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Z Year3 Clinical Presentations > Nausea and Vomiting > Flashcards

Nausea and Vomiting Flashcards

1
Q

Where is the vomiting centre in the brain?

A

medulla oblangata

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2
Q

What can the vomiting centre be activated by?

A
  1. Vestibular system
  2. Central Nervous system (CNS)
  3. Chemoreceptor trigger zone (CTZ)
  4. Cranial Nerves IX and X
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3
Q

What are the conditions with nausea and vomiting that come from the vestibular system?

A
  1. BPPV
  2. Labyrinthitis
  3. Motion sickness
  4. Ménieres disease
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4
Q

What are the conditions with nausea and vomiting that come from the chemoreceptor trigger zone (CTZ)?

A
  1. Medications
  2. Alcohol
  3. Hormones
  4. electrolytes
  5. Toxins
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5
Q

What are the conditions with nausea and vomiting that come from the CNS?

A
  1. Pain
  2. Anxiety
  3. Raised ICP
  4. Meningitis
  5. Encephalitis
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6
Q

What are the conditions with nausea and vomiting that come from the cranial nerves IX and X?

A
  1. GI obstruction
  2. GI infection
  3. Inflammation of diaphragm
  4. Inflammation of liver, pancreas, gallbladder, peritoneum
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7
Q

What receptors does the CTZ use?

A

dopamine receptors

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8
Q

What receptors does the VS use?

A

histamine and acetylcholine receptors

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9
Q

What receptors does the cranial nerves IX and X use?

A

serotonin and acetylcholine receptors

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10
Q

What questions are key to ask about the details of the vomit?

A
  1. Contents
  2. Timing
  3. Assoicated with eating
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11
Q

What would undigested vomit suggest?

A

oesophageal disorder e.g. achalasia, pharyngeal pouch

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12
Q

What would partially digested vomit suggest?

A

gastric outlet obstruction, gastroparesis (delayed stomach emptying e.g. in DM)

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13
Q

What would bile (green) vomit suggest?

A

small bowel obstruction (distal to ampulla of Vater)

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14
Q

What would feaculent vomit suggest?

A

distal intestinal or colonic obstruction

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15
Q

What would blood/coffee ground vomit suggest?

A

haematemesis

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16
Q

What would a large volume of vomit suggest?

A

less likely to be functional

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17
Q

What would early morning vomit suggest?

A
  • pregnancy

- raised ICP

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18
Q

What would a longer time course of nausea and vomiting suggest?

A

makes acute pathologies e.g. bowel obstruction less likely

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19
Q

What would vomiting within 1hr of eating suggest?

A

upper GI proximal to gastric outlet - if so ask about PUD as can cause scarring and pyloric stenosis

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20
Q

What would vomiting long after eating suggest?

A

obstruction low GI tract - small bowel

21
Q

What would long early sateity, postprandial bloating and abdominal discomfort suggest?

A
  1. gastroparesis

2. outlet obstruction

22
Q

How do you ask about details of pain?

A

socrates

23
Q

What would RUQ pain with nausea and vomiting suggest?

A

hepatobiliary cause

24
Q

What would epigastric pain with nausea and vomiting suggest?

A

pancreatic or gastroduodenal cause

25
Q

What would relief of pain after vomiting suggest?

A

obstruction

26
Q

What other symptoms should you ask about with nausea and vomiting?

A
  1. Fever
  2. Headache, visual disturbance
  3. Vertigo, difficulty standing
27
Q

What would a fever with nausea and vomiting suggest?

A
  1. gastroenteritis
  2. appendicitis
  3. cholecystitis
  4. cholangitis
  5. pancreatitis
  6. hepatitis
  7. UTI
  8. meningoencephalitis
28
Q

What would headache, visual disturbance, any other neurological symptoms with nausea and vomiting suggest?

A
  1. Raised ICP
  2. meningitis
  3. encenphalitis
  4. migraine
29
Q

What would vertigo/difficulty walking or standing due to it with nausea and vomiting suggest?

A
  1. Labyrinthitis
  2. Menieres disease
  3. BPPV
30
Q

What bowel movement (flatus and feaces) questions would you ask with nausea and vomiting

A
  1. Delay/absolute constipation

2. Diarrhoea

31
Q

What would long delay with nausea and vomiting suggest?

A

bowel obstruction

32
Q

What would constipation with nausea and vomiting suggest?

A

eating less, vomiting

33
Q

What would absolute constipation with nausea and vomiting suggest?

A

bowel obstruction

34
Q

What would diarrhoea and vomiting suggest?

A

infectious gastroenteritis

35
Q

What could close contacts also suffering nausea and vomiting suggest?

A
  1. rotavirus
  2. adenovirus
  3. norovirus
36
Q

What could living in close quarters with nausea and vomiting suggest?

A

common outbreak of GI pathogens

37
Q

What would recent foreign travel with nausea and vomiting suggest?

A
  1. different hygeine standards 2. local pathogens risk of GI infections
38
Q

What would unusual food with nausea and vomiting suggest?

A

exposure to infectious GI pathogen

39
Q

What medications can cause nausea and vomiting?

A
  1. opiate
  2. chemo
  3. anticonvulsants
  4. antibitoics
40
Q

What industrial chemicals can cause vomiting?

A
  • arsenic

- organophosphate fertilizer

41
Q

What else do you check in SHx with nausea and vomiting?

A

Alcohol? Ilicit drugs?

42
Q

What PMHx is important to ask with nausea and vomiting?

A

previous abdominal surgery predisposes to adhesion between peritoneum and bowel which can cause bowel obstruction

43
Q

What would an acute onset (<1month) of nausea and vomiting with abdominal pain with fever suggest?

A
  1. Gastroenternritis
  2. Food poising
  3. Appendicitis
  4. Mesenteric adenitis
  5. Cholecystitis
  6. Pancreatitis
44
Q

What would an acute onset (<1month) of nausea and vomiting with abdominal pain without fever suggest?

A
  1. SBO
  2. DKA
  3. Drug side effect/OD
  4. Toxins (lead)
  5. LBO
  6. Mesenteric ischaemia
  7. MI
  8. Due to pain e.g. kidney stone, testicular torsion
45
Q

What would an acute onset (<1month) of nausea and vomiting with headache suggest?

A
  1. Meningitis
  2. Raised ICP (SOL, hydrocephalus)
  3. Migraine
46
Q

What would an acute onset (<1month) of nausea and vomiting with vertigo suggest?

A
  1. Labyrinthitis
  2. Menieres
  3. BPPV
  4. Motion sickness
  5. Acoustic Neuroma
47
Q

What would an acute onset (<1month) of nausea and vomiting shortly after food suggest?

A

gastric outlet obstruction

48
Q

What would an acute onset (<1month) of nausea and vomiting with no major other symptoms?

A
  1. Drugs side effect
  2. Psychogenic
  3. Hyperthryoid
  4. Renal failure + uraemia
  5. Cyclic vomiting syndrome

Z Year3 Clinical Presentations (37 decks)

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