Vomiting centre

Question 1

4 main causes of vomiting?

Answer 1

1. Gastric stasis/irritation
2. Toxic (drugs, electrolyte imbalance, infections)
3. Raised ICP
4. Vestibular

Question 2

Clinical presentation of gastric stasis?

Answer 2

Early satiety (fullness)
Hiccups
Heart burn

Minimal nausea, large vomits

Question 3

Causes of gastric stasis?

Answer 3

Tumour
Heaptomegaly/large liver mets
Ascites
Dysmotility (drugs)

Question 4

Management of gastric stasis?

Answer 4

1st line = Metaclopramide (20-30mg PO/SC or 30-60mg over 24hrs)
(PPI if gastric irritation)

2nd line = domperidone

Question 5

Toxic causes of vomiting?

Answer 5

Drugs: opioids, digoxin, anti epileptic

Hypercalcaemia, Infection, uraemia

Question 6

Clinical presentation of toxic vomiting?

Answer 6

Nausea (persistent or intermittent)
Small vomits (posseting/wretching)

Question 7

Management for toxic vomiting?

Answer 7

1st line = Haloperidol

2nd line = metaclopramide or cyclizine or Levomepromazine

Question 8

Clinical presentation of raised ICP?

Answer 8

Early morning headache - worse when coughing or bending over)
Vomiting (little nausea)
Neurological signs

Question 9

Investigations for raised ICP?

Answer 9

Urgent MRI/CT - Growing tumour

Question 10

Management of raised ICP?

Answer 10

Dexamethasone 8-16mg

Cyclizine - 50mg TDS PO/SC

Question 11

What is used for chemo related N+V?

Answer 11

Odansetron

Question 12

What is anticipatory N+V?

Answer 12

Anxiety from cancer/cancer treatment

Question 13

Presentation of anticipatory N+V?

Answer 13

Specific precipitant: chemo, Rx, surgery, consultation, bad news
Neurological - rumination, derealisation,

Question 14

Treatment for anticipatory N+V?

Answer 14

Benzos - midazolam or lorazepam