lec 8 Nausea and vomiting

Question 1

The risk factors for PONV include

Answer 1

female gender,
 history of motion sickness or PONV,
 non-smoking status, and
 use of opioids in the postoperative period

Question 2

Postoperative nausea and vomiting (PONV) occurs in

Answer 2

30% of surgical patients , and in up to 70% of highrisk patient

Question 3

↑ risk of Postoperative nausea and vomiting (PONV) due to

Answer 3

1. disturbing the vagus nerve
2. the choice of anesthetic agents
3. the duration of surgery.

Question 4

disturbing the vagus nerve leading to

Answer 4

gastric motility abnormalities

Question 5

Pregnancy-associated nausea and vomiting is common, affecting

Answer 5

70% to 85% of pregnant women, especially

early in pregnancy

Question 6

hyperemesis gravidarum due to

Answer 6

raised levels of human chorionic gonadotrophin

Question 7

lifethreatening condition of prolonged nausea, vomiting

Answer 7

malnutrition weight loss, dehydration

Question 8

drugs causes nausea and vomiting including

Answer 8

1.Cancer chemotherapy agents
2.Radiation therapy→ abdominal malignancies.
3.Oral contraceptives, hormone therapy, oral hypoglycemic agents, anticonvulsants,
and opiates
4.digoxin and theophylline (bronchodilator
5.Ethanol

Question 9

Nausea and vomiting stages:

Answer 9

1. Nausea
   2) retching
   (3) vomiting.

Question 10

Nausea

Answer 10

feeling of a need to vomit

accompanied by autonomic symptoms

Question 11

autonomic symptoms such as

Answer 11

pallor,
tachycardia,
diaphoresis, and
salivation

Question 12

Retching

Answer 12

1. can occur without vomiting
   2.produces the pressure gradient needed for vomiting
   no gastric contents are expelled.

Question 13

Vomiting is a

Answer 13

reflexive,
rapid, and
forceful oral expulsion of upper gastrointestinal contents

Question 14

Vomiting is due to

Answer 14

First: powerful and sustained contractions in the abdominal and thoracic musculature.
Second: reverse peristalsis accompanied by
Third: relaxation of esophageal sphincters.

Question 15

Four muscle groups are stimulated in synchronous order to produce vomiting.

Answer 15

1. Inspiratory Muscles
2. Abdominal Muscles
3. Esophageal, gastric, and duodenal muscles
4. Esophageal sphincter

Question 16

Inspiratory Muscles

Answer 16

1.Deep inspiration
↓
negative thoracic pressure to facilitate upchuckingت

Question 17

Abdominal Muscles

Answer 17

positive intra-abdominal pressure

Question 18

Esophageal, gastric, and duodenal muscles all undergo

Answer 18

reverse peristalsis.

Question 19

Esophageal sphincter (LES and UES) must

Answer 19

relax for vomiting to occur.

Question 20

Regurgitation

Answer 20

1. is a passive process without involvement of the abdominal wall and diaphragm
2. wherein gastric or esophageal contents move into the mouth

Question 21

In patients with gastro-esophageal reflux disease (GERD), one hallmark symptom is

Answer 21

acid regurgitation

Question 22

Autonomic Discharge occurs with vomiting.

Combined

Answer 22

sympathetic / parasympathetic on salivary glands causes hyper-salivation

Question 23

Chemoreceptor trigger zone (CTZ) located

Answer 23

outside the blood–brain barrier (BBB) in the area postrema of the fourth ventricle of the brain

Question 24

Chemoreceptor trigger zone (CTZ) is exposed to

Answer 24

to cerebrospinal fluid and blood

Question 25

Chemoreceptor trigger zone, is easily stimulated by

Answer 25

uremia, acidosis, and the circulation of toxins such as

chemotherapeutic agents

Question 26

The CTZ has

Answer 26

serotonin type 3 (5-HT3)و neurokinin-1 (NK1),dopamine (D2)

Question 27

Visceral vagal nerve fibers are rich in

Answer 27

5-HT3 receptors, neurokinin-1 (NK1), and

dopamine (D2) receptor.

Question 28

Visceral vagal nerve fibers respond to

Answer 28

gastrointestinal distention, mucosal irritation,

and infection

Question 29

Motion sickness is caused by

Answer 29

stimulation of the vestibular system

Question 30

the vestibular system contains many

Answer 30

histaminic (H1) and muscarinic cholinergic

receptors

Question 31

The higher brain (i.e., cerebral cortex) is affected by

Answer 31

sensory input such as sights, smells, or emotions that can lead to vomiting