The chapter describes the case of a 55-year-old male with severe abdominal pain, nausea, and vomiting, who presents with worsening abdominal distension, pain, and two episodes of vomiting. The patient has a history of hypertension, diabetes, and asthma, and has had swelling in the groin before, but it has gotten worse, more painful, and has become “hard.” The physical examination reveals a distended, diffusely tender abdomen, bowel sounds absent, and a large right inguinal hernia that is not reducible, with overlying skin that is dusky. The patient is diagnosed with an incarcerated hernia with bowel obstruction. Critical actions include recognition of the hernia, large-bore IV access and fluid bolus, upright chest x-ray, CT abdomen pelvis with IV contrast, pain management and antiemetics, nasogastric tube placement if symptoms are not controlled, broad-spectrum antibiotics, and surgery consult. The chapter provides several pearls, including the importance of fluid resuscitation, recognition of peritoneal signs, and avoiding reduction of a strangulated hernia, which can lead to perforation and sepsis.

The chapter describes a case of a 61-year-old man with epigastric pain and nausea. The patient had a history of type 2 diabetes and hypertension. He was pale, clammy, and in moderate distress. The primary survey revealed cool and clammy skin, normal capillary refill, and increased respiratory rate. The patient was given peripheral IV line access, CBC, BMP, LFT, cardiac enzymes, and PT/PTT labs. He was also given a 500 mL NS bolus and a cardiac monitor was set up. The patient was diagnosed with inferior wall myocardial infarction with right ventricular involvement. The critical actions included obtaining EKGs, recognizing the myocardial infarction pattern, IV access and fluid bolus, aspirin administration, avoiding nitroglycerin and morphine administration and activating cardiology consultation. The chapter provides pearls on the treatment of inferior wall myocardial infarction and the use of drugs that decrease preload. Reperfusion therapy was recommended for both inferior and right ventricular myocardial infarction.

Perforated viscus presents a life-threatening emergency requiring immediate clinical recognition and swift medical and surgical intervention. In this scenario, perforation likely arises from small bowel obstruction, causing increased intraabdominal pressure and subsequent wall rupture. Symptoms include sudden-onset abdominal pain worsened by movement. Urgent actions include focused physical assessment, detection of peritoneal signs, IV fluid resuscitation, pain management, selection of appropriate imaging, early antibiotic administration, surgical consultation, and advocating for laparotomy. Key points emphasize the superiority of upright CXR for free-air detection, the significance of peritoneal signs, and the crucial importance of timely evaluation in elderly patients with abdominal pain.

Chapter 2.9 covers drugs acting on the gastro-intestinal tract that are relevant to anaesthesia. We include antiemetic drugs, with detail on the vomiting centre and the mechanisms of action of commonly used antiemetics. We then discuss gastric acid secretion and drugs used to control this. Finally we discuss drugs used in diabetes – oral hypoglycaemic agents. Here we include detail on the diagnosis of diabetes mellitus, commonly used drugs and the perioperative management of such drugs.

Hyperemesis gravidarum is considered the severe end of the spectrum of nausea and vomiting of pregnancy. While there is no agreed upon strict definition for this condition, the criteria include persistent vomiting not related to other causes, a measure of acute starvation, and documented weight loss, most often at least 5% of pre-pregnancy weight. Electrolyte, thyroid, and liver abnormalities also may be present. The incidence of hyperemesis gravidarum is approximately 0.3–3% of pregnancies, but the reported incidence varies because of different diagnostic criteria and ethnic variation in study populations. Risk factors include patients with increased placental mass (molar gestation or multiple gestation), a history of motion sickness, migraine headaches, a family history, and a history of hyperemesis gravidarum in a previous pregnancy. Daughters and sisters of patients who had hyperemesis gravidarum are more likely to have the same condition, as are patients carrying a female fetus. The workup involves ruling out other causes, and the treatment focuses on relieving symptoms and preventing serious morbidity. Hyperemesis gravidarum can significantly impact the quality of life of patients and their families and may be challenging to treat.

