SAM 2 > Vomiting > Flashcards

Vomiting Flashcards

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1
Q

Is vomiting a reflex?

A

Yes

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2
Q

What is vomiting?

A

Forceful expulsion of stomach contents through the mouth

Very common presentation of illness

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3
Q

What are the three phases of vomiting?

A

Nausea
Retching
Expulsion

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4
Q

What is the nausea phase also known as?

A

Prodromal phase

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5
Q

What are the clinical signs of the prodromal/nausea phase?

A

Ptyalism, hiding/attention seeking, yawning, shivering, tachycardia, pallor

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6
Q

What is the retching phase characterized by?

A

Contraction of the abdominal muscles, chest wall, and diaphragm without any expulsion of gastric content

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7
Q

What is retrograde contraction?

A

Duodenal contents pushed back into the stomach

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8
Q

What is inhibited during the retching phase of vomiting?

A

Respiratory center- lessen chances of aspiration

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9
Q

Does the stomach actually contract during forceful expulsion?

A

No- the sphincters are relaxed and abdominal muscles and diaphragm contract

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10
Q

What is the pathway from stimulation to vomiting?

A

Stimuli
Afferent pathways, higher brain, vestibular apparatus, CRTZ
Emetic center
Effenent motor signals–> Vomiting

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11
Q

What are some things that will lead to vomiting?

A
  • Activation of chemo or machanoreceptors
  • Stimulation of visceral afferent receptors
  • Direct stimulation of the cerebral cortex and limbic system
  • Vestibular stimulation
  • CRTZ stimulation
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12
Q

What are the things that stimulate the cerebral cortex and limbic systems which case vomiting?

A

Fear, stress, or trauma

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13
Q

What are some Ddxs for vomiting?

A
  • Metabolic disease
  • Toxins
  • Dietary indescretion or foreign body
  • Drug induced
  • Primary GI disease
  • Environmental, motion sickness
  • Organ failure
  • Pancreatitis
  • Urinary or repro disease
  • Neoplasia
  • Pain
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14
Q

What are some emetogens?

A
  • Medications
  • Infections
  • Metabolic disease
  • Uremia
  • Radiation
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15
Q

What is the mechanism for vomiting due to motion sickness?

A

aka Kinetosis

Inner ear/labyrinth stimulation–> dopamine and serotinin released from CRTZ–> Ach released from emetic center

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16
Q

What is the mechanism for vomiting due to drugs such as chemo-agents?

A

5-HT3 serotonergic receptors and CRTZ

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17
Q

What is the mechanism for vomiting due to intestinal inflammation?

A

Direct afferent input to vomiting center

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18
Q

What is the mechanism for vomiting due to opioids?

A

Stimulation of CRTZ, increased vestibular sensitivity, gastric stasis, or impaired intestinal motility and constipation

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19
Q

What is the mechanism for vomiting due to toxins?

A

CRTZ permeable and initiates neurotransmitter cascade

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20
Q

What is the mechanism for vomiting due to uremia?

A
  • Decreased gastric clearance–> ulcers and gastritis
  • Toxins crossing BBB–> stimulation central and peripheral receptors
  • Activation of CRTZ via D2- dopaminergic receptors
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21
Q

What are the clinical signs/presenting concerns for a vomiting patient?

A
  • Vomiting…..
  • Lethary and inappetence
  • May have diarrhea and weight loss
  • Systemic signs of illness
  • Respiration changes if aspiration
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22
Q

What are some questions you should ask concerning the vomiting?

A
  • Quantity and quality
  • Duration
  • Relationship to food and diet change
  • Current feeding and environment
  • Medical history
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23
Q

What are some common physical exam findings for a vomiting patient?

A

Dehydration, abdominal pain and distention, palpable foreign material?, Thickened intestines, constipation, ptyalism, altered mental and respiratory status, Diarrhea, weight loss, systemic illness

MAY BE TOTALLY NORMAL

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24
Q

What are some diagnostics that are useful in the vomiting patient?

