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GI2 E1 > nausea and vomiting > Flashcards

nausea and vomiting Flashcards

clin med

1
Q

define rumination

A

regurge, rechew, + reswallow

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2
Q

what general complications are associated with N/V

A 
dehydration
malnutrition
dental caries
metabolic alkalosis+hypokalemia
aspiration
pneumonia
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3
Q

what is the trx for N/V secondary to inner ear dysfunction

A

antihistamines

meclizine

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4
Q

what is the trx for gastroparesis

A

metoclopromide + erythromycin

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5
Q

what is the trx for N/V secondary to motion sickness

A

anticholinergic scopolamine

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6
Q

what is the trx for N/V secondary to chemotherapy

A

ondonsetron, SSRI, glucocorticoid

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7
Q

what is the clinical presentation of gastroparesis

A

intermittant, worsening, waxing + waning, early satiety, N/V 1-3 hours after meals

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8
Q

what are common causes of gastroparesis

A

DM

hypothyoid, post-surgery complication, parkinson/MS, postvital/chagas, amyloidosis

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9
Q

how do you diagnose gastroparesis

A

gastric scintigraphy= gastric content retention 60% after 2 hours, >10% after 4 hours is abn

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10
Q

what is the treatment for gastroparesis

A

eat small meals with decreased fiber, milk, and fat

avoid opioids/ antichol
give meds to increase gastric emptying (metoclopromide, erythromycin)

electric stimulation

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11
Q

what is the trx for an acute exacerbation of gastroparesis

A

nasogastric suction and IV fluids

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12
Q

what is the clinical presentation of acute paralytic ileus

A

n/v, obstipation, distention, decrease bowel sounds

post surgery patients w electrolyte abn, severe illness

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13
Q

how do you diagnose an acute paralytic ileus

A

plain abd radiography/ CT scan w gas, fluid distension in bowels

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14
Q

what is the trx for acute paralytic ileus

A

restrict oral intake w slow liberalization of diet, control analgesics + avoid opioids

in severe/prolonged ileus= need nasogastric suction, parenteral administration of fluids+electrolytes

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15
Q

what is the etiology acute small bowel obstruction

A

caused by adhesion, (abd surgeries, diverticulitis, crohn’s)

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16
Q

what is the clinical presentation of acute small bowel obstruction

A

n/v can be feculent, obstipation, distension, HIGH PITCHED TINKLING BS, no BM or flatus

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17
Q

how do you diagnose of acute small bowel obstruction

A

KUB/abd radiography, CT showing dilated loops of small bowel and air fluid levels

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18
Q

what is the trx for acute small bowel obstruction

A

nasogastric tub to suction, suppurative

if persist, surgery

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19
Q

define functional dyspepsia

A

> 3 months of dyspepsia w/o an organic cause

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20
Q

define pyrosis and describe the etiology that leads to it

A

heartburn/indigestion + waterbrash (bad taste in mouth from acid)

=result of acid reflux into esophagus from stomach, gastric motor dysfunction, visceral afferent hypersensitivity

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21
Q

pyrosis is worsened by ____

A

increased gastric contents, lying down/bending over, obesity/pregnancy/ascites, tight clothes, hiatal hernia decreased LES tone (smoking, scleroderma…)

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22
Q

what sx are present with pyrosis

A

30-60 min after eating, N/V/dysphagia –> asthma, cough, aspiration/pneumonia, chronic bronchitis, dental caries, sleep apnea

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23
Q

what are complications that can develop from pyrosis

A

laryngopharyngeal reflux (LPR), esophagitis, barrett’s esophagus

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24
Q 
what are the two types of gastritis and differentiate between their
location
inflammatory infiltrate
acid production
gastrin produciton
histology
Ab type
associated CA
A

