fundus herniate through hiatus, fundus above GE Junction
Type IV “large defect”, presence of structure other than stomach within hernia sac

A

hiatal hernia

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14
Q

Hiatal hernia dx

A

Barium swallow
endoscopy to determine if gastric or esophageal inflammation is present and ruling out cancer

Reflux symptoms = manometry and pH monitoring

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15
Q

How do you treat a hiatal hernia?

A

Type I = GERD → PPIs and weight loss

Type II = surgical repair
Type III = surgical repair
Type IV = surgical repair

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16
Q

asymptomatic = swelling or fullness in hernia site, enlarges with increased intraabdominal pressure/standing, may develop scrotal swelling
Incarcerated = painful, enlargement, N/V if bowel obstruction
Strangulated = systemic toxic

A

inguinal hernia

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17
Q

What predisposes someone to an inguinal hernia?

A

Prior surgery
Obesity
Increased abdominal pressure, aging, congenital

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18
Q

hesselbach’s triangle – indirect (MC) or direct protrusion

A

inguinal hernia

19
Q

How do you treat other hernias?

A

Small incisional hernias treated early – direct fascia-fascia repair, nonabsorbable sutures, increased tension
OR
Elastic corset

Larger hernias: dissection, non-absorbable mesh

20
Q

bulge near femoral nodes

A

femoral hernia

21
Q

femoral hernias are common in

22
Q

protrusion of abdominal cavity contents below inguinal ligament
Highest rate of incarceration and strangulation

A

femoral hernia

23
Q

umbilical hernias are most common in

24
Q

surgery is required for umbilical hernias if unresolved by

25
incisional hernias can happen after
abdominal surgery
26
What are RFs for diarrhea?
Age Immunodeficiency Medications Travel Infected food/water Food sensitivity
27
What are the many types of diarrhea?
Osmotic, secretory, inflammatory, medication induced, malabsorption, motility disorder, chronic infections Acute = <2 weeks noninflammatory (toxin-producing bacterium) or inflammatory (disruption and destruction of intestinal epithelium), mostly infectious Chronic = >2-4 weeks from conditions, medications
28
What may you see on a PE for diarrhea?
PE: poor skin turgor, HOTN, AMS, abdominal tenderness, rebound tenderness, hemoccult, weight loss Worrisome findings: high fever >101.3, dehydration, frequent bloody stools w/ tenesmus, severe abdominal pain, immunosuppression, no improvement Can do: stool tests, cultures, testing, endoscopy, mucosal biopsy, imaging
29
SSRIs (citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline), cholinesterase inhibitors (rivastigmine, donepezil/memantine, galantamine), NSAIDs, ARBs, metformin, PPIs, allopurinol, orlistat
chronic medication-induced diarrhea
30
Stool volume decreases with fasting, increased stool osmotic gap
osmotic diarrhea
31
what can cause osmotic diarhrea?
Meds – antacids, lactulose, sorbitol Disaccharidase deficiency – lactose intolerance Factitious diarrhea – magnesium (antacids, laxatives)
32
Large volume >1L/day, little change with fasting, normal stool osmotic gap
secretory diarrhea
33
What can cause secretory diarrhea?
Hormonal - VIPoma, carcinoid, medullary carcinoma of thyroid, Zollinger-Ellison syndrome Factitious diarrhea (laxative abuse) Villous adenoma Bile salt malabsorption Antibiotics, metformin cholerae
34
Fever, hematochezia, abdominal pain UC, Chron’s disease Microscopic colitis Malignancy Radiation enteris
inflammatory conditions inducing chronic diarrhea
35
Weight loss, abnormal lab values, fecal fat >10g/24 hour Small bowel mucosal disorders, lymphatic obstruction, pancreatic disease, bacterial growth
malabsorption syndromes inducing chronic diarrhea
36
Prior abdominal surgery or systemic disease Post-surgical, systemic disorders, IBS
motility disorders inducing chronic diarrhea
37
chronic infections are often
parasite or aids related
38
what's first line in treating diarrhea
DIET: bowel rest by avoiding high-fiber foods, fats, milk products, caffeine, and alcohol Drink tea and “flat” beverages Eat easily digested foods (soup, crackers, bananas, applesauce, rice, toast Rehydrate Lactated rings if severe dehydration
39
for NONINVASIVE diarrhea, what are meds you can try?
Antidiarrheal/antimotility (NOT for those with invasive diarrhea): Bismuth subsalicylate (pepto-bismol) Safe with dysentery (fever + bloody diarrhea) SE: dark colored stools NO in children with viral illness Opioid agonists diphenoxylate/atropine (lomotil) SE: CNS/anticholinergic effects, N/V, abdominal pain, constipation Loperamide Indicated for noninvasive diarrhea Avoid with dysentery
40
is empiric treatment always indicated for diarrhea?
no. risk of HUS with STEC.
41
what are safe abx meds for diarrhea generally?
fluoroquinolones and azithromycin
42
specific antimicrobial treatment is not recommended in those with
nontyphoid salmonella, campylobacter, or yersinia expect in SEVERE disease
43
STEC should/should not be treated with antibiotics
SHOULD NOT