A

Labwork, rads/US, coritsol, GI panel, fecal, coag profile, endoscopy

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25
What is the time frame used to describe acute versus chronic vomiting?
Acute = 1 week
26
What are some of the top differentials for acute vomiting?
- Toxins/medications - Diet change - Foreign body - Acute organ disease, pancreatitis - Dietary indiscretion - Addisonian crisis
27
What are some of the top differentials for chronic vomiting?
- Intermittent foreign body - Organ failure/dysfunction - Chronic pancreatitis - Primary gastric or intestinal disease - Atypical addisonian or hyperthyroid
28
What are the general guidelines for therapy for an acute vomiting patient that is not systemically ill?
Symptomatic therapy and a few days of a bland diet and medications then wean off
29
What are the general guidelines for therapy for a chronic vomiting patient that is not systemically ill?
Symptomatic therapy and a food trial of at least 2-3 weeks +/- medication trials
30
What are the general guidelines for therapy for an acute vomiting patient that is systemically ill?
Symptomatic therapy and laboratory evaluation with imaging
31
What are the general guidelines for therapy for a chronic vomiting patient that is systemically ill?
Symptomatic therapy and laboratory evaluation with imaging +/- biopsy
32
What are the "Big 4" of a diagnostic work up?
PCV, TS, Glucose, AZO stick
33
Why is abdominal imaging useful?
Rule out GDV, obstruction, foreign body, constipation, masses, urinary obstruction, pyometra
34
Why is thoracic imagining useful?
- aspiration pneumonia - dilated esophagus - Diaphragmatic hernia
35
What is abdominal ultrasound useful for determining??
- Obstruction - Mass size and evaluation - Alterations in the lining or layering - Pancreatitis - Other organ issues - Acquire peritoneal fluid or organ aspirates
36
Why is endoscopy useful?
- Visualize esophagus, sphincters, stomach, and duodenum - Remove foreign bodies - Biopsy tissue of interest
37
T/F: It is common to find hypochloremia in vomiting patients.
True- selective chloride loss in vomitus
38
How do you medically manage an acutely vomiting patient with no signs of systemic illness?
Antacid +/- fluid therapy and weight
39
Are anti-nausea medications recommended for acute vomiting, non-ill patients?
No since they can suppress normal vomiting response to expel FB
40
What is the feeding protocol for an acutely vomiting non-ill patient?
No water for 6-8hr then small frequent amounts working back to normal If no vomiting then feed small meals every 4-6 hours with a bland or prescription diet
41
Why is important to administer fluids to vomiting patients?
Ongoing dehydration issues that cause debilitating issues
42
What kinds of animals should you be cautious about giving fluids to?
Heart failure or severely hypoproteinemic patients
43
What are the types of fluids we typically give to vomiting patients?
Maintenance fluids SQ/IV Normosol, plasmalyte, LRS, isotonic saline
44
What do H2 receptor antagonists do?
Affect the gastric parietal cell receptors that limit the acid secretion with little effect on pH
45
What drugs are H2 receptor antagonists?
Famotidine, ranitidine, cimetitidine
46
What do proton pump inhibitors do?
Inhibit gastric proton pumps and hepatic cytochrome P-450 to limit acidity in the stomach
47
What drugs are proton pump inhibitors?
Pantoprazole and omeprazole
48
What is the MOA of antiemetic medications??
Block or compete with neurotransmission at receptor sites associated with emesis
49
T/F: Many antiemetic drugs are used off label in veterinary medicine.
True
50
What is scopalamine?
A M1 cholinergic receptor antagonist May cause excitement in cats but typically not used due to sedation and hypotension
51
T/F: Histamine antagonists work really well in cats.
False- cats do not hav histamine receptors in CRTZ
52
What are some histamine antagonist drugs?
Diphenhydramine, meclizine, cyproheptadine
53
What is metoclopramine?
A D2 dopaminergic antagonist that stimulates movement of distal esophagus in cats and works as an antiemetic in dogs Has multiple drug interactions
54
What are dolasetron and ondansetron?
5-HT3 serotoin antagonists- work in the GIT and CRTZ
55
What is maropitant?
Substance P competetor peripherally and centrally Labeled for vomiting and for motion sickness but need higher doses for motion sickness
56
What drug is a gastric mucosal protectant?
Sucralfate Stimulates PG and reacts with HCl to form a paste which helps protect ulcers and is a weak antacid
57
What two drugs are used to treat advanced gastric disease?
Misoprotol- prostaglandin analog Octretide- somatostatin analog
58
What is misoprotol used to treat?
Used to treat and prevent gastric ulcers and enhances mucosal degense system
59
What is octretide used to treat?
Insulinomas and gastrinomas
60
What drugs are prokinetics?
Metoclopramide, cisapride, ranitidine, erythromycin
61
What drug is a 5-HT4 receptor activator and how does it work?
Cisapride and metoclopramide Improves gastric emptying and GI motility
62
How does erythromycin increase motility?
Stimulates production of motilin which promotes intestinal motility
63
What is cyproheptadine?
H1 receptor blocker and serotonin antagonist that stimulates appetite
64
How do tetracyclic antidepressants work to improve appetite?
Increase NE secretion ie Mirtazapine
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