H PYLORI TYPE=TYPE A

antrum
neutrophils+subepithelial plasma cells
increased acid production, 
gastrin normal to low
polyps
anti-H. Pylori Ab
B cell lymphoma, adenocarcinoma (low), MALTOma
AUTOIMMUNE= TYPE B
fundus+body
lymphocytes and Mø
decreased acid production
increased gastric production --> achlorhydria
neuroendocrine hyperplasia
Ab to parietal cells
carcinoid tumor, adenocarcinoma (high)
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25
how do you detect h pylori
fecal ag test urea breath test warthin starry stain
26
what is the trx of h pylori gastritis
none unless they have PUD or MALToma, which you would trx that
27
what are the diagnostic measures for autoimmune gastritis
cbc serum Vit B12, acid assays IF Ab/parietal cell Ab
28
what is the trx of autoimmune gastritis
parenteralB12 | if extensive damage, do periodic surveillance
29
use of what medication will increase risk of H Pylori
prednisone
30
what is the clinical presentation of PUD
nausea, dyspepsia, burning pain
31
what complication of PUD is a surgery emergency
perforated viscus= a hollowed out organ perforates | cxr shows free air under the diaphragm or in the mediastrinum
32
what are the two types of stress ulcers (PUD)
curling= peptic ulcers in patients with severe burns cushings= peptic ulcers s/p TBI or CNS lesion
33
when do you want to eradication H Pylori what is the abx trx
in the setting of MALToma omeprazole/lansoprazole clarithromycin metronidzaole amoxicillin
34
what are the risk factors for gastric adenocarcinoma
``` increased risk with smoked fish+meat pickled veggies nitrosamines benxpyrenes decreased fruits and veg H Pylori smoking blood type A menetriere ds ```
35
what physical exam findings are indicative of gastric adenocarcinoma
virchows node is showing in the neck about the clavicle as having a metastasis linitis plastica= diffuse stomach CA signet-ring cells krukenburg tumors of the ovary
36
most gall bladder stones are what time
cholesterol 20% pigment stones
37
what are the risk factors for cholelithiasis
Fat Female Fertile Fair uncontrolled DM, increased carbs/TG males w cirrhosis or Help C biliary sludge with prolonged fasting
38
clinical presentation of cholelithiasis
obstruction of the cystic or common bile duct biliary colick= severe, steady, RUQ age starting 30-90 minutes after a meal, radiate to the R scapula or back white, clay like stools (bilirubin is blocked), tea colored urine
39
what are the physical exam findings associated with cholecystitis
RUQ and epigastric pain w (+) Murphy's sign guarding +rebound tenderness palpable GB, jaundice
40
what are the test findings with acute vs chronic cholecystitis
acute= bilirubinemia, increase liver enzymes+serum amylase, US shows increased wall thickness, pericholecystic fluid, chronic= test are normal, US shows stones and contracted GB
41
what are some complications of acute cholecystitis
gangrene s/p vasoconstriction perforation+necrosis emphysematous GB secondary to DM fistula
42
what are some complications of chronic cholecystitis
porcelain GB-->incidental calcified lesion, poor prognosis w increased risk of CA
43
what are the main causes of pancreatitis
gallstones in the biliary tract heavy EtOH use also hyperTG, celiac ds, vasculitis, mumps, CMV.. cystic fibrosis
44
PE findings with pancreatitis
boring epigastric pain going straight to the back, (+) cullen sign= periumbilical echymosis grey turner sign= flank echymosis (+) chvostek and trousseau sign for hypocalcemia xray= sentinal loop, conol cutoff sign
45
what are the diagnostic criterion for pancreatitis
at least 2= epigatric pain, lipase/amylase>3x ULN, CT changes consistent w pancreatitis
46
how do you quantify the severity of pancreatitis
``` ranson criterion apache II criterion > 8= high mortality HAPS BISAP 0-5= < 1% mortalirt, =BUN, Impaired mental status, Sirs, Age >60yo, Pleural effusion ```
47
what is the trx for pancreatitis
