N/V/D + hernias

Question 1

How do you treat N/V?

Answer 1

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

Question 2

How do you treat a hiatal hernia?

Answer 2

Type I = GERD → PPIs and weight loss

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

Question 3

How do you treat other hernias?

Answer 3

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

Larger hernias: dissection, non-absorbable mesh

Question 4

surgery is required for umbilical hernias if unresolved by

Answer 4

age 5

Question 5

what’s first line in treating diarrhea

Answer 5

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

Question 6

for NONINVASIVE diarrhea, what are meds you can try?

Answer 6

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

Question 7

is empiric treatment always indicated for diarrhea?

Answer 7

no. risk of HUS with STEC.

Question 8

what are safe abx meds for diarrhea generally?

Answer 8

fluoroquinolones and azithromycin

Question 9

specific antimicrobial treatment is not recommended in those with

Answer 9

nontyphoid salmonella, campylobacter, or yersinia expect in SEVERE disease

Question 10

STEC should/should not be treated with antibiotics

Answer 10

SHOULD NOT