Today we discussed the case of an elderly woman with history of diabetes and afib who presented with subacute onset nausea/emesis and epigastric abdominal pain, with gastric emptying study showing marked delayed gastric emptying with >90% of food retained at 4 hours.
We discussed a framework for nausea/emesis as well as how to approach and treat gastroparesis.
Nausea/Emesis can be broken into Acute and Chronic etiologies.
Common etiologies for ACUTE nausea/emesis:
Infections- acute gastroenteritis
Postop Nausea/Emesis- 1/3 of surgical pts have nausea/emesis or both after general anesthesia
Vestibular Neuritis- Rapid onset severe vertigo w/ nausea/emesis, gait instability
Chemo- Common; Anticipatory antiemetic indicated when highly emetogenic chemo regimen given
Earlier this week, we discussed the case of a young woman who immigrated from Mexico as a child, who presented with subacute fever, increased abdominal girth and acute onset abdominal pain, nausea, and PO intolerance found to have ascites with SAAG <1.1 consistent with exudative ascites, and diffuse peritonitis on CT.
We reviewed the differential for exudative ascites as the following: Peritoneal Carcinomatosis Peritoneal Tuberculosis Pancreatitis (additionally serositis, nephrotic syndrome, bowel perforation/infarction)
We reviewed the diagnostic studies for peritoneal TB and notably learned that elevated ascites fluid adenosine deaminase level is particularly helpful in supporting in a diagnosis of peritoneal TB and against diagnosis of peritoneal carcinomatosis.
We reviewed the utility of different imaging modalities when suspecting gynecologic malignancy, notably Ultrasound being first line imaging modality, MRI having the role of detecting pelvic extent of disease and local staging, and finally CT and PET/CT to evaluate extra-pelvic disease and distant metastases.
Today we discussed the case of an elderly woman with prior history of ischemic stroke, HTN, HLD who presented with dysarthria and hemiplegia found to have an acute ischemic stroke for which she was given tPA with subsequent hemorrhagic conversion and angioedema.
We reviewed inclusion and exclusion criteria for tPA administration and discussed managed of angioedema post tPA.
Today we discussed the case of a young man with recent use of Whippets who presented with acute onset bilateral lower extremity and upper extremity numbness and paresthesias, found to have Vitamin B12 deficiency despite lack of anemia or macrocytosis.
We learned that Nitrous Oxide acts by direct depletion of Vitamin B12 as it irreversibly binds to cobalt ions of vitamin B12 and inactivates it. In turn the pathways that rely on Vitamin B12 in order to synthesize DNA, RNA and myelin are disrupted, leading to demyelination and damage in the dorsal columns.
Today we discussed the case of a young woman with subacute onset URI symptoms and polyarticular arthralgias with acute onset unilateral painful red eye and photophobia, in context of recent travel to Texas and insect bites.