Nausea and vomiting as PC

Question 1

What’s in the vomit?

Answer 1

Reports of ‘coffee grounds’ may indicate upper GI bleeding.
Coffee grounds vomit is one of the most over-called signs in clinical medicine- always verify yourself and look for other evidence of GI bleeding.
Recognisable food - gastric stasis
Feculent- Small bowel obstruction

Question 2

Timing of the vomit

Answer 2

Morning
1h post food
Vomiting that relieves pain
Preceded by loud gurgling

Question 3

Tests in a patient with nausea and vomiting

Answer 3

Bloods: FBC, U&Es, LFTs, Calcium, glucose, amylase
ABGs: A metabolic alkalosis from loss of gastric contents indicates severe vomiting
Plain AXR: If suspected bowel obstruction
Upper GI endoscopy: If suspicion of bleed or persistent vomiting.

Question 4

Treatment of nausea and vomiting

Answer 4

Identify and treat the underlying cause
Symptomatic relief
Give IV fluids with K+ replacement if severely dehydrated (monitor electrolytes and fluid balance)

Question 5

What does vomiting in the morning indicate?

Answer 5

Pregnancy or raised ICP

Question 6

What does vomiting 1h post-food indicate?

Answer 6

Gastric stasis/ Gastroparesis (DM)

Question 7

What does vomiting that relieves pain indicate?

Answer 7

Peptic ulcer

Question 8

What does vomiting that is preceded by a loud gurgling indicate?

Answer 8

GI obstruction

Question 9

Which drug is used to produce symptomatic relief in nausea and vomiting?

Answer 9

Anti-emetics- give pre-op for post-op symptoms

Try oral route first. 30% need a 2nd line anti-emetics

Question 10

Types of anti-emetics

Answer 10

Cyclizine (H1 antagonist)
Cinnarizine (H1 antagonist)
Metoclopramide (D2 antagonist)
Domperidone (D2 antagonist)
Prochlorperazine (D2 antagonist)
Haloperidol (D2 antagonist)
Ondansetron (5HT3 antagonist)- stops you from being sick and it's expensive 
Hyosine hydrobromide (antimuscarinic)
Dexamethasone
Midazolam