Week 9 Clinical Examination N /V

Question 1

Before breakfast N/V :

5 causes

Answer 1

1. Preg
2. Alcohol
3. Uremic
4. High intracranial P
5. Cannabis use (Compulsive showering and bathing)

Question 2

N/V immediately after meal :

Answer 2

Bulimia or psychogenic cause

Question 3

Food undigested after more then 1hr after meal N/V

Answer 3

Gastric outlet obstruction

Gastroparesis

Question 4

N/V all the time : 4 causes

Answer 4

1. Gastroparesis
2. Gastric outlet obstruction
3. Dymotility
4. CNS or systemic problem

Question 5

N/V with no abd pain

Answer 5

Food poisoning
Gastroenteritis
Drugs
Disease (DKA, sepsis)

Question 6

N/V WITH ABD PAIN SEVERE

Answer 6

Peritonitis
-itis in an organ
Obstruction
Pancreatic or Biliary tree problem

Question 7

Things to consider with N/V

Answer 7

Migraine
Vertigo 
Meningitis 
CNS tumor
Hemorrhage 
Renal problem
Heart problem

Question 8

D is what

Answer 8

More then 3 bowel movements a day or liquid stools

Question 9

Non-inflammatory D is like what

Answer 9

Watery, non-bloody, mild self limited, viral or non-invasive bacteria
= cramping (bacteria)
= Poop and NIGHT
= V (virus)
= in SI ** (so watery)
= ETEC, S. Aureus, B. Cereus, C. perfringens, Shigella, Giardia, entaritis, norovirus)

Question 10

D inflammatory is like what and from what

Answer 10

Blood + fever + LLQ pain*, urgency , tenesmus (incomplete emptiness)
= invasive bacteria
= in colon (so not as watery)
= shigella, salmonella, campylobacter, Yersinia, Amebiasis, C. Diff, STEC)

Question 11

Chronic D

Answer 11

More then 4 weeks

= medication (NSAIDs, , Metformin**, Allopurinol, PPI, ACE2 inhibitors)

Question 12

Osmotic D

Answer 12

After eating (lactose, sorbitol (sugar substitute), fructose, alcohol, high fructose), Mg/ P = laxatives

Question 13

Secretory D

What is it and 3 causes

Answer 13

Watery
= bile salt malabsorption (like after removing GB)
= IBD
= endocrine tumor

Question 14

Inflammatory chronic D

Answer 14

Blood and pus, abd pain, fever can happen, WL, hematochezia

= IBD

Question 15

Malabsorption chronic D

Answer 15

Significant WL, nutritional def, osmotic D, steatorrhea
= Pancreatic insufficiency
= Lymph obstruction
= SI overgrowth bacteria

Question 16

Conditions that can casue chronic D

Answer 16

DM
Collagen vascular disorder
Thyroid problem
IBS —> no other problems (motility problem)

Question 17

How to look at hydration of pt

Answer 17

Hypotension 
Tachy 
Dry mucous 
Skin turgor 
Sunken eyes and dry no tears 
 Hypotension orthostatic

Question 18

Dehydration is what

Answer 18

Water loos without loosing electrolytes
= hypernatremia
= can be from osmotic D

Question 19

Orthostatic hypotension

Answer 19

1. Patient lays down 3-10min
2. Take BP
3. Pt stands up for 3 min
4. Take BP
   = Systolic reduction by 20mmHg or more, diastolic reduction in 10mmHg or more is + sign
   = diastolic in normal people should go up a little

Question 20

What pt are very sensitive to volume depletion

Answer 20

Children