Vomiting Flashcards
Diagnostic approach to vomiting patient
Define the problem, system, location and lesion
Defining the problem
Either vomiting, regurgitation, gagging, coughing, reflux
Physiology of vomiting
Coordinated response
The emetic reflex includes visceral receptors, vagal and sympathetic afferent neurons, CRTZ, vomiting center in the reticular formation of medulla oblongata
Nausea
Reduced gastric tone
Duodenal and proximal jejunal tone ↑
Duodenal contents reflux into stomach
Depression, hypersalivation, repeated swallowing
Vomiting
Glottis closed
Soft palate pressed up against nasopharynx (protects against aspiration)
Abdominal muscles and diaphragm contract
Cardia opens, pyloris contracts
Reverse peristalsis
Cardiac rhythm disturbances
Changes in colonic motility
Regurgitation
Passive process
Induced by alteration in food consistency and exercise
Facilitated by gravity when head/ neck down
Characteristics of regurgitation
Undigested food
Mucus when esophagus irritated
Cough (concurrent aspirated pneumonia)
Vomiting can be treated ____________
Symptomatically
Useful tests for vomiting
Biochemistry
Haematology
Urinalysis
Abdominal imaging
Endoscopy
Exploratory laparotomy
Investigating regurgitation
Usually a bad disease
Images of the esophagus (rads, contrast, fluoroscopy)
Endoscopy
Defining the system
Primary GI disease or Secondary GI disease
Primary GI (structural)
Stomach to the colon (surgical or medical problem)
Secondary GI (functional)
Accessory digestive organ (Pancreas, liver)
Electrolyte imbalance (K+, Na+, Ca2+)
Endogenous toxins (kidney, liver, ketoacidosis, infection)
Exogenous toxins
Primary CNS
Tests to investigate secondary GI disease
Haematology
Urinalysis
Exploratory laparotomy
Tests to investigate primary GI disease
Abdominal imaging
Endoscopy
Exploratory laparotomy
Vomiting from primary GI disease
Relates in time to eating
Delayed for some hrs with non-imflamm gastric disorders
Foreign bodies or secretory disorders (not eating)
Occurs after eating in lower bowl disorders
Evidence of primary GI disease
Abnormality palpable in the gut
Vomiting with diarrhea
Norm. in other aspects
Vomiting B4 signs of malaise
Vomiting related to eating
Evidence of secondary GI disease
Vomit after signs of malaise
Other clinical signs present
Patients metabolically ill (except pancreatitis and hyperthyroid in cats)
Primary diseases of the stomach
Gastritis, gastric foreign bodies, gastric ulceration, disorders of the pylorus, abnormal gut motility
Primary diseases of the intestine
Enteritis (parvo, carona, garbage), intestinal obstruction, IBD, neoplasia
Secondary GI causes of vomiting
Pancreatitis, liver, renal and endocrine disease (diabetic ketoacidosis, hypoadrenocorticism, hypercalcemia)
What if the patient is regurgitating?
Define location b4 system (esophagus primary disease)
Define lesion b4 system
Anatomic esophageal disorders
Cricopharyngeal disease
Hiatal hernia
Diverticulum
Megaesophagus
Congenital
Acquired- primary (idiopathic) or secondary (systemic causes like MG and hypoadrenocorticism)
External compression (esophageal disorders)
Persistent right aortic arch
Mediastinal lyphoma
Thyroid tumors
When is symptomatic therapy appropriate?
Patient has primary GI disease due to toxin or dietary indiscretion
Mild pancreatitis
When is symptomatic therapy not enough?
No response to symptomatic therapy
Vomiting persistant an severe
Other CS suggesting secondary GI disease (jaundice, PU/PD, anemia)
