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GI - mine > nausea and vomiting > Flashcards

nausea and vomiting Flashcards

1
Q

what is nausea

A

unpleasant urge to vomit

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2
Q

what is vomiting

A

forceful expulsion of stomach contents through mouth/nose by contraction of abdominal muscles

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3
Q

what is vomiting also known as

A

emesis

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4
Q

what is vomiting frequently preceded by

A

profuse salivation
sweating
high HR
nausea

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5
Q

what is retching

A

repetitive reverse peristalsis of the stomach and oesophagus without vomiting

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6
Q

what is regurgitation

A

effortless movement of swallowed food/ stomach contents back into the mouth

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7
Q

what is regurgitation NOT associated with

A

nausea

retching

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8
Q

toxics stimulate what cells in the mucosa

A

enterochromaffin cells

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9
Q

where is the vomiting centre located

A

medulla oblongata

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10
Q

what do the visceral efferents effect during vomiting

A

oesophagus = shortens it
stomach = proximal relaxation
small intestine = giant retrograde contraction

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11
Q

what do the motor neurones effect during vomiting

A

anterior abdominal muscle = contraction

diaphragm = contraction

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12
Q

what do autonomic/somatic efferents effect during vomiting

A 
heart = increase rate & force
salivary glands = increased secretions
skin = pallor, cold sweat
bladder = sphincter constricts
anus = sphincter constricts
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13
Q

describe the pathway of vomiting

A

toxic materials in gut lumen or systemic toxins stimulate enterochromaffin cells in mucosa

enterochromaffin cells release mediators which depolarise sensory afferent terminals in the mucosa causing an AP in vagal afferents to the brainstem.

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14
Q

where is the chemoreceptor trigger zone (CTZ) located

A

brainstem

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15
Q

consequences of severe vomiting

A 
dehydration
loss of gastric protons and Cl-
hypokalaemia
mallory-weiss tear 
aspiration of vomit
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16
Q

where is the nucleus of the solitary tract (NTS) located

A

brainstem

17
Q

describe the process of vomiting

A

Intestinal slow wave activity is suspended, retrograde contractions occur from ileum to stomach. Breathing is suspended as the glottis closed to prevent aspiration. LOS relaxes, diaphragm contracts and abdominal muscles compress the stomach causing ejection of gastric contents through open UOS.

18
Q

how is chemo-induced vomiting treated

A

triple therapy:

5HT3-receptor-antagonist = odansetron
corticosteroid = prednisolone
Aprepitant

19
Q

what causes morning sickness

A

Human chorionic gonadotropin (HCG) produced by placenta

20
Q

treatment of morning sickness

A

changes in diet
use of ginger or pyridoxine (vit B6)
wrist acupuncture

21
Q

what is hyperemesis gravidarum

A

extreme morning sickness

22
Q

what causes hyperemesis gravidarum

A

fluid and electrolyte disturbances or nutritional deficiency due to intractable vomiting in pregnancy

23
Q

treatment of hyperemesis gravidarum

A

1st line = antihistamine

2nd antihistamine + dopamine antagonist

24
Q

list anti-vomiting drugs (6)

A 
dopamine antagonist
prokinetic drugs 
5TH3 receptor antagonists 
H1 histamines
anticholingeric
adjuvant antiemetics
25
Q

list adjuvant antiemetics (4)

A

Nk1 receptor antagonists = aprepitant
corticosteriods
benzodiazepines
cannabinoid

26
Q

mechanism of action of dopamine antagonists

A

act centrally by blocking the chemoreceptor trigger zone

27
Q

mechanism of action of prokinetic drugs

A

increases gastric peristalsis and increase LOS tone, blocks D2 receptor in CTZ

28
Q

example of prokinetic drugs

A

metoclopramide, domperidone

29
Q

mechanism of action of 5HT3 receptor antagonists

A

blocks 5TH3 receptors in GI tract and CNS

30
Q

example of 5HT3 receptor antagonists

A

“-setron”

ondansetron

31
Q

mechanism of action of H1 antihistamine

A

blocks H1 receptor in vestibular nuclei and NTS

32
Q

example of H1 antihistamine

A

“-zine”

cyclizine

33
Q

mechanism of action of anticholinergic

A

blocks muscarinic receptors in vestibular nuclei, NTs,and vomiting centre

34
Q

example of anticholinergics

A

hyosine

GI - mine (17 decks)

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