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PATHOPHYSIOLOGY > Nausea and Vomiting > Flashcards

Nausea and Vomiting Flashcards

1
Q

Give 5 reasons as to why nausea and/or vomiting may occur.

A
  1. To avoid the injection of toxins
  2. to expel toxins from the stomach
  3. during pregnancy to protect the foetus
  4. food allergies or intolerences
  5. behavioral mechanisms to protect against toxins
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2
Q

Define nausea

A

A non-specific symptom which can be felt for a number of reasons. Can occur alongside other symptoms and can occur without vomiting.

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3
Q

Define vomiting

A

Involuntary and forceful expulsion of stomach contents through the mouth. Occurs as a result of the GI tract relaxing and the diaphragm, abdominal and intercostal muscles contracting.

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4
Q

Define regurgitation

A

Return of undigested food to the oesophagus and the mouth without the force associated with vomiting

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5
Q

Define anticipatory nausea and vomiting

A

A conditioned response to a stimulus which has previously caused vomiting. Can occur in any situation where a neutral stimuli is associated with the mechanism of vomiting.

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6
Q

Define retching

A

An attempt to vomit. Involves reverse peristalsis into the stomach without vomiting. Function is to mix gastric contents with intestinal refluxate in order to buffer the gastric contents and give it momentum in preparation for vomiting.

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7
Q

What is the neurophysiology of vomiting also referred to as?

A

Emetogenisis

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8
Q

Neurons of which brain department make up the vomiting centre..

A

The medulla oblongata of the brainstem

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9
Q

What must be stimulated in order for the vomiting centre to send out efferent signals?

A

An action potential following a certain threshold point being reached

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10
Q

Afferent signals to the vomiting centre arise from (give 4):

A

The labyrinth/vestibular region of the inner ear
The GI system/pharynx
The chemorecpetor trigger zone
The higher cortical centres of the brain

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11
Q

Breifly describe what happens within the chemoreceptor trigger zone

A

It is made up of interconnecting neurones and receives input about blood borne drugs, hormones, electrolytes and toxins within the body. Receptors receive signals from these inputs and an action potential may be triggered. If an action potential is reached the CTZ receptors will trigger the vomiting centre to respond.

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12
Q

What are the two types of receptor which exist on neurons in the chemoreceptor trigger zone?

A

Receptors on the surface of the neuron called chemreceptors and receptors which exist deeper within the neuron dendrites.

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13
Q

Sensory fibres within the pharynx are activated when:

A

They are irritated by infection presence or by a foreign object in the mouth triggering the gag reflex

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14
Q

Which nerve supplies sensory nerve fibres to the pharynx?

A

The vagus nerve

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15
Q

The labyrinth is a part of the …… and is also known as?

A

The inner ear and is also known as the vestibular system.

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16
Q

What is the vestibular system responsible for?

A

Balance and movement- reacting to position change and sending messages to the CTZ recpetors.

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17
Q

What do position changes detected by the vestibular system trigger the release of?

A

Histamine which is sent to the CTZ receptors

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18
Q

Te cerebral cortex and limbic system cause nausea and vomiting when triggered by: (give 3 things)

A

The senses (particularly smells), anxiety, pain, learned associations or increased inter cranial pressure.

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19
Q

Peripheral pathways recieve input from:

A

The gastrointestinal tract

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20
Q

Sensory signals are transmitted from the gastrointestinal tract by which two nerves?

A

The vagal nerve and the spinal sympathetic nerves

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21
Q

Sensory signals are transmitted from the GI tract in response to:

A

Toxin presence

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22
Q

What in the intestinal walls are activated by abnormal contractions during diarrhoea, distention following overeating or distortion due to tumor growth?

A

Mechancoreceptors

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23
Q

Which three different efferent pathways are initiated by the vomiting centre?

A
  1. motor pathway directs nerves to the diaphram, intercostal and abdominal muscles and the larynx and pharynx.
  2. parasympathetic pathway increases salivation as stomach acid enters the mouth
  3. sympathetic pathway initiates sweating and increased heart rate as a part of the sympathetic nervous system response
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24
Q

What happens during the prodromal phase of vomiting?

