Nausea and Vomiting Flashcards
(53 cards)
The effortless passage of gastric
contents into the mouth in the absence of
nausea and without diaphragmatic muscular
contractions.
Regurgitation
An involuntary act with all the movements
of vomiting without the expulsion of gastric contents because the cardiac orifice remains closed
Retching
The effortless regurgitation of recently
ingested food into the mouth, followed by rechewing and reswallowing or spitting out.
Rumination
What are the red flags for vomiting
- Marked pallor
- Signs of hypovolaemia
- Peritoneal signs
- Headache, stiff neck, confusion
- Distended tympanic abdomen
Vomiting without bile-stained vomitus =
pyloric
obstruction
Vomiting of bile =
obstruction below duodenal
ampulla
Vomiting of ingested food =
oesophageal obstruction.
Vomiting without nausea and possibly
projectile =
↑ intracranial pressure
Green vomiting = urgent surgical referral for
possible_____ and ____
intestinal malrotation with volvulus
Non bile-stained vomitus (curdled milk): consider________
pyloric stenosis, GORD, feeding problems, concealed infection (e.g. UTI, meningitis).
Important warning signs in neonates of vomiting
- Excessive drooling of frothy secretions from mouth
- Bile-stained vomitus—always abnormal
- Delayed passage of meconium (beyond 24 hours)
- Inguinal hernias
- Usually sudden onset vomiting 3rd–6th week
- Projectile vomitus
- Failure to thrive
Congenital hypertrophic pyloric stenosis
Congenital hypertrophic pyloric stenosis biochemistry
metabolic alkalosis: sodium usually
<130 mmol/L, chloride <100 mmol/L
Special investigations for Congenital hypertrophic pyloric stenosis
— barium meal (_______)—concern about
aspiration
— ________
string sign
abdominal ultrasound
________ or severely delayed gastric emptying is a moderately common condition, which is a cause of nausea and vomiting.
Gastroparesis (gastropathy)
Medications to improve gastric motility
domperidone 10–20 mg (o) tds, 15–30 minutes before meals
or
metoclopramide 5–10 mg (o) tds, 30 minutes
before meals
or
erythromycin (has prokinetic properties)
Other measures to improve gastric motility
1
2
• Injection of botulinum toxin into the pylorus
• Gastric pacing with internally implanted
neurostimulators
- severe, unexplained vomiting or nausea occurring at varying intervals in a normal healthy person
- lasts hours to days
Cyclical vomiting
The first-line management in vomiting is to _______
ensure that any fluid and electrolyte imbalance is corrected and that any underlying cause is identified and treated
Avoid the use of centrally acting dopamine antagonist drugs (DADS, e.g. metoclopramide and prochlorperazine) in children because of risk of \_\_\_\_\_\_\_
extrapyramidal side effects (EPSE), usually acute dystonic reactions.
These include ondansetron, granisetron, dolasetron, palonosetron and tropisetron and are effective at _______ and ____
preventing chemotherapy- and radiotherapyinduced
emesis when initiated prior to treatment
_______ enhances the effect of 5-HT3 agents
Dexamethasone
How to manage severe Drug-induced nausea and vomiting
ondansetron 8 mg (o) or IV prior to therapy then two doses 6 hourly
plus
dexamethasone 8 mg IV 30 minutes prior to
therapy, then two doses 6 hourly
Most effective drugs for vestibular disturbances
The phenothiazine derivatives are the most effective, while the dopamine D 2 -receptor antagonists are relatively ineffective
