Vomiting in the morning suggests what? - correct answer...✔✔+ Pregnancy
+ Uremia
+ ETOH intake
+ ↑ ICP
Vomiting after meals suggests what? - correct answer...✔✔+ Bulimia
+ Peptic ulcer disease
+ Other psychogenic causes
(McPhee p 589, Shimp p 373)
Vomiting of undigested food 1-2 hours after a meal suggests what? - correct answer...✔
✔+ Gastroparesis
+ Small bowel obstruction
+ Gastric outlet obstruction
NOTE: Sucussion splash often heard on auscultation
(McPhee p 589, Shimp p 373)
4 causes of nausea and vomiting - correct answer...✔✔1) Visceral afferent stimulation
(seratonin receptors)
AGRADESOLUTIONS
,2) Vestibular disorders (fibers ↑ in histamine and muscarinic receptors)
3) CNS disorders
4) Irritation of chemoreceptor trigger zone
(McPhee Table 15.1)
Ways to stimulate the chemoreceptor trigger zone and cause vomiting - correct
answer...✔✔1) Chemo
2) Medications and drugs
3) Radiation therapy
4) Systemic disorders
CNS disorders that can cause vomiting - correct answer...✔✔1) Migraine
2) ↑ ICP
3) Infections (e.g. meningitis, encephalitis)
4) Psychogenic
Vestibular disorders that can cause vomiting - correct answer...✔✔Labyrinthitis,
Meniere syndrome, motion sickness
Define RETCHING - correct answer...✔✔Strong, spasmodic, involuntary effort to vomit
without bringing up emesis.
(McPhee and Shimp)
Define REGURGITATION - correct answer...✔✔Effortless return of gas or small
amounts of food from stomach (McPhee and Shimp)
Common causes of vomiting in infants - correct answer...✔✔1) Any acute illness (esp
gastroenteritis)
2) Hypertrophic pyloric stenosis (2 - 8 weeks of life, may feel an "olive" in epigastric
area after feeding)
3) Intussisception (6 - 18 months of life, sausage-shaped mass and "currant jelly"
stools)
4) Regurgitation ("spitting up") -- usually normal and usually resolves by 6 - 12 months.
(Shimp)
Medications associated with N/V - correct answer...✔✔+ Antidepressants
--SSRIs
--venlafaxine
OLD CART - correct answer...✔✔*O*nset -- When did it start
*L*ocation -- Can you pinpoint it? Does it radiate?
*D*uration -- How long have you had it?
*C*haracter-- Is it sharp, dull, throbbing, burning, crampy, colicky?
*A*ggravating factors -- What makes it worse?
*R*elieving factors -- What makes it better?
*T*iming -- Is the pain constant or intermittent? Does it occur at a certain time of day?
Antiemetic medications - correct answer...✔✔1) Seratonin-receptor antagonists
(McPhee/Shimp)
- Ondansetron (and other -setrons)
2) Corticosteroids (McPhee)
- Dexamethasone and methylprednisolone (used to enhance action of seratonin-
receptor antagonists used for post-operative and chemo-related n/v)
3) Dopamine receptor antagonists -- SEDATING but good for post-op gastroparesis or
nausea
AGRADESOLUTIONS
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