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Gastroenetrology > Nausea and Vomiting > Flashcards

Nausea and Vomiting Flashcards

1
Q

What is nausea?

A

The unpleasant urge to vomit

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2
Q

What is vomiting?

A

The forceful expulsion of the stomach contents through the mouth/nose

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3
Q

What is retching?

A

Repetitive peistalsis of the stomach and oesophagus without vomiting

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4
Q

What is regurgitation?

A

The effortless movement of swallowed food contents back into the mouth

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5
Q

What occurs during vomiting?

A

Forceful inspiration
Reflex closure of the glottis
Elevation of the soft palate
Closure of airways and nasal passages

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6
Q

Where is vomiting coordinated?

A

The Vomiting centre (VC) of the medulla

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7
Q

What contents are involved in vomiting?

A

The contents of the stomach and the small intestine

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8
Q

What is the sequence of events in vomiting?

A

Suspension of intestinal slow wave activity > Retrograde contractions from ileum to stomach > Suspension of breathing> Relaxation of LOS contraction of diaphragm and abdominal muscles> Ejection of gastric contents through open UOS

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9
Q

What autonomic/somatic symptoms precede vomiting?

A

Salivation
Sweating
Elevated heart rate
Nausea

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10
Q

What are the 2 most important things that stimulate vomiting?

A 
Presence of toxic materials in the gut
Systemic toxins (e.g. drugs)
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11
Q

What cells do the stimuli stimulate?

A

Enterochromaffin cells in the mucosa

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12
Q

Enterochromaffin cells release what mediators and what does this result in?

A

5-HT and Substance P

The depolarization if sensory afferent terminals in mucosa

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13
Q

Where do action potentials in the vomiting cycle occur from?

A

The mucosa

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14
Q

Where do the action potentials move to?

A

CTZ - chemo receptor trigger zone

NTS - Nucleus tractus solitarius

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15
Q

What do the CTZ and NTS do?

A

Co-ordination of the vomiting

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16
Q

what is the population of portpatrick and what are their names?

A

5

Joanne, Billy, Elaine, Gillian McKeith and Ozzy

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17
Q

How can MI cause vomiting?

A

Intense pain can stimulate vomiting

Stimulation of………..

18
Q

What is anticipatory vomiting?

A

Patients feeling sick when seeing the hospital or in advance of chemotherapy
CNS stimulation

19
Q

What causes motion sickness?

A

The difference between the stimuli received from the eyes and the rest of the body

20
Q

Where is the motor output that coordinates vomiting located?

A

The brainstem - vomiting centre

21
Q

What is the vomiting centre?

A

A group of interconnected neurones within the medulla that receives input from the NTS

22
Q

What are the 3 types of motor output?

A

Vagal efferents
Somatic motor neurones
Autonomic/somatic efferents

23
Q

What do vagal efferents result in?

A

Shortening of oesophagus
Relaxation of stomach
Retrograde contraction of the small intestine

24
Q

What do somatic motor neurones do?

A

Contraction of the anterior abdominal muscle

Contraction of the diaphragm

25
Q

What do autonomic/somatic efferents do?

A

Increased heart rate
Increased salivation
Cold Skin
Constriction of bladder and anus

26
Q

What are the consequences of sever vomiting? (5)

A

Dehydration
Loss of gastric protons and chloride (Hypochloraemic metabolic alkalosis)
Hypokalaemia
Mallory-Weiss tear
Aspiration of the vomitus into the air passage and lungs

27
Q

What is a Mallory-Weiss tear?

A

Tear of the inner mucosal walls of the oesophagus

Results in reddish streaks of fresh blood in the vomitus

28
Q

What drugs can cause nausea and vomiting?

A 
Cancer chemotherapy
Radiotherapy
General Anesthetics 
Dopamine receptor stimulants
Morphine and other opiate analgesics
Cardiac glycosides
Drugs that enhance the function of 5HT
29
Q

What do 5HT3 receptor antagonists (Setrons) used for?

A

Antiemetic drugs
Suppress chemotheraphy and radiation-induced emesis and post-operative nausea and vomiting
Block peripheral and centeral 5HT3 receptors

30
Q

What do 5HT3 receptor antagonists do?

A

Reduce acute nausea, retching and vomiting

31
Q

When are 5HT3 receptor antagonists less effective?

A

During subsequent treatments

32
Q

What improves the action of a 5HT3 receptor antagonist?

A

Addition of a corticosteroid and a neurokinin receptor antagonist

33
Q

What are muscarinic acetylcholine receptor antagonists and what are they used for?

A

Anti-sickness drugs
For motion sickness
E.g. Hyosine/Scopolamine

34
Q

What is the mechanism of Muscarinic ACH receptor antagonists?

A

Block ACH receptors at multiple locations at affector organs innervated by the parasympathetic nervous system
Causes inhibition of the GI movements and relaxation of the GI tract

35
Q

What are 2 examples of a H1 receptor antagonist?

A

Cyclizine

Cinnarizine

36
Q

What are H1 receptor antagonists used for?

A

Prophylaxis and treatment of:
motion sickness and acute nausea
vomiting caused by stomach irritants

37
Q

What is the mechanism of H1 receptor antagonists?

A

Blockade of H1 receptors in the vestibular nuclei and NTS

38
Q

What are the side effects of H1 receptor antagonists?

A

CNS suppression

39
Q

What are Dopamine receptor antagonists?

A

Used for treatment off drug induced vomiting

40
Q

What are 2 examples of Dopamine receptor antagonists?

A

Domperidone

Metoclopramide

41
Q

What is the mechanism of action of Dopamine receptor antagonists?

A

Block Dopamine D2 and D3 receptors in the CTZ

Exert a prokinetic action on the oesophagus, stomach and small intestine

Gastroenetrology (17 decks)

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