Vomitting

Question 1

Vomitting

Answer 1

Forceful ejection of gastric conents through the mouth. Occurs when the vomitting centre in the medulla oblongata is stimulated. This may be due to direct stimulation of the centre (central vomitting) or via afferent fibres (reflex vomitting)

Question 2

Causes

Answer 2

Central vomitting

• drugs e.g narcotic analegsia, chemotherapy agents
• acute infections
• endocrine/ metabolic (pregnancy, uraemia, DKA)

Reflex vomitting

• GI disease - appendicitis, cholecysttis, pancreatitis, peptic ulceration
• Obstruction- small bowel obstruction, pyloric stenosis, large bowel obstruction
• CNS causes - rasied ICP, labyrinthe disorders, head injury, migrane
• Pyschogenic - offensive sights and smells

Question 3

History

Answer 3

General

• nature - bright red blood, altered blood (coffee grount). Bile (high SBO), faeculent (LBO), recently eaten food, food several days old (pyloric stenosis), projecttile (infantile pyloric stenosis)
• time- soon after meal (GU, Gastric carcinoma), early morning (pregnancy), chornic chest infection
• relief of pain - PUD

Central

• drug history- pregnancy, metabolic disorders

Reflex

• GI - history, localised tenderness, irritant drugs
• CNS-
  
  • raised ICP = headache, drowsniness and fits
  • laybyrinthitis- nausea, vomitting, vertigo and often hearing defect
  • menieres disease - vertigo, tinitus and deafness (attacks last minutes to hours)
  • migrane - visual aura, unilateral throbbing headache and sometimes photophobia
• psychogenic - bulima, hysteria

Question 4

Examination

Answer 4

GI

• full GI exam- signs of local tenderness or signs of intestinal obstruction

CNS

• raised ICP - listlessness, irritability, drowsiness and pulse rate will be low with rising BP
• papilloedema
• acute labyrinthisi- nystagmus to the opposite side of the lesion
• menieres - rotatory nystagmus and unsteadiness of stance

Psychogenic

• anoerxia - wasted hirsute female will present

Question 5

Investigations

Answer 5

• FBC, ESR, CRP
  
  • hb down - GI disease, malignancy, anorexia
  • WCC increased - abdominal inflammation
  • ESR Increased - inflammation and tumour
• U&E
  
  • dehydration, uraemia, hyperkalaemia occurs in addisons
• LFTs - biliary tract
• serum amylase - pancreatitis
• urinalysis - glucose and ketones for DKA, white cells and proteins - UTI, blood may indicate kidney stone
• CXR- congestive heart failure - pulmonary edema
• ECG- MI
• AXR- obstruction
• barium enema - malignancy
• small bowel enema - GI disease (crohns)