Vomiting Flashcards
Which two centers in the brain control vomiting?
The vomiting center (neural - in the medulla), and the chemoreceptor trigger zone (chemical - in the floor of the 4th ventricle).
What does the presence of red blood or “coffee grounds” in the emesis suggest?
An upper GI bleed.
What three conditions should one consider if there is undigested food in the vomitus?
Achalasia, delayed gastric emptying, and rumination.
What two conditions might one consider if a patient presents with projectile vomiting?
Pyloric stenosis and antral webs.
What does bilious vomiting suggest?
GI obstruction beyond the duodenum (e.g. malrotation)
What four things should be on the differential if an adolescent presents with vomiting?
Pregnancy, migraine, bulimia, and drugs (especially chronic heavy marijuana use).
What is the best diagnostic test for evaluation of chronic vomiting?
Endoscopy
What are the two most common causes of chronic vomiting in patients with histologically-confirmed diagnoses?
Esophagitis and gastritis (H. pylori-induced vomiting).
What is the most common etiology for chronic vomiting?
Most patients have a functional cause for vomiting such as cyclic vomiting or rumination syndrome.
What is cyclic vomiting?
Cyclic vomiting is characterized by paroxysms of vomiting followed by intervals of complete health. The vomiting episodes may last from hours to days, and the “well spells” last from several weeks to many months between episodes.
What family history finding is strongly associated with cyclic vomiting in children?
There is a strong association with a family history of migraine headaches.
At what age and in which patients is cyclic vomiting most likely to appear?
Median age of onset is 5 years, and there is a slight female predominance.
What is the recommended treatment for cyclic vomiting?
Avoidance of triggers, lifestyle changes, ondansetron to abort acute episodes, and cyproheptidine, propranolol, or amitriptyline for prophylaxis.
What is rumination syndrome?
It is characterized by patients having episodes of vomiting that occur immediately after eating. The emesis is often semipurposeful and small in volume.
What is the recommended treatment for rumination syndrome?
Supportive management with psychotherapy and cognitive behavioral therapy.