mild case= npo, rest, increased fluids (LR or NS), opioids, resume food with improvement severe case= surgery consult, hemodynamic monitoring, Ca gluconate IV, serum albumin infusion, pressors if hypovolemic, start enteral feeding w/n 48 hours of administration
48
what are potential complications of pancreatitis
3rd spacing, ileus, pre-renal azotemia, pleural effusion, necrosis w infection -> need debridement, pseudocysts, ascites
49
define an acute upper GI bleed
bleeding from a source proximal to the ligament of trietzw
50
describe a possible hx of someone with an acute upper GI bleed
anemia/hypovolemia, hematemesis, melena, hematochezia ``` hx of aoritc stenosis, renal ds portal HTN EtOH use NSAID use ASA (salicylate use), glucocorticosteroids, anticoag, peptobismol ```
51
what are the diagnostic measures for an acute upper GI bleed
1. check volumete status, fitals
52
what are the risk factors for an acute uper gi bleed
>60 yo | SBP>90, P>90blood of nasogastric or rectal exam.. admit to ICU
53
what is the trx for a GI bleed (upper or lower)
first, stabilize the patient with 2 large bore 18 gauge or bigger IV lines check their blood type for possible transfusion get an endoscopy within 24 hours if secondary to PUD, give PPI octreotide if have portal HTN
54
what increases the risk of bleeding with esophageal varices
increase with increased size, presence of dilated venules (Red whale markings), severity of liver ds, active EtOH abuse
55
how do you diagnose esophageal varices
EGD
56
how do you trx esophageal varices
1. acute resuscitation, get an 18 gauge IV in for fluids and blood emergent upper endoscopy w variceal bonding prophylactic abx balloom tamponade, TIPS, liver transplant
57
what can be done to prevent rebleeding of esophageal varices
non-selective B blockers (propranolol, nadolol) | band ligation
58
what are the sx of hemorrhagic gastropathy/gastritis
``` upper GI bleed is the most common coffee ground emesis epigastric discomfort nausea melena increased bowel sounds ```
59
how do you diagnose hemorrhagic gastropathy/gastritis
EGD w biopsy, subepithelial hemorrhage, petechiae, erosion
60
trx of hemorrhagic gastropathy/gastritis
remove offending agent, O2 + blood volume, hourly oral antacids enteral nutrition (to lower the risk of stress related bleeding) if have portal HTN, use b blockers give a PPI to prevent stress ulcers
61
compare and contrast zollinger ellison syndrome and menetriere ds location
ZES= duodenum, pancreas, fundus MD= body and fundus
62
zollinger ellison syndrome is a primary ____, and secretes ____
gastrinoma, gastrin
63
giant, thickened gastric folds in the body and fundus of the stomach, mostly mucous cells, limited lymphocyte infiltrate
menetriere ds
64
what syndrome is a risk factor for zollinger ellison syndrome
MEN 1= hyperparathyroidism, increased Ca, gigantism,
65
2/3 of zollinger ellison gastrinomas are ___ and will go to the ____
malignant | liver
66
where are gastrinomas most commonly located
duodenim (45%) | pancreas (25%)
67
diagnostic measures for zollinger ellison syndrome
age ~ 50 hypertrophic mucosal folds fastring serum gastrin > 100= CONFIRMATORY (+) secretin stimulant test
68
how do you diagnose menetriere ds
endoscopy w biopsy | hypoproteinemia + weight loss +diarrhea
69
what is the trx for zollinger ellison syndrome
PPI, laparatomy w resection
70
increased PTH --> increased Ca --> ___
constipation
71
what is the trx for menetriere ds
cetuximab gastric resection in severe cases increased risk of adenocarcinoma
72
fried rice --> vomiting
bacillus cereus
73
what is the treatment of mallory weiss tear
usually stops bleeding spontaneously, can give epi, clipping, or catheterization therapy
74
PE findings with boerhave syndrome
CXR with air in the mediastinum subQ emphysema subQ crepitus
75
what is the trx of boerhaave syndrome
NPO, parenteral abx, surgery, endoscopic stenting
76
what is the most common cause of food poisoning and what kinds of foods do you get it from
staph aureus | mayo and eggs
77
what foods can give you shigella caused food poisoning
lettus

GI2 E1 (19 decks)

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