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Junior Surgery- GI > Nausea and Vomiting > Flashcards

Nausea and Vomiting Flashcards

1
Q

What would you want to ask in relation to symptoms of vomiting in the history?

A
  • Timing
  • Relation to meals
  • Amount
  • Content
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2
Q

What are GI causes of vomiting?

A
  • Gastroenteritis
  • Peptic ulcer
  • Pyloric stensosis
  • Intestinal obstruction/Paralytic ileus
  • Acute cholecystitis
  • Acute pancreatitis
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3
Q

What are CNS causes of vomiting?

A
  • Meningitis/Encephalitis
  • Migraine
  • Raised ICP
  • Brainstem lesions
  • Motion sickness
  • Meniere’s disease
  • Labrynthitis
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4
Q

What are metabolic causes of vomiting?

A
  • Uraemia
  • Hypercalacemia
  • Hyponatraemia
  • Pregnancy
  • DKA
  • Addison’s Disease
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5
Q

What drugs can cause vomiting?

A
  • Antibiotics
  • Opiates
  • Cytotoxics
  • Digoxin
  • Alcohol
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6
Q

What mnemonic can you use to remember non-GI causes of vomiting?

A
  • AKI/Addisons
  • Brain - Raised ICP etc.
  • Cardiac - MI
  • DKA
  • Ears
  • Foreign substance
  • Gravidity
  • Hypercalcaemia/hyponatraemia
  • Infection
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7
Q

If vomiting was occuring in the morning, what might you suspect as the cause?

A
  • Pregnancy
  • Raised ICP
  • Alcohol dependence
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8
Q

If vomiting was occuring 1h post ingestion of food, what might be the cause?

A

Gastric stasis/gastroparesis

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9
Q

What would pain which is relieved by vomiting indicate as a potential cause?

A

Peptic ulcer

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10
Q

How would you investigate vomiting?

A

If presistent, Consider following,

  • Bloods - FBc, U+E’s, LFTs, Ca2+, glucose, amylase, ABG
  • Imaging - AXR
  • Other - upper GI endoscopy
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11
Q

What metabolic abnormality might you see on ABG in someone with severe vomiting?

A

Hypochloraemic hypokalaemic metabolic alkalosis from loss of gastric contents

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12
Q

What might faeculent vomit suggest?

A

GI obstruction

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13
Q

What are classes of anti-emetics?

A
  • H1 antagonists
  • D2 antagonists
  • 5HT3 antagonists
  • Hyoscine hydrobromide
  • Dexamethasone
  • Midazolam
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14
Q

What are examples of H1 antagonists?

A
  • Cyclizine
  • Cinnarizine
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15
Q

How do dopamine (D2) antagonists work?

A
  • D2 receptor is the main receptor in the CTZ - blocks effects of drugs on this area
  • Prokinetic effect - Promotes gastric emptying
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16
Q

How is dopamine involved in vomiting?

A

2 main actions

  • Receptor is the main receptor in the chemoreceptor trigger zone (CTZ) - area responsible for sensing emetogenic substances in the blood (e.g. drugs).
  • Important neurotransmitter in the gut - promotes relaxation of the stomach and LOS and inhibits gastroduodenal coordination.
17
Q

Why are D2 antagonists said to have a prokinetic effect?

A

Drugs that block D2 receptors have a prokinetic effect – promoting gastric emptying – which contributes to their antiemetic action

18
Q

What are examples of D2 antagonists?

A
  • Metoclopramide
  • Domperidone
  • Prochlorperazine
  • Haloperidol
19
Q

How do H1 antagonists work?

A

. Histamine (H1) and acetylcholine (muscarinic) receptors predominate in the vomiting centreand in its communication with the vestibular system. Drugs such as cyclizine block both of these receptors.

20
Q

What are H1 antagonists particularly effective at treating?

A

Nausea and vomiting, particularly in the context of motion sickness or vertigo

21
Q

What are examples of 5HT3 antagonists?

A

Ondansetron

22
Q

How do 5HT3 antagonists work?

A

5-HT3 antagonists act by blocking 5HT3 receptors in CTZ and the gut, preventing stimulation of vagus nerve which causes vomiting.

They are effective against nausea and vomiting due to CTZ stimulation (e.g. drugs) and visceral stimuli (gut infection, radiotherapy), but not in motion sickness.

23
Q

How does serotonin play a role in vomiting?

A
  • High density of 5-HT3 receptors in the CTZ
  • Key neurotransmitter released by the gut in response to emetogenic stimuli -> stimulates the vagus nerve via 5HT3- > vomiting centre via the solitary tract nucleus
24
Q

How does the chemoreceptor trigger zone (CTZ) polay a role in vomiting?

A

Receives inputs from blood-borne drugs or hormones, and communicates with other structures in the vomiting center to initiate vomiting.

25
Q

What are 5HT3 antagonists particularly useful for?

A

Nausea and vomiting, particularly in the context of general anaesthesia and chemotherapy

26
Q

What is the mechanism of action of phenotiiazines?

A

Blockade of various receptors, including:

  • D2 receptors in the CTZ and gut
  • Histamine (H1) and acetylcholine (muscarinic) receptors in the vomiting centre and vestibular system.
27
Q

What are D2 antagonists particularly good at treating?

A
  • Nausea and vomiting due to CTZ stimulation (e.g. due to drugs)
  • Reduced gut motility (e.g. due to opioids or diabetic gastroparesis)
28
Q

What are examples of phenothiazines?

A
  • Prochlorperazine
  • Chlorpromazine
  • Levomepromazine
29
Q

What are phenothiazines particularly useful for?

A

Nausea and vomiting in a wide range of conditions, including chemotherapy, radiotherapy and particularly when due to vertigo - Regarded as broad spectrum anti-emetic

30
Q

How would you manage nausea and vomiting?

A
  • Treat cause
  • Symptomatic relief - anti-emetics depending on cause
  • Consider IV fluids + K+ replacement - if severely dehydrated
  • Monitor electrolyte and fluid balance

Junior Surgery- GI (43 decks)

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