N&V Flashcards
Appearance:
- Coffee grounds
- Recognisable food
- Faeculent
Upper GI bleeding
Gastric stasis
thicker and foul-smelling - distal bowel obstruction
Timing:
- Morning
- Post-prandial
- Vomiting relieving pain
- Preceded by loud gurgling
Pregnancy
Raised ICP
Gastric stasis/gastroparesis - happens in DM and pyloric sphincter closure
Peptic ulcer
GI obstruction
Causes:
- Infection
- Gallbladder and pancreas
- Occurs more distally
- Malignancy
- Ulcer
Gastroenteritis
Acute cholecystitis or pancreatitis
Intestinal obstruction
Gastric cancer
PUD
Non-GI causes:
Mneumonic - ABCDEFGHI
A - 2 B C D E F G H - 3 - thyroid and 2 electrolytes I
AKI. Addisons
Brain - migraine, raised ICP
Cardiac - MI
DKA
Ears - labyrinthitis, Meniere’s
Foreign substance - alcohol, drugs
Gravidity - morning sickness or HG
Hypercalcaemia
Hyponatraemia
Hyperthyroidism
Infection - UTI or sepsis
Investigations:
Why do you do an ABG?
Why do you look for in a AXR?
What appropriate investigation is used for blood/persistent vomiting?
Metabolic alkalosis after loss of gastric contents - loss of acid
Bowel obstruction
Upper GI endoscopy
Management
What needs to be given first to relieve symptoms?
What needs to be monitored?
Anti-emetics
Electrolytes and fluid balance
Anti-emetics:
Anti-histamines - think of some examples - 2
What is the MOA?
What is another effect that is has that could possibly become an adverse effect? - e.g. dry mouth
Cyclizine
Promethazine
Dimenhydrinate
Diphenhydramine
Act centrally on vomiting - brain
Anti-cholinergic effects:
Typical symptoms include dry mouth, constipation, urinary retention, bowel obstruction, dilated pupils, blurred vision, increased heart rate, and decreased sweating
Anti-emetics - Anti-dopaminergic
Metaclopamide - avoided in pregnancy
MOA - 1
Side effects - mind and neurological
Acts centrally in chemoreceptor trigger zone
Confusion
Dyskinesia and Parkinsonism
Anti-emetics - Anti-dopaminergic
Levomepromazine:
Why is this a good choice?
What can it cause which makes it good in palliative care?
Has a range of effects - Anti-dopaminergic, anti-histaminergic, anticholinergic, and anti-serotonergic effects
Sedation
Anti-emetics - Anti-dopaminergic
Domperidone:
In what type of patient is it safe in? - neuro disease
2 routes of admin?
What is it not useful for?
What ECG side effect does it have?
Parkinsons
PO or PR
Central N&V
Prolonged QT
Anti-emetics - Anti-serotonergics
3 examples
2 side effects - GI and ECG effect
Ondansetron
Granisetron
Palonosetron
Constipation
QT prolongation
Other agents to treat N&V:
What can be sniffed for rapid relief of nausea?
In what scenario is dexamethasone used as an adjunct anti-emetic?
Sniffing isopropyl alcohol swabs
Post op and chemotherapy
