Vomiting, Diarrhea, Constipation Flashcards Preview

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Flashcards in Vomiting, Diarrhea, Constipation Deck (77)
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1

Nausea and vomiting pathway

Brainstem mediated in medulla, stimulated by:
-Afferent vagal fibers from GI viscera 5-HT3 receptors due to biliary or GI distention, mucosal or peritoneal irritation, or infections.
-Vestibular system, H1 and muscarinic cholinergic receptors
-Amygdala (sights/smells/emotion)
-Chemoreceptor trigger zone (outside blood brain barrier; rich in opioid, serotonin 5-HT3, dopamine D2 receptors)

2

Visceral afferent stimulation caused by Mechanical obstruction

malignancy, gastric volvulus, peptic ulcer disease, adhesions, hernias, Crohns,
carcinomatosis

3

With abdominal/epigastric pain, always think

cardiac (MI)

4

Pancreatitis causes epigastric pain that radiates to

back (will see increased lipase on blood tests)

5

Cholelithiasis

gallstones

6

Cholecystitis

inflamed gallbladder

7

Choledocholithiais

stone on common bile duct

8

Visceral afferent stimulation caused by dysmotility

gastroparesis (from diabetes, post viral, post vagotomy), scleroderma, amyloidosis, familial myoneuropathies

9

Visceral afferent stimulation caused by peritoneal irritation

peritonitis, perforated viscus, appendicitis, spontaneous bacterial peritonitis, viral gastroenteritis, Norwalk agent, rotavirus, food poisoning toxins from Bacillus cereus, Staph aureus or clostridium perfringens, Hep A or B, acute systemic infection

10

Visceral afferent stimulation caused by Hepatobiliary or pancreatic disorders

acute pancreatitis, cholecystitis/lithiasis

11

Visceral afferent stimulation caused by topical GI irritants

alcohol, NSAIDs, antibiotics (Tetracyclines- take with milk or crackers)

12

Visceral afferent stimulation caused by Post op/other

cardiac disease, acute MI, heart failure, urologic disease, stones, pyelonephritis

13

Vestibular disorders that can cause N/V

Labyrinthitis, Meniere syndrome, motion sickness

14

CNS disorders that can cause N/V

Increased intracranial pressure (CNS tumors, subdural/subarachnoid hemorrhage)
Migraine infections (meningitis, encephalitis)
Psychogenic- anticipatory vomiting, anorexia/bulimia, psych disorders

15

Irritation of CRTZ

-Antitumor & Chemo/ Radiation meds
-Meds/Drugs (opioids, anticonvulsants, antiparkinsons, Bblockers, antiarrhythmics, digoxin, nicotine, BC pills, cholinesterase inhibitors, diabetes meds)

16

Systemic disorders that can irritate CRTZ

Diabetic ketoacidosis, uremia, adrenocortical crisis, parathyroid disease, hypothyroidism, pregnancy, paraneoplastic syndrome

17

History clues- morning vomiting?

Pregnancy, alcohol, increased ICP

18

History clues- after meals?

Biliary (think gallstone or gallbladder issue possibly)

19

History clues- undigested food?

Gastroparesis or gastric outlet obstruction

20

History clues- green emesis?

Bowel obstruction, biliary (classic presentation)

21

Rebound pain?

Peritonitis

22

RUQ pain? Murphy's sign?

appendicitis

23

Pelvic pain in woman?

gyn/ovarian pathology

24

CMP will show

CLASSIC: Hypochloremic, hypokalemic, metabolic alkalosis (prolonged emesis)
-Could be from vomiting, diuretics

25

Other Tests to order

-KUB (kidney, urinary, bladder), Obstructive Series (xrays standing, sitting, laying, to check air fluid levels)
-NM Gastric Emptying Study
-Barium Upper GI Study (up to small intestine)
-EGD (put camera in mouth/down throat to look into stomach)
-CT w or w/o, RARELY w and w/on (note that is 2 scans)  usually only WITH or WITHOUT
-Head CT? to rule out tumor

26

Small bowel obstruction on Xray

MUST KNOW FOR TEST!!
-air fluid levels (and stool on X-ray)

27

Complications

Dehydration, electrolytes, aspiration, Boerhaave’s Syndrome, Mallory Weiss Tears

28

Aspiration- if someone throws up look for complications; if they throw up and take deep breath, vomit goes into lungs, causes chemical inflammation- may show up hours or days later- if they spike a fever- start on ________

antibiotic for anaerobic coverage (bacteria from gut is in lungs)

29

Mallory Weiss Tears

small tear in esophagus and you throw up blood- from force of throwing up (bulimics and alcoholics)

30

Boerhaave’s Syndrome

esophageal rupture (in FA)