Flashcards in Vomiting, Diarrhea, Constipation Deck (77)
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
-Chemoreceptor trigger zone (outside blood brain barrier; rich in opioid, serotonin 5-HT3, dopamine D2 receptors)
Visceral afferent stimulation caused by Mechanical obstruction
malignancy, gastric volvulus, peptic ulcer disease, adhesions, hernias, Crohns,
With abdominal/epigastric pain, always think
Pancreatitis causes epigastric pain that radiates to
back (will see increased lipase on blood tests)
stone on common bile duct
Visceral afferent stimulation caused by dysmotility
gastroparesis (from diabetes, post viral, post vagotomy), scleroderma, amyloidosis, familial myoneuropathies
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
Visceral afferent stimulation caused by Hepatobiliary or pancreatic disorders
acute pancreatitis, cholecystitis/lithiasis
Visceral afferent stimulation caused by topical GI irritants
alcohol, NSAIDs, antibiotics (Tetracyclines- take with milk or crackers)
Visceral afferent stimulation caused by Post op/other
cardiac disease, acute MI, heart failure, urologic disease, stones, pyelonephritis
Vestibular disorders that can cause N/V
Labyrinthitis, Meniere syndrome, motion sickness
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
Irritation of CRTZ
-Antitumor & Chemo/ Radiation meds
-Meds/Drugs (opioids, anticonvulsants, antiparkinsons, Bblockers, antiarrhythmics, digoxin, nicotine, BC pills, cholinesterase inhibitors, diabetes meds)
Systemic disorders that can irritate CRTZ
Diabetic ketoacidosis, uremia, adrenocortical crisis, parathyroid disease, hypothyroidism, pregnancy, paraneoplastic syndrome
History clues- morning vomiting?
Pregnancy, alcohol, increased ICP
History clues- after meals?
Biliary (think gallstone or gallbladder issue possibly)
History clues- undigested food?
Gastroparesis or gastric outlet obstruction
History clues- green emesis?
Bowel obstruction, biliary (classic presentation)
RUQ pain? Murphy's sign?
Pelvic pain in woman?
CMP will show
CLASSIC: Hypochloremic, hypokalemic, metabolic alkalosis (prolonged emesis)
-Could be from vomiting, diuretics
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
Small bowel obstruction on Xray
MUST KNOW FOR TEST!!
-air fluid levels (and stool on X-ray)
Dehydration, electrolytes, aspiration, Boerhaave’s Syndrome, Mallory Weiss Tears
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)
Mallory Weiss Tears
small tear in esophagus and you throw up blood- from force of throwing up (bulimics and alcoholics)