Nausea and vomiting

Question 1

Whata re 4 things to think about as causes of N&V

Answer 1

Problems in the brain
Problems with heart and abdomen
Vertigo
Things in the blood

Question 2

What does undigested food suggest about N&V

Answer 2

Oesophageal disorder- achalasia, pharyngeal pouch

Question 3

What does slightly digested food suggest about cause of N&V

Answer 3

Gastric outflow obstruction- cancer, pyloric, stenosis and pancreatic pseudocyst
Gastroparesis

Question 4

What is gastroparesis

Answer 4

Delayed gastric emptying

Question 5

Who is gastroparesis seen in

Answer 5

Diabetics

Question 6

What does bilous vomit suggest about cause

Answer 6

Bowel obstruction distal to ampulla of vater

Question 7

What 2 things can cause feculent vomit

Answer 7

Distal bowel obstruction

Gastrocolonic fistula

Question 8

Why is timing of vomit relevant

Answer 8

In morning suggests raised ICP

Question 9

What does vomiting within an hour of eating suggest about cause of N&V

Answer 9

Obstruction proximal to gastric outlet

Question 10

Why is peptic ulcer history relevant in N&V history

Answer 10

Can lead to scarring and ultimatly pyloric stenosis

Question 11

What does vomiting a long time after eating suggest about cause of N&V

Answer 11

Small bowel obstruction

Question 12

What symptoms tend to present with gastroparesis and gastric outflow obstruction

Answer 12

Early satiety
Bloating
Abdo discomfort

Question 13

What does early satiety suggest about vomiting cause

Answer 13

Gastric outflow obstruction

Question 14

What does fever suggest with nausea and vomiting cause

Answer 14

Any inflammation or infection of abdo organ

Question 15

Why is focal neurology relevant with nausea and vomiting

Answer 15

Migraine
Meningitis
Encephalitis
Motility disorder

Question 16

What questions to ask about for exposure to pathogens in suspected gastroenteritis

Answer 16

Travel
Living in close quarters
Close contacts have something similair
Unusual meals recently

Question 17

First thing to think about with cause of nausea and vomiting

Answer 17

Is it acute (under 1 month)

Or chronic

Question 18

If acute vomiting what symptoms help narrow down differentials

Answer 18

Vertigo
Abdo pain
Headache

Question 19

What are categories of acute N&V differentials

Answer 19

Vertigo
Abdo pain
Headache
Shortly after food
None of these symptoms

Question 20

Causes of vertigo and nausea and vomiting

Answer 20

Menieres
Vestibular neuritis
BPPV
Acoustic neuroma

Question 21

Causes of headache nausea and vomiting

Answer 21

ICP SOL
Meningitis
Encephalitis
Migraine

Question 22

Causes of abdo pain with fever and nausea and vomiting

Answer 22

Appendicits
Cholecystitis
Hepatitis
Mesenteric adenitis
Pancreatitis
Food poisoning

Question 23

Causes of abdo pain with no fever and nausea and vomiting

Answer 23

UTC
MI
SBO
DKA
LBO
Mesenteric ischaemia
Testicular torsion
Drug overdose

Question 24

Causes of chronic nausea and vomiting

Answer 24

Upper GI obstruction- mechanical and functional
Coeliac disease
Oesophagitis
Pharyngeal pouch

Question 25

Problems in brain leading to nausea and vomiting

Answer 25

SOL Migraine Meningitis Encephalitis

Question 26

Things in blood leading to nausea and vomiting

Answer 26

Drug overdose Uraemia from renal failure Excess of hormones Electrolyte abnormalities

Question 27

Reduced consciousness with nausea and vomiting

Answer 27

DKA Meningitis ICP

Question 28

What looking for on inspection of nausea and vomiting

Answer 28

``` Hydration status- vomiting loses fluids Abdo distension- SBO Scars- SBO Jaundice- hepatobiliary cause Hernias- SBO ```

Question 29

Bloods ordered nausea and vomiting

Answer 29

``` FBC- infective cause U&Es- electrolyte abnormalities from those lost VBG- lactate and electrolytes Amylase- exclude pancreatitis Liver enzymes- hepatobiliary picture Group and save- off to surgery ```

Question 30

How long must patient be sat up before erect CXR

Answer 30

10mins

Question 31

Investigations for nausea and vomiting if young woman

Answer 31

Pregnancy

Question 32

What analgesia shouldnt be given in dehydrated patients

Answer 32

NSAIDS

Question 33

What anti-emetic shouldnt be given in context of SBO

Answer 33

Metoclopramide | Cyclizine or ondensatron are better options

Question 34

Managment plan for SBO

Answer 34

``` NBM Drip and suck Analgesia Antiemetics Trial conservative management provided no strangulation signs If hasnt resolved go to surgery ```

Question 35

What would make you definetely go to surgery in SBO

Answer 35

Strangulation or peritonism signs Conservative trial hasnt worked No history of abdo surgery meaning sinister causes more likely Patient is in a lot of pain

Question 36

Main clinical sign is gastroenteritis not food poisoning

Answer 36

Food poisoning lasts less than 24 hours generally

Question 37

What does ketonuria suggest in gastroenteritis

Answer 37

In state of starvation as not eating

Question 38

Why would patient with DKA have hyponatraemia

Answer 38

Pseudohyponatraemia from high glucose

Question 39

In DKA how is insulin given

Answer 39

Infusion

Question 40

If have burst appendix what is done in surgery

Answer 40

Appendicectomy and wash out of any contents