Effects of vomiting

Question 1

What are the complications of associated with vomiting

Answer 1

• Dehydration
• Electrolyte disturbances
• Acid-base imbalance
• Malnutrition
• Pulmonary aspiration
• Pneumothorax
• Esophageal rupture
• Dental enamel erosion
• Mallory-Weisssyndrome: Mucosal tears at oesophagogastric junction
• Boerhaaves syndrome: Full thickness ontaneous oesophageal rupture

Question 2

What is Gastric outlet obstruction caused by

Answer 2

• Motor disorders
• Benign pyloric strictures
• Malignant disease
• Inflammatory causes i.e. gastroduodenal Crohn’s disease
• Rare cause- bezoars , large gastric polyps

Question 3

What are the clinical features of Gastric Outlet Obstruction

Answer 3

• Nausea and vomiting
• Epigastric pain
• Early satiety
• Weight loss
• Succussion splash - sounds like water splashing inside a half filled bucket or balloon

Question 4

What electrolyte disturbances are associated with Gastric Outlet Obstruction

Answer 4

• Hypokalemia - due to selective renal excretion as H+ is reabsorbed
• Hypochloremia - due to vomiting
• Hyponatremia - due to vomiting
• Metabolic alkalosis - due to loss of H+ caused by vomiting

Question 5

Explain the two components of gastric juice

Answer 5

Mucus secretions:
- pH of 7.7 and electrolyte components: Na, K, Ca, Cl, HCO3

Acid secretions
- Always in mixture with mucus

Question 6

How is Gastric Outlet Obstruction treated?

Answer 6

Based on underlying cause
- Medical therapy first: Fluid therapy with normal saline and correct electrolyte disturbances

Causes:
- Benign fibrotic strictures: Endoscopic balloon dilatation (EBD)
- Crohn’s disease: Steroids/medical therapy/EBD/surgery
- Malignant strictures: EBD and stent, surgical resection, chemotherapy

Question 7

What are the complications of post operative nausea and vomiting

Answer 7

• Aspiration
• Suture rupture and wound dehiscence
• Delay resumption of oral intake
• Prolonged hospital stay
• Patient dissatisfaction with surgical experience

Question 8

What are the effects of mild vomiting in pregnancy

Answer 8

Increase in HPT and pre-eclampsia
Increased depression

Question 9

Explain what and the effects of Hyperemesis Gravidarium

Answer 9

Severest form of vomiting in pregnancy

Causes severe maternal morbidity and adverse effects for fetus due to vomiting complications

Neonate side effects:
- Low birth weight
- Preterm birth
- Small for gestational age
- ↑ risk for foetal death