13. Nausea and Vomiting Flashcards Preview

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Flashcards in 13. Nausea and Vomiting Deck (22)
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1

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

Vestibular system
CNS
Chemoreceptor trigger zone
Cranial nerves IX + X

2

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

details of the cotnent
timing + duration
association with eating

3

What does undigested vomit suggest?

Oesophageal disorders: achalasia, pharyngeal pouch

4

What does partially digested vomit suggest?

Gastric outlet obstruction
Gastroparesis

5

What does faeculent vomit suggest?

Distal intestinal or colonic obstruction

6

What does vomiting within an hour of eating suggest?

Obstruction high in the GI tract

7

What does vomiting a few hours after eating?

Obstruction lower in the GI tract

8

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

Fever
Headache, visual disturbance, other neuro symptoms
Vertigo

9

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

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

10

What is the immediate management for small bowel obstruction?

Nil by mouth
'Drip + suck' IV fluid + aspiration of gastric contents by nasogastric tube
Analgesia
Antiemetics

11

List 4 vertigo/ vestibular system related causes of nausea and vomiting

BPPV
Labyrinthitis
Motion sickness
Menieres disease

12

List 5 chemical/ CTZ related causes of nausea and vomiting

Medication
Alcohol
Hormones
Electrolytes
Toxins

13

List 5 CNS related causes of nausea and vomiting

Pain
Anxiety
Raised ICP
Meningitis
Encephalitis

14

List 4 abdo + heart (CN9+10) related causes of nausea and vomiting

GI obstruction
GI infection
Inflammation of diaphragm
Inflammation of liver, pancreas, gallbladder, peritoneum

15

What does bile/ green vomit suggest?

Small bowel obstruction (distal to ampulla of vater)

16

What is early morning sickness associated with?

Pregnancy
Raised ICP

17

What condition is suggested by a motionless patient with a rigid abdomen and absent bowel sounds?

Peritonitis

18

What condition is suggested by bilious/ faeculent vomiting, distended abdome, absolute constipation and abdominal pain?

Bowel obstruction

19

What condition is suggested by early morning vomiting, headache worse when lying down and 6th nerve palsy?

Raised ICP

20

What may absence of bowel sounds or high pitched tinkling sounds suggest?

Absence: Ileus
Tinkling: Mechanical obstruction

21

What causes transaminitis (raised ALT + AST)?

Hepatitis

22

What is a postoperative adhesion caused by? What may this result in?

Postsurgical inflammatory response leads to formation of fibrous adhesions between the bowel + parietal peritoneum
Bowel obstruction if loop of bowel gets twisted around adhesion