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Rosens > 25. Nausea/Vomiting > Flashcards

25. Nausea/Vomiting Flashcards

1
Q

3 phases of nausea/emesis

A

Nausea
Retching
Emesis

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2
Q

Ruminating defn

A

Confused with emesis but non forcing, dribbling of stomach contents out, maybe swallowed

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3
Q

Ruminating defn

A

Confused with emesis but non forcing, dribbling of stomach contents out, maybe swallowed

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4
Q

What is the CNS sequence of vomiting?

A

Vomiting centre is coordinated by medulla
Activation of muscarjnic receptors triggers vomiting center
Four main triggers: GI itself (main stomach, duod , outside main GI tract (biliary), CNS, chemoreceptor trigger zone in postrema of fourth ventricle
Efferent effects Through vagus, phrenic and spinal nerves

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5
Q

What 4 receptors are required to hit for anti nausea meds?

A

Histamine
Dopamine
Serotonin
Cholinergic

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6
Q

Acute vs chronic emesis timeline

A

<1 week
> 4 weeks

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7
Q

Cyclic emesis defn

A

Distinct episodes with asymptomatic period

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8
Q

Cyclic emesis defn

A

Distinct episodes with asymptomatic period

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9
Q

DDX vomiting

A

V- vestibular or vascular (MI)
Obstruction - sbo
Metabolic - DKA
Infection/infalmmatin - Crohn’s/ibd, gastritis, pancreatitis, biliary cause, PUD
CNS - CO,
Iatrogenic/ingestion
Neoplasm
Gravardum (pregnancy, cannabis etc) or GU- torsion!!

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10
Q

DDX Bright red blood vomit

A

PUD
gastritis
varices (esophageal)
aortoenteric fistula
esophageal rupture
duodenal or gastric tumor
mallory weiss tear
dieulafoy lesion
FB

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11
Q

DDX coffee ground emesis

A

PUD
gastritis
esophageal varices
duod or gastric tumor
MalloryWeiss syndrome

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12
Q

Vomiting undigested food -ddx 4

A

gasttric outlet obstruction
achalasia
esophageal stricture
fb

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13
Q

Vomiting feces or adult bilious emesis - 2ddx

A

small or large bowel obstructions

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14
Q

Rome IV criteria for cannabinoid hyperemesis syndrome: criteria

A
  1. stereotypical episodic emesis (meets defn of cyclic)
  2. presentation after prolonged, excessive cannabis use
  3. relief of emesis episodes by sustained cessation of canabis

Criteria need last 3 mo fulfilled with at least 6 mo pre dx

May feel better after prolonged hot bath or shower

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15
Q

PE of emesis: head to toe

A

vitals, fluid status
HENENT: nystagmus, oral exam if bulimia
abdo exam
neuro exam if concern for central

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16
Q

Ancillary testing for emesis

A

chem 7
lipase
LFT and ammonia
serum drug - asa, acetaminophen, vpa, carbamazepine, phenobarbital
blood gas/bhb if dka
bcg
urinalysis
POCUS
abdo ct +/- head ct

17
Q

When is an abdo xray useful?

A

air under diaphragm
FB
Boerhaave syndrome: for pneumomediastinum

18
Q

What receptor does ondansetron treat?

A

serotonin antagonist

19
Q

Ondansetron ecg risk?

A

prolonged qt –> torsades

20
Q

Name 6 possible sequelae of emesis

A

Hypovolemia
Metabolic alkalosis
Hypokalemia
Mallory weiss tear
booerhave syndrome
aspiration pneumonitis and pneumonia

21
Q

What is the mechanism of metoclopramide?

A

prokinetic agent useful for gastroparesis and dysmotility order

dopamine and serotonin antagonist

22
Q

How does haloperidol work for nausea?

A

Dopamine antagonist

23
Q

What is the mechanism of prometahzine and dimenhydrinate in antinausea?

A

antihistamine H1 receptor

24
Q

What is the mechanism of prochlorperazine in nausea/emesis?

A

dopamine antagonist

25
Q

Adverse effects of metoclopramide?

A

dystonic reaction
tardive dyskinesia
NMS
restless

26
Q

MC cause peds emesis?

A

gastroenteritis

27
Q

Tx of chemo induced emesis

A

ondansetron 4mg IV then can repeat q30 mins up to 16mg IV

28
Q

Options for nausea/emesis cyclic emesis tx:

A

ondansetron, metoclopramide and prochlorperazine as combo

capsaicin on stomach to mediate emesis in CNS +/- ?lorazepam

TCA LT control

29
Q

Vertigo: nausea treatment

A

antihistamines - dimenhyrinate - gravol

benzos as second line agents

30
Q

Vomiting intact food eaten over 12 hours earlier is consid- ered pathognomonic for ?

A

gastric outlet obstruction

31
Q

Best antinausea for pregnancy?

A

metoclopramide

Rosens (40 decks)

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