Vomitting Flashcards
4 aims of managing vomitting
- to address fluid and electrolyte disturbances caused by vomiting
- to reduce the frequency/stop vomiting
- to reduce acid production particularly if there are concerns for gastro-duodenal ulceration
- to improve gastric emptying
4 groups of Anti-emetics
NK1 pathway inhibitors
Anti-dopaminergics
Serotonin antagonists
Phenothiazines
Example of NK1 pathway inhibitors
Maropitant
How does NK1 Pathway Inhibitors like maropitant work
NK1 antagonists block substance P action at neurokinin 1 receptors in the brainstem, reducing nausea and vomiting
Example of Anti-dopaminergics
Metoclopramide
How does Anti-dopaminergics like Metoclopramide work
Blocking dopamine receptors in the brain, particularly in the chemoreceptor trigger zone (CTZ) and the vomiting center.
Example of Serotonin antagonists
Ondansetron
Example of Phenothiazines
Chlorpromazine
How does Phenothiazines like Chlorpromazine work
the role of histamine (H1) receptor activation (via the CTZ) in vomiting associated with motion sickness in dogs,, histamine antagonists such as chlorpheniramine have been used in the prevention of this syndrome.
How does Serotonin antagonist like Ondansetron work
Particularly effective for chemotherapy associated emesis which is mediated via serotonin release, both at the CTZ and peripherally. Although ondansetron is not licensed for veterinary use in the UK, it has been used as an adjunctive anti-emetic therapy for chemotherapy induced nausea and vomiting (CINV) and in the management of parvoviral enteritis (ref), and has a role in the management of intractable vomiting in veterinary species.
Name groups of antiulcer drugs
Histamine (H2)- blockers
Proton pump inhibitors
Sucralfate
Synthetic prostaglandins
Example of Histamine H2 blockers
Cimetidine, Ranitidine, Famotidine
Example of Proton pump inhibitors
Omeprazole
Name examples of prokinetics
Metoclopramide
Name the drug that has both prokinetic and Antiemetic properties
Metoclopramide
When is Endoscopic Evaluation of the Chronic Vomiting Patient indicated and differnetial list
When primary GI disease is suspected
Investigation of haematemesis (vomitting blood)
Gastric ulceration
Gastric neoplasia
Chronic gastritis
Duodenal disease e.g. IBD
Aetiology of Gastric/Gastro-duodenal Ulceration
Gastritis
Gastric neoplasia
NSAID-associated ulceration
Metabolic/endocrine disease e.g. renal failure, liver disease, hypoadrenocorticism
Mast cell disease
Gastrinoma (rare)
Most common gastric neoplasia
Gastric adenocarcinoma
Management of Gastro-duodenal Ulceration
Treat the underlying disease process
Anti-ulcer drugs
- Omeprazole (q 12 hours)
- H2 –Blockers
- Sucralfate
- Misoprostol
Symptomatic treatment
- Anti-emetics
Delayed Gastric Emptying
Food in stomach for > 8 hours post ingestion
Potential Causes of Delayed Gastric Emptying:
Intramural disease – gastritis, pyloric stenosis
Electrolyte disorders, hypothyroidism (rarely)
Post anaesthetic complication
Local peritonitis
Extramural compression
GI foreign body
Dysautonomia (rare)
Treatment for Delayed gastric emptying caused by pyloric stenosis
Pyloro-myotomy
Pyloro-plasty
