Vomiting Flashcards
Retching
Regurg
reverse peristalsis of esophagus/stomach w/out expulsion
effortless passing of gastric contents in absence of reverse peristalsis
Nausea arises from brainstem nuceli
requires ____ perception
Inner ear geerates nausea due to
Gastric irritants, IO, mesenteric ischemia stimulate
Bloodborne stimuli activate
NTS
conscious, cerebral cortex important
motion/vertigo
PNS afferents
CTZ in area postrema of medulla
Inputs on the vomiting center in NTS stimulate
Process ___/____ contract
____ herniates through diaphragm
Normal slow wave proplsive contractions of esophagus/stomach/duodenum
orally propagated electrical spikes stimulate
coordinated contraction of muscles resulting in emesis
inspiratory thorax/ab wall muscles, inc pressures
gastric cardia
cease
retrograde contractions that expel gastric contents
Acute N/V indicares
Drugs/toxins/infections
Existing condtions cause
immediate process
acute sx
chronic sx
Neural input and etiologies
Cerebral cortex
Labryinthe
CTZ
Migraines, cyclic vomitting syn
Inc ICP, cerebral edema/hydrocephalus, emotion, psych dz
motion sickness, semicircular canal dz (VN, meniere), vestibular schwanoma
Drugs (chemo, ab, antiarrhy, OC)
toxins (alc, NH4, THC)
Metabolic- Keto, uremia, adrenal in, hypoThy, preg
Neural input and etiology
GI tract
GI irritation
Visceal irritation
Drugs
obs
Dysmot
peritoneal irritation
Intestinal ischme
Gastroenteritis, PUD, appendicitis, CD
Cholecyst/pancreatitis, hepatitis
analgesics, erythro
SBO, GOO, CO
gastroparesis, SI
peritonitis, PC
mesenteric ischemia
Acute N/V suggests
Infections include
may be followed w
S aureus, B cereus
drug, toxin, infection, IO
GI tract, systemic (meningitis, UTI, OM)
diarrhea, myalgia, fever, HA
N/V within hours
Vestibular neuritis
Typical presentatin
IO presentation
selt limited, post infectious, affects vestibular fxn
Vertigo, N/V, instability
Diffuse ab pain, distension (L), NV (SB), obsti
Patho and etiology
Hematemesis
Bilious
Undigested food
Bleeding proximal to LoT- PUD/ malignacy/MWS
SBO- malrotation/volvulus/adhesion/tumor/hernia
Esoph O- Achalasia, GERD, ZD
Chronic N/V
Pregnancy
begins around, resolves by
Cyclic vomiting syndrome
course
MC in women of CBA
6wks, 20 wks
recurrent NV- families w hx of migraines
vomitting lasting hrs/days separated by periods of normal health
Gastroparesis presentation
MCC
Autonomic neuropathy
post prandial N, vomitting, early satiety, ab pain, wl
DAN
abnormal gastric accomodation due to NO release
Inc ICP cz of vomiting
sx start
brain tumors, hydrocephalus, benign ICP
typically exacerbated by
w/out
other sx
inc pressure to CTZ
neuro
more gradual inc/longer
duration
abrupt change in position/awakening
NAUSEA
HA, visual probs
Test of choice for hematemsesis
Test of choice for bilious vomiting
Upper endoscopy
CT ab
Mx first step
Antihistamines
Anticholinergic
5HT3 antagonist
Meds and clinical conditions useful for
etiology
Promethazine, dimenhydrinate- motion sickness, inner ear
Scopolamine- same
Odansetron (setron)- chemo induced, gastroparesis
NKI antag
Prokinetic
Motilin ag
Cannabinoids
Meds and clinical conditions
Aprepitant- chemo induced
metoclopromide- gastroparesis
erythromycin- gastroparesis
tetrahydrocannabinol- chemo induced
