Nausea and Vomiting Lecture Powerpoint

Question 1

Nausea definition

Answer 1

Unpleasant sensation of being about to vomit

Question 2

Vomiting

Answer 2

Forceful discharge of gastric content thru the mouth, can occur with or without nausea

Question 3

Retching

Answer 3

Vomiting but with absence of expulsion fo gastric content (dry heaving)

Question 4

Regurgitation and rumination

Answer 4

Gentle return of small amounts of food or secretions from the esophagus to the pharynx or the stomach into the hypopharynx respectively

Question 5

4 afferent pathways of vomiting

Answer 5

• CNS
• chemoreceptor trigger zone
• vestibular system
• visceral nervous system

Question 6

CNS pathway of vomiting common triggers (4)

Answer 6

• distension of the hollow viscus (cn x stimulation)
• pharyngeal stimuli (X, V, and IX)
• increased intracranial pressure
• MI

Question 7

3 Phases of vomiting

Answer 7

1) nausea, sweating, salivation (parasympathetic and sympathetic)
2) retching (motor system deep breath/breath hold to block the glottis, reverse peristalsis begins from the mid intestines)
3) posturing, contraction of abdominal muscles, and ejection

Question 8

Approach to a patient with nausea and vomiting (PE and potential labs) (6)

Answer 8

• what is their hydration status (orthostatic VS)
• neuro exam
• EKG and troponin
• CBC
• BUN and creatinine
• pregnancy test

Question 9

Imaging for nausea and vomiting (5)

Answer 9

• xray
• ultrasound
• ERCP
• CT scan
• endoscopy

Question 10

Chronic vs acute nausea and vomiting

Answer 10

Chronic lasts longer than 7 days

Question 11

Most common cause of acute episodes of vomiting and treatment (1)

Answer 11

Viral gastroenteritis, supportive care and hydration

Question 12

Common nausea medications and their classes (4)

Answer 12

Transdermal scopolamine (anticholinergic)
Promethazine (H1 antihistamine)
Metoclopramide (dopamine receptor antagonist)
ondansetron/zofran (5HT3-antagonist)

Question 13

Gastroenteritis treatment options (2)

Answer 13

• metoclopramide 1st line

- ondansetron 2nd line

Question 14

Post op nausea and vomiting treatment options (2)

Answer 14

• ondansetron for prevention

- metoclopramide

Question 15

Pregnancy induced nausea treatment options (2)

Answer 15

• doxylamine

- ondansetron

Question 16

Migraine headache treatment options (2)

Answer 16

• metoclopramide

- oral antiemetics

Question 17

Vestibular nausea treatment options (2)

Answer 17

• antihistamines

- anticholinergics

Question 18

Functional chronic nausea and vomiting and treatment (1)

Answer 18

Unexplained vomiting at least once a week that is NOT cyclical, treated often with low dose tricyclic antidepressants

Question 19

Gastroparesis (diabetic, post viral or idiopathic) and treatment (3)

Answer 19

Symptoms suggestive of obstruction (food not moving thru intestine or emptying of stomach within an hour), treated with dietary modification and metoclopramide or erythromycin

Question 20

Cyclic vomiting syndrome

Answer 20

Stereotypical incapacitating attacks often with specific triggers, have prodromal phase with distinct aura then associated with severe abdominal pain, pallor, excess salivation and intense thirst

Question 21

Cannabinoid hyperemesis syndrome

Answer 21

Condition where severe bouts of nausea and vomiting occur mainly in daily long term users of marijuana due to effect it has on intestinal receptors (which opposes the brain effect), begins with prodromal phase (early morning nausea and abdominal pain) then hyperemetic phase (hot showers ease!!!) and recovery phase (goes away), treated with cessation

Question 22

Complications of vomiting (6)

Answer 22

• dehydration
• hypokalemia
• metabolic acidosis
• aspiration
• mallory weiss tear
• ruptured esophagus (boerhaave’s syndrome)

Question 23

Mackler’s triad for boerhaave syndrome

Answer 23

• chest pain
• vomiting
• subcutaneous emphysema due to rupture