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13 Cards in this Set
- Front
- Back
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What are some mechanisms by which an intraperitoneal condition might cause nausea and vomiting?
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Obstruction, inflammation, infection, biliary colic, sensorineural
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What are some mechanisms by which an extraperitoneal condition might cause nausea and vomiting?
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Cardiopulmonary disease, inner ear disease, intracerebral, drugs, metabolic
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What classes (and examples) of medications are used as anti-emetics?
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- anticholinergics (scopalamine)
- anti-histiminergic (meclizine and dimenhydrinate) - Anti-dopaminergic (metoclopramide) - 5-HT3 antagonist (ondansetron) - NK1 antagonist (Aprepitant - TCAs (amitriptyline, nortriptyline) |
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What classes (and examples) of medications are used as prokinetics?
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- 5-HT4 agonist (Metoclopramide- which is also antidopaminergic, and Tegaserod)
- Motilin agonist (erythromycin) - Peripheral dopaminergic (domperidone) - Somatostatin analogue (octreotide) |
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What classes and examples of medications may be used to help control chemotherapy induced emesis?
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- Benzodiazepines (lorazepam)
- Glucosteroids (methylprednisolone and dexamethasone) - Cannaboids |
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What are some red flag symptoms associated with indigestion?
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Odynophagia (infection?) dysphagia (obstruction- malignancy, web?) Weight loss (malignancy, stenosis?) evidence of bleeding, recurrent vomiting, palpable mass or adenopathy
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What action should be taken if the patient with GERD has alarm symptoms? What other scenarios might indicate this action?
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Upper endoscopy is indicated if red flags are present in a patient with GERD. A upper endoscopy might be considered if the patient is refractory to treatment, has atypical symptoms or is over 50 with GERD for over 5 years.
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In a low risk patient under 55 years old with GERD, what is the typical approach to treatment?
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PPI for 4 weeks, as well as testing for and treating H. pylori. If failure at 4 weeks, order an upper endoscopy.
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What is triple therapy for H. pylori infection?
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- PPI (omeprazole 20mg BID)
- Amoxicillin (1000mg BID) - Clarithromycin (500mg BID) For two weeks |
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What is quadruple therapy for H. Pylori infection?
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- PPI (omeprazole 20mg BID)
- Bismuth 525mg QID - Metronidazole 250mg QID - Tetracycline 500mg QID For two weeks |
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When is quadruple therapy used for GERD?
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What type of therapy is used when H. pylori resistance rates to clarithromycin are greater than 20%?
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When should eradication be confirmed in H. pylori therapy?
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Eradication should be confirmed if patients have persistent symptoms after treatment, if they have an H. pylori associated ulcer, if they have MALT lymphoma or they had early gastric cancer resected.
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How should eradication of H. pylori be confirmed?
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Urease breath test, fecal antigen test, or upper endoscopy >4 weeks after treatment.
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