A

The gastric muscles relax along with the stomach and the oesophagus and their sphincters. The diaphragm, intercostal muscles, abdominal muscles as well as the larynx and pharynx contract forcing the stomach contents out.

25
Q

What happens during the ejection phase of vomiting?

A

Retching occurs and is followed by the vomiting process requiring vigorous contractions of the abdominal muscles and relaxation of the upper oesophageal sphincter.

26
Q

What are 7 consequences of vomiting?

A
  1. dehydration
    2, reluctance to continue with important treatment processes such as chemotherapy
  2. Electrolyte disturbances
  3. Malnutrition
  4. Vitamin deficiency
  5. A tear in the gastro-oesophageal walls lining
  6. Metabolic alkalosis (acid base balance disturbance)
27
Q

Which 7 things must be assessed during the clinical management of vomiting and nausea?

A
  1. medical history
  2. medications taken
  3. other symotoms experience (e.g. headache, diarrhoea)
  4. effect on nutrition- fluid and food intake
  5. impact on activities of daily living
  6. nausea- onset, frequency, intensity
  7. vomiting- onset, frequency, intensity, force, colour, timing and pattern
28
Q

When conducting a physical examination on a vomiting/nauseous patient what 5 things is it important to include?

A
  1. Abdominal examination to check for constipation or distention of the abdomen
  2. Chest examination and assessment of cough presence
  3. Psychological examination- assessing anxiety and other psychological trauma which may cause vomiting and nausea symptoms
  4. Signs of optic disk swelling in the eyes (papilloedema)
  5. Signs of infection in the mouth/oropharynx including ulceration
29
Q

Which neurotransmitter molecule is released in response to toxins in the gastrointestinal tract?

A

Serotonin

30
Q

Which region of the brain is directly stimulated by factors in the circulation that trigger emisis?

A

CTZ (chemoreceptor trigger zone)

31
Q

Describe osmotic diarrhoea

A

Non absorbable substances are drawn into the bowel such as salty foods and sugars. Water is drawn into the foods within the lumen of the bowel rather than being absorbed. This is often the case with food intolerance.

32
Q

Describe secretory diarrhoea:

A

Increased mucousal secretions of fluid and electrolytes due to infection.

33
Q

Describe motility diarrhoea:

A

decreased transit time results in limited water absorbtion. Often the cases in small bowel operations.

34
Q

Describe exudative diarrhoea:

A

Damage or inflammation to the epithelial lining of the intestine resulting in less fluid absorbtion for example in IBS.

35
Q

Name the three types of constipation?

A

Normal transit constipation, slow transit constipation and pelvic floor/outlet constipation.

36
Q

Name the four types of diarrhoea?

A
  1. secretary
  2. osmotic
  3. motility
  4. exudative
37
Q

What occurs during normal transit constipation?

A

Regular passing of stools but evacuation is difficult. Associated with a sedentary lifestyle, low residue diet and low fluid intake.

38
Q

What occurs during slow transit constipation?

A

Frequent bowel movement, straining to pass stools and mild abdominal distention by impaired colon activity.

39
Q

What happens during pelvic floor/outlet dysfunction with relation to constipation?

A

Poor action of the pelvic floor muscles or anal sphincter muscle leads to difficulty in defaecating.

40
Q

Name four bacterial infections causing diarrhoea:

A
  1. salmonella
  2. e coli
  3. shingella
  4. campylobacter
41
Q

Name two viral infections causing diarrhoea:

A
  1. rotavirus

2. noravirus

42
Q

How can multiple organ failure occur due to vomiting and diarrhoea/

A

Fluid is lost which decreases the intravascular fluid volume. This decreases the stroke volume and therefore cardiac output within the heart. This decreases blood pressure, lowering tissue perfusion reducing the oxygen and nutrient delivery to cells resulting in organ failure.

