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Charis & Ellie vs GI > Nausea and Vomiting > Flashcards

Nausea and Vomiting Flashcards

1
Q

What is nausea

A

Subjective, unpleasant sensation
Normally result of Upper intestinal contractions forcing contents via reverse peristalsis into the stomach.
Usually before vomit but can be in isolation

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2
Q

How does nausea present?

A 
Unpleasant sensation 
Pallor 
Sweating 
XSive salivation 
Relaxation of the stomach and lower oesophagus
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3
Q

What is retching?

A

Rhythmic reverse peristalsis of the stomach and oesophagus

  • forceful and involuntary contraction of the abdominal muscles and diaphragm which causes cardiac portion of stomach to be pushed into thorax
  • upper intestinal contractions which force intestinal contents via reverse peristalsis into the stomach
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4
Q

How does retching present?

A

Dry vomiting
Pallor
Sweating
Excessive salivation

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5
Q

What is emesis?

A

Forceful expulsion of gastric/intestinal contents of the mouth
Controlled via the vomiting centre in the medulla oblongata of the brain stem

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6
Q

Process of Emesis?

A
  • Forceful inspiration and reflex closure of glottis and elevation of soft palate to close of airways/nasal passages
  • Stomach, oesophagus and associated sphincters are relaxed
  • Suspension of intestinal slow wave activity
  • Retrograde contractions from ileum to stomach
  • Breathing has been suspended
  • Lower oesophageal sphincter relaxes and the diaphragm/abdominal muscles contract to compress the stomach
  • Gastric contents are ejected through the open upper oesophageal sphincter
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7
Q

Who vomits?

A

Patients who:

  • Ingested toxic materials
  • Mechanical stimuli
  • Pathology in Gi tract
  • Vestibular system (motion s)ickness)
  • Stimuli in CNS (pain, smells
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8
Q

How does vomiting present?

A

Prior to:

  • Profuse salivation
  • Sweating
  • Elevated heart rate
  • Nausea
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9
Q

How is emesis managed?

A
  • 5HT3 receptor antagonists (chemo/radiation/post-op)
  • Muscarinic acetylcholine receptor antagonists (motion sickness)
  • Histamine H1 receptor antagonists (motion sickness/nausea)
  • Dopamine receptor antagonists (drug induced vomiting)
  • NK1 receptor antagonists (chemo)
  • Cannabinoid receptor agonists (chemo)
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10
Q

How 5HT3 receptor antagonists work? +example

A

Setrons (ondansetron)

  • Block peripheral and central 5HT3 receptors stopping stimulation of vagal afferents in GI tract.
  • For Chemotherapy, radiation and post-operative emesis
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11
Q

How Muscarinic acety-5-choline receptor antagonists work?

A

Block muscarinic acetylcholine receptors at the vestibular nuclei, the NTS and the VC, they also cause the GI tract to relax.
Lots of side effects because they block the parasympathetic system

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12
Q

Side effects of Muscarinic acety-5-choline receptor antagonists?

A

Blurred vision

Sedatory effect

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13
Q

How are muscarinic acety-5-choline receptor antagonists delivered. What type of emesis do they treat?

A

Transdermal patch

-Used for motion sickness

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14
Q

Example of histamine H1 receptor antagonists?

A

Cyclizine

Cinnarizine

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15
Q

What type of sickness do H1 receptor antagonists treat?

A

Motion sickness

Nausea and emesis caused by irritants in stomach

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16
Q

How do histamine H1 receptor antagonists work?

A

Block the receptors in the vestibular nuclei and the NTS and can generally cause CNS depression and sedation

17
Q

How dopamine receptor antagonists work?

A

Block the dopamine receptor in the CTZ and peripherally exert prokinetic action on the oesophagus, intestine and stomach.

18
Q

What type of emesis are dopamine receptor antagonists for?

A

Drug induced vomiting

Vomiting in GI disorders

19
Q

Contraindication for dopamine receptor antagonists?

A

NOT IN CHILDREN

20
Q

Doperamidine doesn’t?

A

Cross the blood brain barrier
Therefore
Doesn’t treat motion sickness

21
Q

Example of an NK1 receptor antagonist?

A

Aprepitant

22
Q

Cannaboid receptor agonist example?

A

Nabilone

23
Q

Side effects of emesis?

A

Dehydration
Loss of gastric protons and chloride
Hypokalaemia
Oesophageal tear

24
Q

What does loss of gastric protons and chloride cause?

A

Hypochloraemic metabolic acidosis

Raising of blood pH

25
Q

What is the vomiting centre?

A

Group of interconnected neurones within the medulla which are driven by central pattern generator CPG which receives information from the NTS

26
Q

What coordinates oesophageal shortening, stomach proximal relaxation, giant retrograde contraction of small intestine in vomiting?

A

Vagal efferents

27
Q

What do somatic neurones coordinate in vomiting?

A

Anterior abdominal muscle contraction and diaphragm contraction

28
Q

What do the autonomic/somatic efferents coordinate in vomiting?

A 
Increased HR & Force 
Increased saliva secretion 
Skin to sweat
pallor 
Anal/bladder sphincters to contract

Charis & Ellie vs GI (120 decks)

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