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Year 3 Oral Biology > Vomiting > Flashcards

Vomiting Flashcards

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1
Q

define nausea

A

unpleasant sensation that one may soon vomit

From the latin for ‘ship’

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2
Q

define retching

A

ABORTIVE REFLEX: MUSCULAR activity of abdomen/ thorax (respiratory muscles), often VOLUNTARY, leading to forced inspiration against closed mouth and glottis without oral discharge of gastric contents (dry heave)
free flow between oesophagus and stomach

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3
Q

define vomiting

A

involuntary contractions of abdomen, thoracic and GI smooth muscles leading to FORCEFUL expulsion of stomach contents from the mouth
to get rid of toxins

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4
Q

define regurgitation

A

effortless return of oesophageal or gastric contents in to the mouth NOT associated with nausea or involuntary muscle contractions

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5
Q

define rumination

A

food that is regurgitated in the postprandial (after eating) period, re-chewed then re-swallowed
used to be kids/ ill adults but increasingly in healthy adults

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6
Q

define gagging

A

milder form of retching. reflex to protect airway
triggern include tactile (eg fingers to back of throat)
oropharyngeal response eg contraction of soft palate/ spasm in pharynx (no thorax/ abdominal contractions)

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7
Q

examples of gagging responses

A

contraction of soft palate - spasm in pharynx

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8
Q

4 receptors/ afferents in the vomiting reflex

A
  • GI
  • central (area postrema)
  • vestibular complex (motion stimuli –> area postrema, nucleus of solitary tract)
  • others
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9
Q

explain how GI afferents work

A

2 receptors: -chemoreceptors (toxins, drugs)

  • mechanoreceptors (distention)
  • -> activated 5HT receptors –> vagus n carries signal to central pattern generator
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10
Q

where is the area postrema

A

anterior to 4th ventricle (just inferior/ anterior to cerebellum)
directly superior to nucleus of solitary tract

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11
Q

where does area postrema receive info from 4

A
  • vagus n
  • vestibulocochlear n
  • blood (emetic signals)
  • CSF (emetic signals)
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12
Q

4 examples of ‘other’ afferents in vomiting reflex

A
  • pregnancy (eg morning sickness)
  • post-op (esp opiates)
  • alcohol excess
  • psychological (anorexia, bulemia etc)
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13
Q

what lacks BBB

A

area postrema

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14
Q

name the vomiting centre

A

NO VOMITING CENTRE; multiple circuits involved. nucleus of solitary tract and reticular formation are the CENTRAL PATTERN GENERATOR, important in integration

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15
Q

where is the chemoreceptor trigger zone

A

area postrema

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16
Q

what does the chemoreceptor trigger zone contain 6

A

receptors for:

  • 5HT
  • dopamine
  • histamine
  • acetylcholine
  • adrenaline
  • morphine
17
Q

anatomy of stomach (draw)

symptom of failure of lower oesophageal sphincter

A

heartburn (acid reflux)

18
Q

efferent pathway of retching

A

duodenum contracts –> food moves to stomach –> stomach is squeezed by abdominal muscles and diaphragm –> lower oesophageal sphincter relaxes –> food in to oesophagus (does not reach mouth)

19
Q

efferent pathway of vomiting

A

PROLONGED abdominal contraction –> relaxed inner hiatal diaphragm –> relaxed oesophagus/ lower oesophageal sphincter –> relaxation of CRICOPHARYNGEUS (upper oesphageal sphincter) –> FORCEFUL EXPULSION

20
Q

describe the soft palate and glottis during retching/ vomiting

A

soft palate raised, glottis closed (same as swallowing)

21
Q

what nerve controls the vomiting reflex

A

vagus

22
Q

what may happen if inferior pharyngeal constrictor m (cricopharyngeus) fails to relax?

A

force of bolus coming up causes oesophageal tears (Mallory Weiss tear) –> blood in vomit

23
Q

nutritional complications of vomiting

A

adults: weight loss
kids: failure to gain weight

24
Q

cutaneous complications of vomiting

A

petechia, purpura

25
Q

oropharyngeal complications of vomiting

A

tooth erosion, sore throat

26
Q

oesophageal complications of vomiting

A
  • oesophagitis

- oesophageal haematoma

27
Q

gastro-oesophageal junction complications of vomiting

A
  • mallory weiss tear

- rupture

28
Q

metabolic complications of vomiting

A
  • changes in balance of electrolytes, pH, water

- metabolic alkalosis (loss of H ions)

29
Q

unconscious complications of vomiting

A

aspiration ie choking on sick, bc vomiting reflex is maintained even when unconscious

30
Q

renal complications of vomiting

A
  • prerenal azotemia
  • ATN (acute tubular necrosis)
  • hypokalaemic nephropathy
31
Q

what are emetics agonists of?

A

5HT (serotonin eg opioids, think of MD)

dopamine (D2)

32
Q

pharmacology of anti-emetics

A

5HT/ D2 antagonists

33
Q

what causes characteristic vomiting sound

A

glottis not fully closed

Year 3 Oral Biology (13 decks)

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