Nausea and vomiting

Question 1

What does coffee ground vomiting usually indicate?

Answer 1

An upper GI bleed

Question 2

If a patient presents with morning vomiting what two things could this indicate?

Answer 2

Pregnancy or raised intracranial pressure

Question 3

If a patient presents with vomiting 1 hour after eating food what could this indicate?

Answer 3

Gastroparesis

Question 4

If someone has abdominal pain that is relieved by vomiting what does this usually mean?

Answer 4

The patient likely has a peptic ulcer

Question 5

If a patient has been suffering with severe vomiting how will their ABG usually present?

Answer 5

Metabolic alkalosis

Question 6

How would you manage a patient suffering with severe vomiting?

Answer 6

IV fluids and potassium replacement. Consider NBM.

Prescribe antiemetic if appropriate.

Question 7

Name some examples of a mechanical aetiology of dysphagia?

Answer 7

Malignant stricture

Benign strictures (eg. peptic strictures)

Extrinsic pressure - eg. lung cancer, aortic aneurysm, pharyngeal pouch.

Question 8

Name some examples of a motility aetiology of dysphagia?

Answer 8

Achalasia

Diffuse oesophageal spasm

Systemic sclerosis

Neurological bulbar palsy

Question 9

What is Globus?

Answer 9

This is when a patient gives the description of having a lump in their throat. This can often be linked to generalised anxiety disorder.

Question 10

What is the mechanism of action of Cyclizine?

Answer 10

A H1 receptor antagonist.

It is an anti-emetic that can be prescribed for gastric causes of N+V. Should not be prescribed for the elderly as it can cause drug induced psychosis.

Question 11

What is the mechanism of action of Metoclopramide?

Answer 11

A dopamine receptor antagonist.

It is an anti-emetic that can be prescribed for GI causes and is also a pro-kinetic (not suitable for bowel obstruction).

Side effect: Parkinsonism

Question 12

What anti-emetic is suitable for vestibular causes of nausea and what is its MOA?

Answer 12

Prochlorperazine - a dopamine receptor antagonist.

Question 13

Which anti-emetic is suitable for chemical causes of nausea?

Answer 13

Haloperidol. This is a dopamine receptor antagonist that can lead to Parkinsonism.

Question 14

What is the mechanism of Ondansetron and what dose can be given?

Answer 14

It is a serotonin receptor antagonist.

The given dose is 4-8mg/8hr IV slowly.