43
Q

Describe large volume diarrhoea

A

Volume of faecal output increased, watery and non bloody, bloating, nausea and vomiting. No tissue inflammation.
Caused by toxin producing bacteria.

44
Q

Describe small volume diarrhoea

A

Volume of faecal output remains the same as normal. Bloody stools, lower abdominal pain, urgent desire to defecate, no nausea and vomiting caused by the intestinal invasion of intestinal cells.

45
Q

Name the two sites for bowel obstructions:

A

Small or large bowel

46
Q

Name the three effects obstructions can have on the abdominal wall:

A

Simple: obstruction of the lumen does not affect the blood supply
Strangulated: obstruction of lumen causes decreased blood supply
Closed loop: obstruction occurs and the end of each segment of intestine

47
Q

What is psudeoobstruction?

A

A disorder characterised by dilatation of the colon due to an adynamic bowel in the absense of a mechanical obstruction. Thought to be due to an inturruption of the autonomic nervous system supply to the colon resulting in the absense of smooth muslce action in the bowel wall. Leads to an increased risk of bowel ischaemia and perforation.

48
Q

Why does bowel obstruction result in the loss of fluids and electrolytes?

A

An obstruction causes gas and fluid to gather at the obstruction causing distention of the intestine. Water and electrolytes are unable to be absorbed to their presence within the lumen increases. Individual vomits resulting in the loss of water and electrolytes. Fluid and plasma volume decreases resulting in hypotension and tachycardia.

49
Q

What is a bowel perforation and what does it cause?

A

A perforation is a hole in the wall of the colon. This may be a puncture, cut or a tear. Colon material leaks into the abdominal cavity causing peritonitis which is an infection of the peritoneum (protective membrane over the abdominal organs). This may result in sepsis.

50
Q

What is avoidant restrictive food intake disorder?

A

Abnormal eating habits that result in reduced nutritional intake. Normally caused due to lack of food availability, medication side effects or another health condition. Does not aim to lose weight but weight will decrease.

51
Q

What is refeeding syndrome?

A

Biochemical abnormalities occur after an individual begins to eat normally again following a period of fasting. Characteristic features include low sodium, potassium, phosphate and magnesium levels. Can cause major complications including heart failure and muscle weakness. Major risk factors are alcohol and drug use, calorie malnutrition of any cause, a low BMI or a period of starvation lasting more than 5 days. Patient must be fed and monitored very carefully following starvation period to reduce the risk of developing refeeding syndrome.

52
Q

What is the difference between anorexia and anorexia nervosa?

A

Anorexia is characterised by a lack of desire to eat usually associated with nausea, vomiting and abdominal pain. Anorexia nervosa is a mental health condition related to restricting food intake in order to lose weight. Individuals with anorexia nervosa often demonstrates body dysmorphia.

53
Q

What is bulimia nervosa?

A

Frequent episodes of binge eating where the individual loses control over their eating. Usually accompanied by behaviours aimed at preventing weight gain such as vomiting, use of laxatives or enemas or strenuous exercise. Individual is not typically underweight.

54
Q

What is PICA?

A

Characterised by the regular consumption of non nutritive substances such as non food objects and materials. Behaviour causes damage to health, impairment in functioning or significant risk due to the frequency, amount or nature of the substances or objects injected.

55
Q

How are the bodies needs met during periods of starvation?

A

The body switches from metabolising carbohydrates to metabolising fats. Bodies needs are met by ketone bodes and fatty acids.

56
Q

Name three cardiovascular effects of starvation:

A

Heart rate decrease
Blood pressure decreases
ECG changes occur

57
Q

Name 5 other symptoms occurring with starvation:

A 
Urge to binge eat
Light headedness 
Headaches 
Poor memory 
OCD 
Irrational and negative thinking
58
Q

What are the 6 functions of the GI system?

A

ingestion, secretion, mixing, digestion, absorbtion, excretion

PATHOPHYSIOLOGY (14 decks)

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