B5.067 Nausea and Vomiting

Question 1

what are important things to ask about in the context of nausea and vomiting

Answer 1

exposure to toxins (food, sick contacts, recent radiation therapy)
duration of symptoms
associated symptoms
alleviating and exacerbating factors

Question 2

how to determine severity of nausea/vomiting

Answer 2

vitals and hydration status

acute abdominal pain on physical exam

Question 3

alarm signs

Answer 3

severe abdominal pain
hematochezia
> 55 years old
unintended weight loss
progressive dysphagia
fam history of cancer
altered mental status
focal neurologic deficit
feculent vomiting

Question 4

abdominal pain relieved by vomiting

Answer 4

bowel obstruction

Question 5

most common cause of nausea and vomiting

Answer 5

self limited viral enteritis
179 million/year
600,000 hospitalizations
norovirus most common in adults

Question 6

signs of dehydration

Answer 6

decreased urine output
skin tenting
dry mucous membranes

Question 7

abdominal x-ray in nausea/vomiting

Answer 7

bowel obstructions

kidney stones

Question 8

CT in nausea/vomiting

Answer 8

infections
bowel obstruction
kidney stones

Question 9

RUQ US in nausea/vomiting

Answer 9

gallstones

Question 10

chronic nausea and vomiting

Answer 10

> 1 month

Question 11

acute nausea and vomiting

Answer 11

< 1 week

Question 12

commonly prescribed anti-emetics

Answer 12

promethazine
metoclopramide
prochlorperazine
ondansetron

Question 13

what works to help nausea and vomiting in pregnant women?

Answer 13

ginger

Question 14

common causes of chronic nausea and vomiting

Answer 14

diabetic gastroparesis
GERD
gastritis
gastric ulcer

Question 15

how to evaluate diabetic gastroparesis

Answer 15

gastric emptying study

Question 16

acute onset vomiting

Answer 16

cholecystitis
gastroenteritis
med effects
pancreatitis

Question 17

associated with diarrhea, headache, myalgias

Answer 17

viral gastroenteritis

Question 18

bilious vomiting

Answer 18

small bowel obstruction

Question 19

continuous vomiting

Answer 19

conversion disorders

Question 20

delayed vomiting (more than 1 hour after meals)

Answer 20

gastric outlet obstruction

gastroparesis

Question 21

feculent or foul odor vomit

Answer 21

intestinal obstruction

Question 22

habitual postprandial, irregular vomiting

Answer 22

major depression

Question 23

insidious onset vomiting

Answer 23

GERD
gastroparesis
medication
metabolic disorders
pregnancy

Question 24

regurg of undigested food

Answer 24

achalasia
esophageal stricture
Zenker

Question 25

projectile vomiting

Answer 25

intracranial disorders | increased intracranial pressure

Question 26

partly digested food or chime vomiting several hours after meals

Answer 26

gastric outlet obstruction (no bile) | gastroparesis

Question 27

4 sources of afferent input to vomiting center

Answer 27

1. afferent vagal fibers from GI viscera stimulated by distention, irritation, or infection (5-HT3) 2. fibers of vestibular system (H1 and muscarinic) 3. high CNS centers, smells, emotional experiences 4. chemoreceptor trigger zone outside BBB (opioid, 5-HT3, NK1, D2)

Question 28

vomiting pre-breakfast

Answer 28

pregnancy uremia alcohol increased intracranial pressure

Question 29

lab abnormalities expected with severe vomiting

Answer 29

hypokalemia azotemia metabolic alkalosis

Question 30

supportive treatment for non-severe vomiting

Answer 30

clear liquids small quantities of dry foods ginger

Question 31

serotonin antagonists

Answer 31

-setron

Question 32

when are serotonin antagonists used

Answer 32

prevent chemo and radiation induced emesis post-op nausea used in combo w steroid and NK1 antagonist

Question 33

antiemetic properties of steroids

Answer 33

enhance efficacy of serotonin antagonists

Question 34

neurokinin receptor antagonists

Answer 34

-prepitant

Question 35

when are neurokinin receptor antagonists used

Answer 35

combo w corticosteroid and serotonin antagonists for nausea associated with chemo

Question 36

dopamine antagonists

Answer 36

phenothiazines butyrophenones benzamides (-azine)

Question 37

when are dopamine antagonists used

Answer 37

infrequently used, mainly in outpatients with minor, self limited symptoms

Question 38

antihistamines and anticholinergics

Answer 38

meclizine dimenhydrinate scopolamine

Question 39

when are antihistamines and anticholinergics used

Answer 39

motion sickness, vertigo, migraines | vomiting during pregnancy