Term
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Definition
| ill defined and unpleasant, although not painful, sensation generally perceived in the pharynx and upper abdomen. It is usually accompanied by hypersalivation and the desire to vomit, or the feeling that vomiting is imminent |
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Term
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Definition
| a forceful expulsion of gastric contents through the mouth |
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Term
| when should you start building your ddx? *(probable test q)* |
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Definition
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Term
| can any infection (bacterial, viral, parasitic) cause acute infectious disease? |
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Definition
| yes. in *children, n/v are common symptoms of systemic infections outside the GI tract |
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Term
| what are considered acute abdominal emergencies? |
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Definition
| perforation (extremely sick), peritonitis (very irritated in belly), intestinal obstruction (ask about BMs), ischemia (seen in older pts w/coronary artery disease, intestinal angina), visceral inflammation (acute hepatitis), appendicitis, pancreatitis, and cholecystitis (overeating) |
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Term
| what are common drug/toxin causes of n/v? |
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Definition
| ETOG, NSAIDs, digoxin, morphine, antibx, and enterotoxins |
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Term
| what CNS disorders can lead to n/v? |
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Definition
| increased CNS pressure due to neoplasms/encephalitis/hydrocephalus, migraine headaches and acute meningitis |
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Term
| when is n/v usually seen associated with pregnancy? |
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Definition
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Term
| what are psychogenic causes of n/v? |
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Definition
| anorexia, bulimia, and emotional upset |
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Term
| how can gastric distention lead to n/v? |
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Definition
| dysmotility (gastroparesis) and pyloric obstruction (usually in babies w/stenosis) |
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Term
| what metabolic and endocrine disorders can lead to n/v? |
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Definition
| DKA, adrenal insufficiency, thyrotoxicosis, acute renal failure, uremia, hypercalcemia |
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Term
| what forms of indigestion can lead to n/v? |
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Definition
| peptic ulcer disease (reflux/abdominal pain) and aerophagia (air swallowing - nervous/hyperventilating people) |
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Term
| what labyrinthine disorders can lead to n/v? |
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Definition
| acute labrinthinitis (vertigo/dizziness), and maniere's disease |
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Term
| what GI bleeding disorders can lead to n/v? |
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Definition
| blood in the stomach may stimulate vomiting as well as diarrhea |
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Term
| what cardiac disease may lead to n/v? |
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Definition
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Term
| is pain more associated with nausea or vomiting? |
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Definition
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Term
| what are the 7 attributes of a symptom? |
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Definition
| location, quantity, quality, duration, setting, remitting/exacerbation factors, and associated symptoms |
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Term
| what should early morning vomiting make you think of? |
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Definition
| pregnancy, alcoholic gastritis, and uremia |
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Term
| what should feculent vomiting make you think of? |
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Definition
| gastrocolic fistula and distal obstruction |
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Term
| what should projectile vomiting make you think of? |
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Definition
| increased intracranial pressure and pyloric stenosis |
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Term
| what should bilious vomiting make you think of? |
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Definition
| obstruction below the ampulla of vater |
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Term
| what should bloody vomiting make you think of? |
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Definition
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Term
| what should vertigo/tinnitus associated with n/v make you think of? |
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Definition
| meniere's disease, labyrinthitis |
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Term
| what should relief of abdominal pain associated with vomiting make you think of? |
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Definition
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Term
| what should early satiety associated with n/v make you think of? |
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Definition
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Term
| what should wt loss associated with n/v make you think of? |
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Definition
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Term
| if a pt vomits during or soon after eating, what is the likely cause? |
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Definition
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Term
| what might delayed vomiting after eating be due to? |
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Definition
| obstruction or dysmotility |
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Term
| what might vomiting old food be associated with? |
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Definition
| impaired gastric emptying |
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Term
| what might vomiting undigested food be associated with? |
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Definition
| esophageal or zenker's diverticulum |
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Term
| can unusual stressors, emotional upset, depression lead to n/v? |
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Definition
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Term
| what etiologies do dental carries lead you to in terms of n/v? |
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Definition
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Term
| what are other signs of altered autonomic activity that might lead you towards that as a cause for n/v? |
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Definition
| diarrhea, increased perspiration, hypersalivation |
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Term
| what does just the word "anorexia" mean? |
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Definition
| loss of appetite - not the same as anorexia nervosa |
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Term
| what are other signs of intravascular volume depletion that might lead you towards that as a cause for n/v? |
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Definition
| tenting (check skin turgor on forehead/center of chest), bradycardia, hypotension, pallor, tachycardia + tilt test |
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Term
| what is the tilt test? *(probable test q)* |
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Definition
| take BP/HR lying down. have pt stand up and wait 3 min. take BP/HR again. measure systolic, diastolic, heart rate and symptoms, need 3 of the 4 positive to be a positive tilt test. systolic blood pressure – 10-20% drop is positive and any drop in diastolic is positive. HR should increase ~10-20% (*most important part of the test*). symptoms such as dizziness are positive. |
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Term
| what needs to be done w/a positive tilt test? |
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Definition
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Term
| what part of the physical exam is really important for n/v pts? |
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Definition
| checking: abdominal tenderness, rebound, guarding, distention, abnormal bowel sounds (hyperactive, hypoactive, absent, high pitched tinkling – sound/sign of obstruction). you are supposed to listen to bowel sounds for 5 min. |
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Term
| what tests can be run for n/v pts? |
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Definition
| CXR, upper GI, EGD, gastric emptying scans, CT of brain, pregnancy test, electrolytis, LFTs, CBC, and TSH levels. |
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Term
| how are pts with n/v managed? |
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Definition
| tx the underlying cause. antiemetics for symptomatic relief. prevent and tx complications if they develop. diet: NPO, BRAT, hard candy, popsicles. pt education for: explanation, sequelae, signs/symptoms that need immediate eval or f/u. |
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Term
| what is the most important factor in determining etiology? |
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Definition
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Term
| what needs to be assessed w/hx of frequent or prolonged vomiting? *(probable test q)* |
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Definition
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Term
| what needs to be checked w/hx of unwitnessed hematemesis? |
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Definition
| stool for occult blood (they will often swallow a little blood w/vomiting) |
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Term
| in females, what needs to be checked w/hx of vomiting and amenorrhea? |
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Definition
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