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GI > Nausea & Vomiting - Exam 3 > Flashcards

Nausea & Vomiting - Exam 3 Flashcards

1
Q

define nausea. define vomiting

A

nausea: Subjective feeling of a need to vomit.
Vague, intensely disagreeable sensation of sickness or “queasiness”

vomitimg: Usually follows nausea, including retching (spasmodic respiratory and abdominal movements)

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2
Q

What is regurgitation? Rumination?

A

Regurgitation: The effortless reflux of liquid or food stomach contents
“Burping up” food contents

rumination: The chewing and swallowing of food that is regurgitated after meals

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3
Q

The motor function of the gut is controlled at three main levels, what are they?

A

parasympathetic and sympathetic nervous systems

enteric brain neurons

smooth muscle cells

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4
Q

What causes nausea?

A

caused by a gastric rhythmic disturbance in which the natural 3-cycle-per minute gastric myoelectrical activity (muscle contraction and relaxation) is altered

naturally increases with food intake but that is normal

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5
Q

define tachygastria. define bradygastria

A

Tachygastria: increased rate of electrical activity in the stomach, more than 4 cycles per minute

Bradygastria: decreased rate of electrical activity in the stomach, less than 2 cycles per minute

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6
Q

Vomiting may be stimulated by ___ different sources. List them

A

4 different sources

  1. Afferent vagal fibers from the GI viscera (rich in serotonin 5-HT3)-> GI distention, mucosal or peritoneal irritation, infections
  2. Fibers of the vestibular system (high concentrations of histamine H1) -> sea-sick, dizzy
  3. Higher CNS centers -> certain sights, smells or emotional experiences may induce vomiting
  4. Chemoreceptor trigger zone (rich in opioid, serotonin 5-HT3, neurokinin 1 (NK1), and dopamine D2 receptors) -> located outside of blood-brain barrier in the area postrema that can be stimulated by drugs, chemo agents, toxins, hypoxia, uremia, acidosis, radiation therapy and induce vomiting
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7
Q

What is area postrema?

A

a structure in the brainstem that detects toxins in the blood and cerebrospinal fluid (CSF) and triggers vomiting

a highly vascular paired structure in the medulla oblongata in the brainstem that can induce vomiting

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8
Q

What is superior mesenteric artery syndrome?

A

When the duodenum gets crushed by the superior mesenteric artery

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9
Q

**Draw the chart that correlates the likely microbe to the incubation period with the likely food source ** know entire chart. What is the big take away?

A

big take aways: bacteria have a much shorter incubation period than viruses

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10
Q

What are some life-threatening disorders that need to quickly rule out that can present with N/V?

A

bowel obstruction
mesenteric ischemia
acute pancreatitis
myocardial infarction

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11
Q

What is the 3 step approach to a pt with N/V?

A
  1. determine etiology
  2. The consequences or complications of nausea and vomiting should be identified and corrected ie: fluid depletion, hypokalemia, and metabolic alkalosis
  3. targeted therapy for underlying cause
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12
Q

What does acute N/V symptoms WITHOUT severe abd pain make you think could be the underlying cause? list 4

A

typically caused by food poisoning

infectious gastroenteritis

drugs

systemic illnesses

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13
Q

What does acute N/V symptoms WITH severe abd pain make you think could be the underlying cause?

A

suggests peritoneal inflammation

acute gastric/intestinal obstruction

pancreatobiliary disease

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14
Q

How does cannabinoid hyperemesis syndrome present? Who is the MC pt? What helps to improve symptoms?

A
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15
Q

What does vomiting of undigested food one
to several hours after meals make you think?

A

gastroparesis
gastric outlet obstruction: may hear a succussion splash

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16
Q

What does vomiting of undigested food one
to several hours after meals with a succussion splash make you think?

A

gastric outlet obstruction

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17
Q

vomiting with what 4 s/s would make you think a neurologic cause?

A

headache
stiff neck
vertigo
focal weakness/paresthesias

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18
Q

if you see feculent vomiting, what are you instantly thinking?

A

Feculent vomiting = Intestinal obstruction

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19
Q

When will hyperactive bowel sounds present in a bowel obstruction?

A

hyperactive bowel sounds happen EARLY in bowel obstruction

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20
Q

define hematemesis

A

Vomiting of blood or coffee-like material

aka upper GI bleed

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21
Q

What are you worried about the pt developing with persistent severe vomiting?

A

electrolyte disturbances

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22
Q

_______ is a good starting point for imaging with N/V. What are you looking for?

A

Flat and upright abd xray

severe bowel obstruction

In SBO, will show intestinal air-fluid levels with reduced colonic air

Ileus - will show diffusely dilated air-filled bowel loops

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23
Q

____ is ordered with most chronic N/V that is unexplained after routine eval. What is a common result? What can an EDG pick up?

A

EGD

often normal

Detects ulcers, malignancy, retained gastric food residue, gastric outlet obstruction

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24
Q

____ test will show inflammation in Crohn’s disease. Would want to order ______ if concerned about motor disorder when anatomic abnormalities are absent

A

MRI

GI motility testing

25
Q

What is a Mallory-Weiss Tear?

A

a tear associated with chronic retching and vomiting. Typically the mucous membrane at the junction of the esophagus and the stomach develops lacerations

26
Q

What is Boerhaave Syndrome?

