CMN 568 - Unit 4 Questions with Complete

CMN 568 - Unit 4 Questions with Complete Solutions Acute onset of severe pain and vomiting suggests what? - Correct Answer + Peritoneal irritation

• Acute gastric or intestinal obstruction
• Pancreaticobiliary disease

(McPhee p 588) Persistent vomiting suggests what? - Correct Answer + Pregnancy

• Gastric outlet obstruction
• Gastroparesis
• Intestinal dysmotility
• Psychogenic disorders
• CNS or systemic disorders

(McPhee p 589) Vomiting in the morning suggests what? - Correct Answer + Pregnancy

• Uremia
• ETOH intake

+ ↑ ICP

Vomiting after meals suggests what? - Correct Answer + Bulimia

• Peptic ulcer disease
• Other psychogenic causes

(McPhee p 589, Shimp p 373) Vomiting of undigested food 1-2 hours after a meal suggests what? - Correct Answer + Gastroparesis

• Small bowel obstruction
• Gastric outlet obstruction 1 / 4

NOTE: Sucussion splash often heard on auscultation

(McPhee p 589, Shimp p 373)

• causes of nausea and vomiting - Correct Answer 1) Visceral afferent stimulation (seratonin

receptors) 2) Vestibular disorders (fibers ↑ in histamine and muscarinic receptors) 3) CNS disorders 4) Irritation of chemoreceptor trigger zone (McPhee Table 15.1) Ways to stimulate the chemoreceptor trigger zone and cause vomiting - Correct Answer 1) Chemo 2) Medications and drugs 3) Radiation therapy 4) Systemic disorders CNS disorders that can cause vomiting - Correct Answer 1) Migraine

2) ↑ ICP

3) Infections (e.g. meningitis, encephalitis) 4) Psychogenic Vestibular disorders that can cause vomiting - Correct Answer Labyrinthitis, Meniere syndrome, motion sickness Define RETCHING - Correct Answer Strong, spasmodic, involuntary effort to vomit without bringing up emesis.(McPhee and Shimp) 2 / 4

Define REGURGITATION - Correct Answer Effortless return of gas or small amounts of food from stomach (McPhee and Shimp) Common causes of vomiting in infants - Correct Answer 1) Any acute illness (esp gastroenteritis) 2) Hypertrophic pyloric stenosis (2 - 8 weeks of life, may feel an "olive" in epigastric area after feeding) 3) Intussisception (6 - 18 months of life, sausage-shaped mass and "currant jelly" stools) 4) Regurgitation ("spitting up") -- usually normal and usually resolves by 6 - 12 months.(Shimp) Medications associated with N/V - Correct Answer + Antidepressants --SSRIs --venlafaxine

• Cardiac meds

--antiarrhythmics --anti-HTN meds (diuretics, beta blockers, CCBs) -- ↓ CHO meds (statins, gemfibrozil, niacin) -- Digoxin

• Chemotherapy agents
• GI meds

--sulfasalazine (for tx of UC) --azathioprine (tx of Crohns or UC)

• Meds to treat infectious diseases

-- Acyclovir -- Anti-fungals

-- ABX

-- UTI meds 3 / 4

-- TB meds

• Pain meds

-- Anti-gout meds -- Aspirin -- NSAIDs -- Opioids

• Others

-- Lithium -- Metformin -- BC pills -- Quinidine (Shimp Table 46-2) OLD CART - Correct Answer *O*nset -- When did it start *L*ocation -- Can you pinpoint it? Does it radiate?*D*uration -- How long have you had it?*C*haracter-- Is it sharp, dull, throbbing, burning, crampy, colicky?*A*ggravating factors -- What makes it worse?*R*elieving factors -- What makes it better?*T*iming -- Is the pain constant or intermittent? Does it occur at a certain time of day?Antiemetic medications - Correct Answer 1) Seratonin-receptor antagonists (McPhee/Shimp)

• Ondansetron (and other -setrons)

2) Corticosteroids (McPhee)

• Dexamethasone and methylprednisolone (used to enhance action of seratonin-receptor antagonists

used for post-operative and chemo-related n/v) 3) Dopamine receptor antagonists -- SEDATING but good for post-op gastroparesis or nausea

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