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STG 2017 > VOMITING > Flashcards

VOMITING Flashcards

1
Q

When should anti-emetics be given in vomiting

A

Only when the cause of vomiting
is known as they may delay diagnosis

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2
Q

Causes of vomiting

A

Disorders of the GIT and liver
Neurological disorders
Endocrine and metabolic disorders
Psychiatric disorders
Drugs
Infections
Cardiovascular disorders
Renal disorders
Pregnancy
Cyclical vomiting syndrome
Labyrinthitis
Otitis media

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3
Q

GIT and liver disorders that can cause vomiting

A

Intestinal obstruction
Peptic ulcer
Pancreatitis
Cholecystitis
Gastroenteritis
Hepatitis

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4
Q

Neurological disorders that can cause vomiting

A

Severe pain
Migraine
Raised ICP (i.e. tumours, haemorrhage, meningitis)
Seizures
Stroke

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5
Q

Endocrine and metabolic disorders that can cause vomiting

A

diabetic ketoacidosis
uraemia,
hypercalcaemia
intestinal pseudo-obstruction

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6
Q

Psychiatric disorders that can cause vomiting

A

depression
severe emotional upset
psychogenic vomiting

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7
Q

Infections that can cause vomiting

A

Malaria
UTI

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8
Q

Vomiting may be associated with these symptoms

A

Abdominal pain
Diarrhoea
Abdominal distension
Heartburn
Chest pain
Jaundice
Vertigo and nystagmus
Anxiety
Depression

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9
Q

Vomiting associated with diarrhea can be due to

A

Gastroenteritis

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10
Q

Vomiting associated with abdominal distension may be due to…

A

Suspected bowel obstruction

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11
Q

Vomiting associated with heartburn can be due to

A

GERD

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12
Q

Vomiting associated with jaundice may be due to

A

Hepato-biliary disease

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13
Q

Vomiting associated with vertigo and nystagmus may be due to

A

Suspected vestibular neuronitis

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14
Q

Vomiting of food eaten several hours earlier is diagnostic of……

A

Gastroparesis or Gastric-outlet obstruction

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15
Q

Faeculent vomiting is diagnostic of …………

A

Intestinal obstruction
Gastro-colic fistula

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16
Q

Vomiting with blood is diagnostic of ……..

A

oesophageal, gastric or duodenal lesion

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17
Q

Early morning vomiting in women can be diagnostic of ……

A

Pregnancy

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18
Q

Projectile vomiting may be diagnostic of …………

A

Pyloric stenosis

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19
Q

Signs in vomiting

A

Abdominal tenderness
Dehydration
Abdominal distension
Succussion splash
Jaundice
Signs of peritonitis

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20
Q

Signs of peritonitis

A

rebound tenderness
rigidity
guarding

21
Q

Investigations in vomiting

A

FBC
BUE and Creatinine
LFT
Blood glucose
Serum amylase
Urine RE
Urine Pregnancy test
ECG (if myocardial infarction suspected)
Abdominal X-ray: Intestinal obstruction
Erect Chest X-ray

22
Q

Purpose of Erec Chest X-ray

A

Diagnose bowel perforation with air under diaphragm

23
Q

Investigations in persistent vomiting

A

Upper gastro-intestinal endoscopy
Serum calcium level
CT scan of brain

24
Q

Treatment objectives in vomiting

A

To identify and treat the underlying cause
To prevent dehydration and electrolyte imbalance
To maintain nutrition by ensuring adequate dietary intake during
illness
To maintain personal hygiene
To eliminate infecting organisms where appropriate

25
Q

Non-pharmacological management treatment of vomiting

A

Maintain adequate oral fluid intake
Maintain adequate nutrition
Place naso-gastric tube when needed
Surgical intervention in suspected intestinal obstruction, peritonitis

26
Q

Anti-emetics for use in migraine

A

Metoclopramide oral, IV or IM
or
Domperidone oral
or
Promethazine oral, IV or IM

27
Q

Dose of metoclopramide

A

Adults
PO, IV, IM
10 mg 8 hourly

27
Q

Maximum duration of domperidone for vomiting in migraine

A

7 days

28
Q

Dose of domperidone

A

Adults
10 mg, 8 hourly

Children
> 12 years (Body weight ≥ 35 kg); 10 mg 8-12 hourly (max. 30 mg
per day)
1 month-12 years (Body weight ≤ 35 kg); 250 micrograms/kg 8-12
hourly (max. 750 microgram/kg per day

