13. Nausea and Vomiting

Question 1

What are the 4 main input systems that can activate the vomiting centre?

Answer 1

Vestibular system
Central nervous system
Chemoreceptor trigger zone
Cranial nerves IX and X

Question 2

What broad questions should you ask about in the presenting complaint in someone who has been vomiting?

Answer 2

details of the cotnent
timing
association with eating

Question 3

What does undigested vomit suggest?

Answer 3

Oesophageal disorders- achalasia, pharyngeal pouch

Question 4

What does partially digested vomit suggest?

Answer 4

Gastric outlet obstruction, gastroparesis

Question 5

What does faeculent vomit suggest?

Answer 5

Distal intestinal or colonic obstruction

Question 6

What does vomiting within an hour of eating suggest?

Answer 6

Obstruction high in the GI tract

Question 7

What does vomiting a few hours after eating?

Answer 7

Obstruction lower in the GI tract

Question 8

What other symptoms should you ask about in someone who has presented with vomiting?

Answer 8

Fever
Headache, visual disturbance, other neuro symptoms
Vertigo

Question 9

What questions should you ask about in the social history in someone who presents with vomiting?

Answer 9

Any close contacts suffering from nausea and vomiting?
Living in close quarters?
Recent foreign travel?
Unusual meals recently?

Question 10

What is the immediate management for small bowel obstruction?

Answer 10

Nil by mouth
‘Drip and suck’ IV fluid and aspiration of gastric contents by nasogastric tube
Analgesia
Antiemetics