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SAM 2 > Vomiting > Flashcards

Vomiting Flashcards

1
Q

Is vomiting a reflex?

A

Yes

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2
Q

What is vomiting?

A

Forceful expulsion of stomach contents through the mouth

Very common presentation of illness

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3
Q

What are the three phases of vomiting?

A

Nausea
Retching
Expulsion

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4
Q

What is the nausea phase also known as?

A

Prodromal phase

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5
Q

What are the clinical signs of the prodromal/nausea phase?

A

Ptyalism, hiding/attention seeking, yawning, shivering, tachycardia, pallor

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6
Q

What is the retching phase characterized by?

A

Contraction of the abdominal muscles, chest wall, and diaphragm without any expulsion of gastric content

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7
Q

What is retrograde contraction?

A

Duodenal contents pushed back into the stomach

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8
Q

What is inhibited during the retching phase of vomiting?

A

Respiratory center- lessen chances of aspiration

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9
Q

Does the stomach actually contract during forceful expulsion?

A

No- the sphincters are relaxed and abdominal muscles and diaphragm contract

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10
Q

What is the pathway from stimulation to vomiting?

A

Stimuli
Afferent pathways, higher brain, vestibular apparatus, CRTZ
Emetic center
Effenent motor signals–> Vomiting

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11
Q

What are some things that will lead to vomiting?

A
  • Activation of chemo or machanoreceptors
  • Stimulation of visceral afferent receptors
  • Direct stimulation of the cerebral cortex and limbic system
  • Vestibular stimulation
  • CRTZ stimulation
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12
Q

What are the things that stimulate the cerebral cortex and limbic systems which case vomiting?

A

Fear, stress, or trauma

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13
Q

What are some Ddxs for vomiting?

A
  • Metabolic disease
  • Toxins
  • Dietary indescretion or foreign body
  • Drug induced
  • Primary GI disease
  • Environmental, motion sickness
  • Organ failure
  • Pancreatitis
  • Urinary or repro disease
  • Neoplasia
  • Pain
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14
Q

What are some emetogens?

A
  • Medications
  • Infections
  • Metabolic disease
  • Uremia
  • Radiation
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15
Q

What is the mechanism for vomiting due to motion sickness?

A

aka Kinetosis

Inner ear/labyrinth stimulation–> dopamine and serotinin released from CRTZ–> Ach released from emetic center

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16
Q

What is the mechanism for vomiting due to drugs such as chemo-agents?

A

5-HT3 serotonergic receptors and CRTZ

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17
Q

What is the mechanism for vomiting due to intestinal inflammation?

A

Direct afferent input to vomiting center

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18
Q

What is the mechanism for vomiting due to opioids?

A

Stimulation of CRTZ, increased vestibular sensitivity, gastric stasis, or impaired intestinal motility and constipation

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19
Q

What is the mechanism for vomiting due to toxins?

A

CRTZ permeable and initiates neurotransmitter cascade

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20
Q

What is the mechanism for vomiting due to uremia?

A
  • Decreased gastric clearance–> ulcers and gastritis
  • Toxins crossing BBB–> stimulation central and peripheral receptors
  • Activation of CRTZ via D2- dopaminergic receptors
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21
Q

What are the clinical signs/presenting concerns for a vomiting patient?

A
  • Vomiting…..
  • Lethary and inappetence
  • May have diarrhea and weight loss
  • Systemic signs of illness
  • Respiration changes if aspiration
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22
Q

What are some questions you should ask concerning the vomiting?

A
  • Quantity and quality
  • Duration
  • Relationship to food and diet change
  • Current feeding and environment
  • Medical history
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23
Q

What are some common physical exam findings for a vomiting patient?

A

Dehydration, abdominal pain and distention, palpable foreign material?, Thickened intestines, constipation, ptyalism, altered mental and respiratory status, Diarrhea, weight loss, systemic illness

MAY BE TOTALLY NORMAL

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24
Q

What are some diagnostics that are useful in the vomiting patient?

A

Labwork, rads/US, coritsol, GI panel, fecal, coag profile, endoscopy

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25
Q

What is the time frame used to describe acute versus chronic vomiting?

A

Acute = 1 week

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26
Q

What are some of the top differentials for acute vomiting?

A
  • Toxins/medications
  • Diet change
  • Foreign body
  • Acute organ disease, pancreatitis
  • Dietary indiscretion
  • Addisonian crisis
27
Q

What are some of the top differentials for chronic vomiting?

A
  • Intermittent foreign body
  • Organ failure/dysfunction
  • Chronic pancreatitis
  • Primary gastric or intestinal disease
  • Atypical addisonian or hyperthyroid
28
Q

What are the general guidelines for therapy for an acute vomiting patient that is not systemically ill?

A

Symptomatic therapy and a few days of a bland diet and medications then wean off

29
Q

What are the general guidelines for therapy for a chronic vomiting patient that is not systemically ill?

