13. Nausea and Vomiting Flashcards
Where is the vomiting centre in the brain? What are the 4 inputs that activate it?
What details will ask you about the vomiting specifically? What details will you enquire about the pain? What other symptoms will you ask about?
Nausea and Vomiting - History
- Bowel movements?
- Infectious contacts?
- Medications?
- Past surgical history?
Outline a flowchart for investigation of nausea and vomiting.
6 Bloods?
Investigations for Nausea & Vomiting
- 2 Imaging?
- 4 Other?
The abdominal xray shows centrally located loops of distended (>3cm diameter) small bowel with valvulae conniventes. The most likely diagnosis is small bowel obstruction. A possible aetiology is entaglement of a loop of bowel in postoperative adhesions from his previous appendicectomy. Post surgical inflammatory reponse, leads, over time, to the formation of ‘fibrous adhesions’ between the bowel and the parietal peritoneum. Obstruction may occur shortly after the operation or, as in the case of Mr, Price, many years later if a loop of bowel gets twisted in a pre-existing adhesion. Small bowel obstruction accounts for 20% of acute surgical admissions.
SBO management? (4)
Mr Price goes to the surgical unit for review. How are the surgeons likely to manage Mr Price?
If a dehydrated patient is unable to tolerate fluids, what is the best fluid to give and why?
What is the basis of the pregnancy test available over the counter?
7 Potential complications of vomitting?
Nausea and vomiting is common in postoperative patients. What factors may be contributing to this?
- 4 Preoperative factors?
- 4 Intraoperative factors?
- 5 Postoperative factors?
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