A

esophageal rupture due to severe straining

27
Q

If a pt is persistently vomiting need to always correct _______ and monitor for s/s of _______

A

ALWAYS ASSESS FOR S/SX HYPOVOLEMIA

ALWAYS OBTAIN ELECTROLYTES IF PROLONGED VOMITING

28
Q

Once a pt starts to improve with fluids and nutrients are restarted, what do they need to avoid in the first few days? Why?

A

avoid high fat food

because lipids delay gastric emptying and prolong gastric retention

29
Q

What is the tx for mil/moderate N/V?

A

Clear liquids (broths, tea, soup, carbonated beverages)

Advance to small quantities bland food (crackers)

Antiemetic medication

30
Q

What is the tx for mod/severe N/V?

A

Hospitalization with IV (isotonic) fluids

Antiemetic medication

NG tube in certain situations (i.e. small bowel obstruction/gastric)

31
Q

What is the goal of replacement fluid therapy for N/V?

A

The goal of replacement therapy is to correct existing abnormalities in volume status and/or serum electrolytes.

32
Q

What does the rate of replacement therapy depend on in N/V?

A

replacement depends on the severity

33
Q

What is the tx for severe volume depletion or hypovolemic shock?

A

At least 1 to 2 liters of isotonic fluids given as rapidly as possible in an attempt to restore tissue perfusion.

Continued at a rapid rate until the clinical signs of hypovolemia improve

34
Q

What is the tx for mild/moderate hypovolemia?

A

Rapid fluid resuscitation is not necessary

Induce positive fluid balance = administration of fluid at a rate that is 50 to 100 mL/hour greater than estimated fluid losses.

35
Q

How do you chose what replacement fluid to use?

A

depends on the type of fluid that has been lost and any concurrent electrolyte disorders

low/high Na: give sodium plus fluids SLOWLY

low K: give K

give bicarb if pt is in metabolic acidosis

36
Q

What 5 pt populations do you need to be use caution when considering giving them a parenteral fluid bolus?

A

infants

patients with poor systolic ejection fraction

kidney disease

chronic severe hyponatremia (without neuro deficits that require hypertonic saline)

DKA in children

37
Q

What drug class is meclizine?

A

Antihistaminergic

38
Q

What drug class is scopolamine?

A

anticholinergic

39
Q

What drug class is ondansetron? What is the MOA? What is important to note about it?

A

5-HT3 antagonist

Blocks serotonin from binding to 5-HT3 receptors
Blocking stimulation of “vomiting center” in medulla

acts on both peripheral and central

40
Q

What drug class is aprepitant? When is it commonly used?

A

NK1 antagonist

chemo induced N/V

41
Q

What drug class is metoclopramide? When is it used?

A

5-HT4 agonist and antidopaminergic

gastroparesis

42
Q

What drug class is octreotide? When is it used?

A

Somatostatin analogue

intestinal pseudoobstruction

43
Q

_____ needs to be avoided in the first trimester due to _____. Is it metabolized by the _______

A

Ondansetron (Zofran)

rare chance of cleft palate

liver, caution in hepatic impairment

44
Q

What are the safety/monitoring requirements for ondansetron? What is the MC SE?

A

pregnancy (NO in first trimester)
QT prolongation

HA

45
Q

**________ is the recommended by American College of OBGYN 1st line therapy N/V with pregnancy

A

doxylamine

46
Q

______ is a first generation antihistamine. What unique form does this medication come in?

A

Promethazine (Phenergan)

rectal suppository if the pt cannot keep anything down

47
Q

What are the 3 highlighted SERIOUS adverse reactions with promethazine?

A

respiratory depression

extrapyramidal SE

bradycardia

48
Q

** What are the 2 BBW with Promethazine (Phenergan)?

A

Respiratory Depression

Tissue Injury/Necrosis -> if given IM only at the injection site

49
Q

What is the CI for promethazine? Pt is on promethazine for a prolonged time frame, what 2 things do you need to monitor?

A

cannot give to kids under 2 years old due to RESPIRATORY DEPRESSION

obtain CBC and need ophtho exam

50
Q

_____ MOA Increases peristalsis primarily by inhibiting dopamine. Enhances response to acetylcholine of tissue in upper GI. Enhances motility and accelerated gastric emptying.
Increases lower esophageal sphincter tone

What drug class?
Give 2 additional times this medication is used.

A

Metoclopramide (Reglan)

prokinetic

gastroparesis and refractory GERD

51
Q

**What is the serious SE of metoclopramide?

A

Neuroleptic malignant syndrome

52
Q

**______ is a life threatening reaction to ________ characterized by fever, autonomic dysfunction, altered mental status and muscle rigidity

A

Neuroleptic malignant syndrome

metoclopramide

53
Q

**What is the BBW for metoclopramide? What are the CI?

A

tardive dyskinesia

CI: seizure dzs, GI obstruction

54
Q

What are the 3 safety/monitoring need to knows with regards to metoclopramide?

A
55
Q

_____ is the Neurokinin receptor antagonists. When is it used?

A

Aprepitant (Emend)

During chemotherapy with dexamethasone

56
Q

**_______ and ______ are given to chemo pts to help with the chemo induced vomiting

A

lorazepam and zofran

57
Q

Go back and look at the case studies and review questions from this lecture!

A

do it!!!

58
Q
A

GI (12 decks)

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