A

Symptomatic therapy and a food trial of at least 2-3 weeks +/- medication trials

30
Q

What are the general guidelines for therapy for an acute vomiting patient that is systemically ill?

A

Symptomatic therapy and laboratory evaluation with imaging

31
Q

What are the general guidelines for therapy for a chronic vomiting patient that is systemically ill?

A

Symptomatic therapy and laboratory evaluation with imaging +/- biopsy

32
Q

What are the “Big 4” of a diagnostic work up?

A

PCV, TS, Glucose, AZO stick

33
Q

Why is abdominal imaging useful?

A

Rule out GDV, obstruction, foreign body, constipation, masses, urinary obstruction, pyometra

34
Q

Why is thoracic imagining useful?

A
  • aspiration pneumonia
  • dilated esophagus
  • Diaphragmatic hernia
35
Q

What is abdominal ultrasound useful for determining??

A
  • Obstruction
  • Mass size and evaluation
  • Alterations in the lining or layering
  • Pancreatitis
  • Other organ issues
  • Acquire peritoneal fluid or organ aspirates
36
Q

Why is endoscopy useful?

A
  • Visualize esophagus, sphincters, stomach, and duodenum
  • Remove foreign bodies
  • Biopsy tissue of interest
37
Q

T/F: It is common to find hypochloremia in vomiting patients.

A

True- selective chloride loss in vomitus

38
Q

How do you medically manage an acutely vomiting patient with no signs of systemic illness?

A

Antacid +/- fluid therapy and weight

39
Q

Are anti-nausea medications recommended for acute vomiting, non-ill patients?

A

No since they can suppress normal vomiting response to expel FB

40
Q

What is the feeding protocol for an acutely vomiting non-ill patient?

A

No water for 6-8hr then small frequent amounts working back to normal

If no vomiting then feed small meals every 4-6 hours with a bland or prescription diet

41
Q

Why is important to administer fluids to vomiting patients?

A

Ongoing dehydration issues that cause debilitating issues

42
Q

What kinds of animals should you be cautious about giving fluids to?

A

Heart failure or severely hypoproteinemic patients

43
Q

What are the types of fluids we typically give to vomiting patients?

A

Maintenance fluids SQ/IV

Normosol, plasmalyte, LRS, isotonic saline

44
Q

What do H2 receptor antagonists do?

A

Affect the gastric parietal cell receptors that limit the acid secretion with little effect on pH

45
Q

What drugs are H2 receptor antagonists?

A

Famotidine, ranitidine, cimetitidine

46
Q

What do proton pump inhibitors do?

A

Inhibit gastric proton pumps and hepatic cytochrome P-450 to limit acidity in the stomach

47
Q

What drugs are proton pump inhibitors?

A

Pantoprazole and omeprazole

48
Q

What is the MOA of antiemetic medications??

A

Block or compete with neurotransmission at receptor sites associated with emesis

49
Q

T/F: Many antiemetic drugs are used off label in veterinary medicine.

A

True

50
Q

What is scopalamine?

A

A M1 cholinergic receptor antagonist

May cause excitement in cats but typically not used due to sedation and hypotension

51
Q

T/F: Histamine antagonists work really well in cats.

A

False- cats do not hav histamine receptors in CRTZ

52
Q

What are some histamine antagonist drugs?

A

Diphenhydramine, meclizine, cyproheptadine

53
Q

What is metoclopramine?

A

A D2 dopaminergic antagonist that stimulates movement of distal esophagus in cats and works as an antiemetic in dogs

Has multiple drug interactions

54
Q

What are dolasetron and ondansetron?

A

5-HT3 serotoin antagonists- work in the GIT and CRTZ

55
Q

What is maropitant?

A

Substance P competetor peripherally and centrally

Labeled for vomiting and for motion sickness but need higher doses for motion sickness

56
Q

What drug is a gastric mucosal protectant?

A

Sucralfate

Stimulates PG and reacts with HCl to form a paste which helps protect ulcers and is a weak antacid

57
Q

What two drugs are used to treat advanced gastric disease?

A

Misoprotol- prostaglandin analog

Octretide- somatostatin analog

58
Q

What is misoprotol used to treat?

A

Used to treat and prevent gastric ulcers and enhances mucosal degense system

59
Q

What is octretide used to treat?

A

Insulinomas and gastrinomas

60
Q

What drugs are prokinetics?

A

Metoclopramide, cisapride, ranitidine, erythromycin

61
Q

What drug is a 5-HT4 receptor activator and how does it work?

A

Cisapride and metoclopramide

Improves gastric emptying and GI motility

62
Q

How does erythromycin increase motility?

A

Stimulates production of motilin which promotes intestinal motility

63
Q

What is cyproheptadine?

A

H1 receptor blocker and serotonin antagonist that stimulates appetite

64
Q

How do tetracyclic antidepressants work to improve appetite?

A

Increase NE secretion

ie Mirtazapine

SAM 2 (21 decks)

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