Nausea and Vomiting Flashcards
What would you want to ask in relation to symptoms of vomiting in the history?
- Timing
- Relation to meals
- Amount
- Content
What are GI causes of vomiting?
- Gastroenteritis
- Peptic ulcer
- Pyloric stensosis
- Intestinal obstruction/Paralytic ileus
- Acute cholecystitis
- Acute pancreatitis
What are CNS causes of vomiting?
- Meningitis/Encephalitis
- Migraine
- Raised ICP
- Brainstem lesions
- Motion sickness
- Meniere’s disease
- Labrynthitis
What are metabolic causes of vomiting?
- Uraemia
- Hypercalacemia
- Hyponatraemia
- Pregnancy
- DKA
- Addison’s Disease
What drugs can cause vomiting?
- Antibiotics
- Opiates
- Cytotoxics
- Digoxin
- Alcohol
What mnemonic can you use to remember non-GI causes of vomiting?
- AKI/Addisons
- Brain - Raised ICP etc.
- Cardiac - MI
- DKA
- Ears
- Foreign substance
- Gravidity
- Hypercalcaemia/hyponatraemia
- Infection
If vomiting was occuring in the morning, what might you suspect as the cause?
- Pregnancy
- Raised ICP
- Alcohol dependence
If vomiting was occuring 1h post ingestion of food, what might be the cause?
Gastric stasis/gastroparesis
What would pain which is relieved by vomiting indicate as a potential cause?
Peptic ulcer
How would you investigate vomiting?
If presistent, Consider following,
- Bloods - FBc, U+E’s, LFTs, Ca2+, glucose, amylase, ABG
- Imaging - AXR
- Other - upper GI endoscopy
What metabolic abnormality might you see on ABG in someone with severe vomiting?
Hypochloraemic hypokalaemic metabolic alkalosis from loss of gastric contents
What might faeculent vomit suggest?
GI obstruction
What are classes of anti-emetics?
- H1 antagonists
- D2 antagonists
- 5HT3 antagonists
- Hyoscine hydrobromide
- Dexamethasone
- Midazolam
What are examples of H1 antagonists?
- Cyclizine
- Cinnarizine
How do dopamine (D2) antagonists work?
- D2 receptor is the main receptor in the CTZ - blocks effects of drugs on this area
- Prokinetic effect - Promotes gastric emptying