29
Q

Promethazine dose in vomiting associated with migraine

A

Promethazine, IV/IM
Adults
12.5-25 mg 6-8 hourly as needed (max. 100 mg in 24 hours)
Or
Promethazine, oral,
Children
2-12 years; 0.25-1 mg 6-8 hourly as needed (max. 25 mg per
dose)
< 2 years; Not recommended

30
Q

Suggested anti-emetics for use in vestibular nausea and vomiting

A

Promethazine PO/IV/IM
or
Cyclizine PO
or
Cinnarizine IV/IM

31
Q

Dose of promethazine in vestibular nausea and vomiting

A

Promethazine, oral,
Adults
20-25 mg 12 hourly
Children
2-12 years; 0.25-1 mg 6-8 hourly as needed (max. 25 mg per
dose)
< 2 years; Not recommended

Or

Promethazine, IV/IM
Adults
12.5-25 mg 6-8 hourly as needed (max. 100 mg in 24 hours)

32
Q

Dose of cyclizine in vestibular nausea and vomiting

A

Cyclizine, oral,
Adults
50 mg 8 hourly as needed
Children
6-12 years; 25 mg 8 hourly as needed (max. 75 mg in 24 hours)

33
Q

Dose of cinnarizine for vestibular nausea and vomiting

A

Cinnarizine, IV/IM,
Adults and children > 12 years
30 mg 8 hourly as needed

Children
5-12 years; 15 mg 8 hourly as needed
< 5 years; not recommended

34
Q

Anti-emetics for use in gastroenteritis

A

Metoclopramide
or
Domperidone

35
Q

Metoclopramide dose in vomiting due to gastroenteritis

A

Metoclopramide, oral/IV/IM,
Adults
10 mg 8 hourly

36
Q

Domperidone dose in vomiting due to gastroenteritis

A

Domperidone, oral,

Adults
10 mg, 8 hourly

Children
> 12 years (Body weight ≥ 35 kg); 10 mg 8-12 hourly (max. 30 mg per day)
1 month-12 years (Body weight ≤ 35 kg); 250 micrograms/kg 8-12
hourly (max. 750 microgram/kg per day)

37
Q

Anti-emetics for use in post-operative vomiting

A

Metoclopramide
or
Cyclizine

38
Q

Metoclopramide dose in post-operative vomiting

A

Adults
10 mg 8 hourly

39
Q

Dose of cyclizine in post-operative vomiting

A

Cyclizine, oral/IV/IM,
Adults
50 mg 8 hourly as needed
Children
6-12 years; 25 mg 8 hourly as needed (max. 75 mg in 24 hours)

40
Q

Dose of ondansetron for chemotherapy induced vomiting

A

Ondansetron, IV,
Adults
8 mg/ 0.15 mg/kg (pre-chemotherapy) infused over 15 minutes
Children
> 6 months; 0.15 mg/kg (pre-chemotherapy) infused over 15 minutes, then repeated 4 and 8 hours after first dose. (max is 16 mg/dose)

Or

Ondansetron, oral,
Adults
8 mg 12 hourly
Children
4-12 years; 4 mg 30 minutes before chemotherapy,
then 4 mg 8 hourly for 24-48 hours as needed
< 4 years; not recommended

41
Q

Antiemetics for chemotherapy induced vomiting

A

Ondansetron
or
Granisetron
or
Dexamethasone
or
Lorazepam

42
Q

Dose of dexamethasone for chemotherapy induced vomiting

A

Adults
8-12 mg before chemotherapy, then 8 mg 24 hourly from days 2-4
Children
Not recommended

43
Q

Dose of granisetron for chemotherapy induced vomiting

A

Granisetron IV
Adults
1mg/10 microgram/kg (30 minutes before Chemotherapy)
Children
2-16 years; same as adults
<2 years; not recommended

Or

Granisetron, oral,
Adults
1mg 1 hour before chemotherapy, then 1 mg 12 hours after 1st dose
Or
2 mg 1 hour before chemotherapy
Children
Not recommended

44
Q

Dose of lorazepam for chemotherapy induced vomiting

A

Lorazepam, oral/IV,
Adults
0.5-2 mg 6 hourly as required

45
Q

Antiemetics for use in pregnancy

A

Metoclopramide
or
Promethazine

46
Q

Metoclopramide dose in pregnancy

A

Metoclopramide, oral,
10 mg 8 hourly
Or
Metoclopramide, IV/IM,
10 mg 8 hourly as needed

47
Q

Promethazine dose in pregnancy

A

Promethazine teoclate, oral,
10-20 mg 8 hourly as needed
Or
Promethazine, IM,
12.5-25 mg 8 hourly as needed

STG 2017 (88 decks)

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