Nausea and Vomiting Flashcards
Where is the vomiting centre in the brain?
medulla oblangata
What can the vomiting centre be activated by?
- Vestibular system
- Central Nervous system (CNS)
- Chemoreceptor trigger zone (CTZ)
- Cranial Nerves IX and X
What are the conditions with nausea and vomiting that come from the vestibular system?
- BPPV
- Labyrinthitis
- Motion sickness
- Ménieres disease
What are the conditions with nausea and vomiting that come from the chemoreceptor trigger zone (CTZ)?
- Medications
- Alcohol
- Hormones
- electrolytes
- Toxins
What are the conditions with nausea and vomiting that come from the CNS?
- Pain
- Anxiety
- Raised ICP
- Meningitis
- Encephalitis
What are the conditions with nausea and vomiting that come from the cranial nerves IX and X?
- GI obstruction
- GI infection
- Inflammation of diaphragm
- Inflammation of liver, pancreas, gallbladder, peritoneum
What receptors does the CTZ use?
dopamine receptors
What receptors does the VS use?
histamine and acetylcholine receptors
What receptors does the cranial nerves IX and X use?
serotonin and acetylcholine receptors
What questions are key to ask about the details of the vomit?
- Contents
- Timing
- Assoicated with eating
What would undigested vomit suggest?
oesophageal disorder e.g. achalasia, pharyngeal pouch
What would partially digested vomit suggest?
gastric outlet obstruction, gastroparesis (delayed stomach emptying e.g. in DM)
What would bile (green) vomit suggest?
small bowel obstruction (distal to ampulla of Vater)
What would feaculent vomit suggest?
distal intestinal or colonic obstruction
What would blood/coffee ground vomit suggest?
haematemesis
What would a large volume of vomit suggest?
less likely to be functional
What would early morning vomit suggest?
- pregnancy
- raised ICP
What would a longer time course of nausea and vomiting suggest?
makes acute pathologies e.g. bowel obstruction less likely
What would vomiting within 1hr of eating suggest?
upper GI proximal to gastric outlet - if so ask about PUD as can cause scarring and pyloric stenosis
What would vomiting long after eating suggest?
obstruction low GI tract - small bowel
What would long early sateity, postprandial bloating and abdominal discomfort suggest?
- gastroparesis
2. outlet obstruction
How do you ask about details of pain?
socrates
What would RUQ pain with nausea and vomiting suggest?
hepatobiliary cause
What would epigastric pain with nausea and vomiting suggest?
pancreatic or gastroduodenal cause
What would relief of pain after vomiting suggest?
obstruction
What other symptoms should you ask about with nausea and vomiting?
- Fever
- Headache, visual disturbance
- Vertigo, difficulty standing
What would a fever with nausea and vomiting suggest?
- gastroenteritis
- appendicitis
- cholecystitis
- cholangitis
- pancreatitis
- hepatitis
- UTI
- meningoencephalitis
What would headache, visual disturbance, any other neurological symptoms with nausea and vomiting suggest?
- Raised ICP
- meningitis
- encenphalitis
- migraine
What would vertigo/difficulty walking or standing due to it with nausea and vomiting suggest?
- Labyrinthitis
- Menieres disease
- BPPV
What bowel movement (flatus and feaces) questions would you ask with nausea and vomiting
- Delay/absolute constipation
2. Diarrhoea
What would long delay with nausea and vomiting suggest?
bowel obstruction
What would constipation with nausea and vomiting suggest?
eating less, vomiting
What would absolute constipation with nausea and vomiting suggest?
bowel obstruction
What would diarrhoea and vomiting suggest?
infectious gastroenteritis
What could close contacts also suffering nausea and vomiting suggest?
- rotavirus
- adenovirus
- norovirus
What could living in close quarters with nausea and vomiting suggest?
common outbreak of GI pathogens
What would recent foreign travel with nausea and vomiting suggest?
- different hygeine standards 2. local pathogens risk of GI infections
What would unusual food with nausea and vomiting suggest?
exposure to infectious GI pathogen
What medications can cause nausea and vomiting?
- opiate
- chemo
- anticonvulsants
- antibitoics
What industrial chemicals can cause vomiting?
- arsenic
- organophosphate fertilizer
What else do you check in SHx with nausea and vomiting?
Alcohol? Ilicit drugs?
What PMHx is important to ask with nausea and vomiting?
previous abdominal surgery predisposes to adhesion between peritoneum and bowel which can cause bowel obstruction
What would an acute onset (<1month) of nausea and vomiting with abdominal pain with fever suggest?
- Gastroenternritis
- Food poising
- Appendicitis
- Mesenteric adenitis
- Cholecystitis
- Pancreatitis
What would an acute onset (<1month) of nausea and vomiting with abdominal pain without fever suggest?
- SBO
- DKA
- Drug side effect/OD
- Toxins (lead)
- LBO
- Mesenteric ischaemia
- MI
- Due to pain e.g. kidney stone, testicular torsion
What would an acute onset (<1month) of nausea and vomiting with headache suggest?
- Meningitis
- Raised ICP (SOL, hydrocephalus)
- Migraine
What would an acute onset (<1month) of nausea and vomiting with vertigo suggest?
- Labyrinthitis
- Menieres
- BPPV
- Motion sickness
- Acoustic Neuroma
What would an acute onset (<1month) of nausea and vomiting shortly after food suggest?
gastric outlet obstruction
What would an acute onset (<1month) of nausea and vomiting with no major other symptoms?
- Drugs side effect
- Psychogenic
- Hyperthryoid
- Renal failure + uraemia
- Cyclic vomiting syndrome