This chapter explores images of plant life in philosophy and literature with particular focus on the works of Friedrich Nietzsche and Jean-Paul Sartre. It pursues the question of what we can learn about the nature of the human being and its place in the world from plants and the way they are rooted in earth. Over the past half-century, many voices identify our disconnection from the earth with the centrality of technological progress, capitalist production, industrialization, and globalization that are essential to our modern self-understanding and way of life. What was supposed to be the root of human distinction has ended up uprooting us. Is this because we have a distorted view of what it means to be rooted in the first place, and our dependency on the rootedness of plant life? This chapter interrogates the metaphor of the root in Jean-Paul Sartre’s famous novel Nausea. Whereas Sartre considers the earth as an inert background in relation to human purposes: always there, meaningless, the earth is the static backdrop of our human drama, Nietzsche’s vegetal imaginary puts forward an idea of human life as deeply embedded in both earthly and planetary life.

Overview of gastrointestinal complications including constipation, diarrhea, nausea, and vomiting, feeding tube complications, bowel perforation and obstruction, and neutropenic enterocolitis

Overview of gastrointestinal complications including constipation, diarrhea, nausea, and vomiting, feeding tube complications, bowel perforation and obstruction, and neutropenic enterocolitis

Overview of gastrointestinal complications including constipation, diarrhea, nausea, and vomiting, feeding tube complications, bowel perforation and obstruction, and neutropenic enterocolitis

Overview of gastrointestinal complications including constipation, diarrhea, nausea, and vomiting, feeding tube complications, bowel perforation and obstruction, and neutropenic enterocolitis

Overview of gastrointestinal complications including constipation, diarrhea, nausea, and vomiting, feeding tube complications, bowel perforation and obstruction, and neutropenic enterocolitis

Overview of gastrointestinal complications including constipation, diarrhea, nausea, and vomiting, feeding tube complications, bowel perforation and obstruction, and neutropenic enterocolitis

Overview of gastrointestinal complications including constipation, diarrhea, nausea, and vomiting, feeding tube complications, bowel perforation and obstruction, and neutropenic enterocolitis

Overview of gastrointestinal complications including constipation, diarrhea, nausea, and vomiting, feeding tube complications, bowel perforation and obstruction, and neutropenic enterocolitis

Overview of gastrointestinal complications including constipation, diarrhea, nausea, and vomiting, feeding tube complications, bowel perforation and obstruction, and neutropenic enterocolitis

Overview of gastrointestinal complications including constipation, diarrhea, nausea, and vomiting, feeding tube complications, bowel perforation and obstruction, and neutropenic enterocolitis

Overview of gastrointestinal complications including constipation, diarrhea, nausea, and vomiting, feeding tube complications, bowel perforation and obstruction, and neutropenic enterocolitis

Overview of gastrointestinal complications including constipation, diarrhea, nausea, and vomiting, feeding tube complications, bowel perforation and obstruction, and neutropenic enterocolitis

The term dolichoectasia refers to generalized nonfocal vessel elongation and tortuosity and is a frequent manifestation of advanced atherosclerosis. It most commonly occurs in posterior circulation (vertebrobasilar dolichoectasia), followed by supraclinoid internal cerebral artery. Patients with vertebrobasilar fusiform aneurysms may present with symptoms related to mass effect, ischemia or hemorrhage. We present a 59 year old male presented to the neurological emergency department with acute vertigo, drowsiness, nausea and sudden worsening of bilateral hearing loss. He was diagnosed with vertebrobasilar fusiform aneurysm

This chapter describes the primary interventions for the lack of interest presentation of ARFID, including:

• Step-by-step instructions for interoceptive exposures to habituate to feelings of nausea, fullness, or bloating to support eating enough for adequate nutritional intake

• Self-monitoring to increase awareness of hunger cues

• Reconnecting to the pleasure of eating by using the five steps with highly preferred foods