Lecture 1: N/V

Question 1

How long is the digestive tract?

Answer 1

33 ft

Question 2

What are the 6 primary functions of the GI system?

Answer 2

• Ingestion
• Mechanical digestion and propulsion
• Chemical Digestion
• Secretion
• Absorption
• Defecation

Question 3

What is considered the middle part of the GI system and what occurs in it?

Answer 3

• Duodenum, jejunum, and ileum
• Most digestion and absorption occurs here!

Question 4

How does the GI system increase its surface area?

Answer 4

• Ridges
• Folds

Question 5

What is emesis?

Answer 5

• Retching
• Follows nausea
• Expulsion of GI contents

Question 6

What is rumination syndrome?

Answer 6

Chewing and swallowing food that has been regurgitated

Question 7

What are the 3 things that control the motor function of the gut?

Answer 7

• Parasympathetic and sympathetic nervous systems
• Enteric brain neurons
• Smooth muscle cells

Question 8

How many cycles occur per minute in the gastric cycle?

Answer 8

3 cycles per minute of smooth muscle contraction in the stomach.

Nausea shifts this

Question 9

What are the two irregular rhythms of stomach motility?

Answer 9

• Tachygastria
• Bradygastria

Question 10

What are the 4 sources that can stimulate vomiting?

Answer 10

1. Afferent vagal fibers from GI viscera (GI distention
2. Fibers of the vestibular system (sea-sickness, dizziness)
3. Higher CNS centers (smells, sights, emotion)
4. Chemoreceptor trigger zone (area posterna)

Question 11

What virus is most likely implicated with vomiting 24-48 hrs post ingestion?

Answer 11

Norwalk-like viruses

Question 12

What does acute onset of N/V w/ severe pain suggest for etiology?

Answer 12

• Peritoneal inflammation
• Acute gastric/intestinal obstruction
• Pancreatobiliary disease

Question 13

What does persistent N/V suggest for etiology?

Answer 13

• Pregnancy
• Gastric outlet obstruction
• Gastroparesis
• Intestinal dysmotility
• Psychogenic disorders
• CNS/Systemic disorders

Question 14

What does morning N/V suggest for etiology?

Answer 14

• Pregnancy
• Uremia
• Alcohol intake
• Increased ICP

Question 15

What improves cannabinoid hyperemesis syndrome usually?

Answer 15

A hot bath

Question 16

If a person constantly vomits right after meals, what is the suspected etiology and how might you check?

Answer 16

• Bulimia
• Perform a TEETH exam!

Question 17

What does feculent vomiting suggest?

Answer 17

Intestinal obstruction

Question 18

What should abdominal XRAY show for SBO? Ileus?

Answer 18

• SBO: Intestinal air-fluid levels with reduced colonic air.
• Ileus: Diffusely dilated air-filled bowel loops.

Order Flat and upright XRAY if sus of mechanical obstruction.

Question 19

How does EGD often present?

Answer 19

Normal

Question 20

What complications should we be wary about in someone with persistent vomiting?

Answer 20

• Volume depletion/dehydration
• Lyte disturbances
• Aspiration
• Mallory-Weiss tear
• Boerhaave syndrome (Esophageal rupture)

Question 21

What two things should we always check in someone vomiting?

Answer 21

• Volume status
• Lyte status

Question 22

What food type should we avoid in someone vomiting that we are attempting to PO test?

Answer 22

Lipids

Lipids delay gastric emptying

Question 23

What is the overall goal of replacement fluid therapy?

Answer 23

• Correct volume status
• Correct lyte abnormalities

Question 24

What is unique about replacing mild hypovolemia?

Answer 24

Positive fluid balance is preferred.

Infusing slightly more fluid than the rate of loss.

Question 25

What electrolyte abnormality should NOT be corrected fast?

Answer 25

Natremias

Question 26

What is the MOA of zofran/ondansetron?

Answer 26

Serotonin 5-HT3 receptor agonist

Blocks stimulation of vomiting center in medulla.

Question 27

When is zofran NOT used for N/V?

Answer 27

• First trimester!!!
• QT prolongation

Cleft palate defect could occur.

Question 28

What kind of patients should zofran use be cautionary in?

Answer 28

Hepatic impaired.

Question 29

What is the MC SE of zofran?

Answer 29

HA

Question 30

What are the preferred medications for N/V in pregnancy?

Answer 30

• Scopolamine
• Meclizine
• Doxylamine

Anticholinergics/anthistamines

Any of these + vit B6 (pyridoxine) + doxylamine = recommended

Question 31

How does promethazine work?

Answer 31

1st gen H1 blocker.

Used for acute N/V only.

Question 32

What are the serious SEs of promethazine?

Answer 32

• Respiratory depression
• Extrapyramidal SEs
• Bradycardia

Question 33

What are the BBWs for promethazine?

Answer 33

• Respiratory depression
• Tissue necrosis/injury

Question 34

Who is promethazine specifically contraindicated in?

Answer 34

Children under 2 due to risk of respiratory depression.

Gotta be a pro to take promethazine

Question 35

How does metoclopramide work and when do we use it?

Answer 35

• Prokinetic
• Used as adjunct for N/V, gastroparesis, and refractory GERD.

Meto makes you move

Question 36

What are the main serious SEs of metoclopramide?

Answer 36

• Extrapyramidal SEs
• Neuroleptic malignant syndrome
• Lowers seizure threshold

Malignant meto

Question 37

What is the BBW of metoclopramide?

Answer 37

Tardive dyskinesia

Question 38

When is metoclopramide contraindicated?

Answer 38

• Seizure d/o
• GI obstruction

Taper med off.

Question 39

When is lorazepam commonly administered for N/V?

Answer 39

Prior to chemo along with zofran

Question 40

What history might preclude us from using promethazine for a N/V patient?

Answer 40

COPD

Promethazine causes respiratory depression.

Question 41

What is preferred medication therapy for N/V during pregnancy?

Answer 41

Vit B6 + doxylamine

UTD says this is the first-line therapy before the anticholinergics but u can add scopolamine or meclizine i guess