Nausea & Vomiting - Exam 3 Flashcards
define nausea. define vomiting
nausea: Subjective feeling of a need to vomit.
Vague, intensely disagreeable sensation of sickness or “queasiness”
vomitimg: Usually follows nausea, including retching (spasmodic respiratory and abdominal movements)
What is regurgitation? Rumination?
Regurgitation: The effortless reflux of liquid or food stomach contents
“Burping up” food contents
rumination: The chewing and swallowing of food that is regurgitated after meals
The motor function of the gut is controlled at three main levels, what are they?
parasympathetic and sympathetic nervous systems
enteric brain neurons
smooth muscle cells
What causes nausea?
caused by a gastric rhythmic disturbance in which the natural 3-cycle-per minute gastric myoelectrical activity (muscle contraction and relaxation) is altered
naturally increases with food intake but that is normal
define tachygastria. define bradygastria
Tachygastria: increased rate of electrical activity in the stomach, more than 4 cycles per minute
Bradygastria: decreased rate of electrical activity in the stomach, less than 2 cycles per minute
Vomiting may be stimulated by ___ different sources. List them
4 different sources
- Afferent vagal fibers from the GI viscera (rich in serotonin 5-HT3)-> GI distention, mucosal or peritoneal irritation, infections
- Fibers of the vestibular system (high concentrations of histamine H1) -> sea-sick, dizzy
- Higher CNS centers -> certain sights, smells or emotional experiences may induce vomiting
- Chemoreceptor trigger zone (rich in opioid, serotonin 5-HT3, neurokinin 1 (NK1), and dopamine D2 receptors) -> located outside of blood-brain barrier in the area postrema that can be stimulated by drugs, chemo agents, toxins, hypoxia, uremia, acidosis, radiation therapy and induce vomiting
What is area postrema?
a structure in the brainstem that detects toxins in the blood and cerebrospinal fluid (CSF) and triggers vomiting
a highly vascular paired structure in the medulla oblongata in the brainstem that can induce vomiting
What is superior mesenteric artery syndrome?
When the duodenum gets crushed by the superior mesenteric artery
**Draw the chart that correlates the likely microbe to the incubation period with the likely food source ** know entire chart. What is the big take away?
big take aways: bacteria have a much shorter incubation period than viruses
What are some life-threatening disorders that need to quickly rule out that can present with N/V?
bowel obstruction
mesenteric ischemia
acute pancreatitis
myocardial infarction
What is the 3 step approach to a pt with N/V?
- determine etiology
- The consequences or complications of nausea and vomiting should be identified and corrected ie: fluid depletion, hypokalemia, and metabolic alkalosis
- targeted therapy for underlying cause
What does acute N/V symptoms WITHOUT severe abd pain make you think could be the underlying cause? list 4
typically caused by food poisoning
infectious gastroenteritis
drugs
systemic illnesses
What does acute N/V symptoms WITH severe abd pain make you think could be the underlying cause?
suggests peritoneal inflammation
acute gastric/intestinal obstruction
pancreatobiliary disease
How does cannabinoid hyperemesis syndrome present? Who is the MC pt? What helps to improve symptoms?
What does vomiting of undigested food one
to several hours after meals make you think?
gastroparesis
gastric outlet obstruction: may hear a succussion splash
What does vomiting of undigested food one
to several hours after meals with a succussion splash make you think?
gastric outlet obstruction
vomiting with what 4 s/s would make you think a neurologic cause?
headache
stiff neck
vertigo
focal weakness/paresthesias
if you see feculent vomiting, what are you instantly thinking?
Feculent vomiting = Intestinal obstruction
When will hyperactive bowel sounds present in a bowel obstruction?
hyperactive bowel sounds happen EARLY in bowel obstruction
define hematemesis
Vomiting of blood or coffee-like material
aka upper GI bleed
What are you worried about the pt developing with persistent severe vomiting?
electrolyte disturbances
_______ is a good starting point for imaging with N/V. What are you looking for?
Flat and upright abd xray
severe bowel obstruction
In SBO, will show intestinal air-fluid levels with reduced colonic air
Ileus - will show diffusely dilated air-filled bowel loops
____ is ordered with most chronic N/V that is unexplained after routine eval. What is a common result? What can an EDG pick up?
EGD
often normal
Detects ulcers, malignancy, retained gastric food residue, gastric outlet obstruction
____ test will show inflammation in Crohn’s disease. Would want to order ______ if concerned about motor disorder when anatomic abnormalities are absent
MRI
GI motility testing
