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  • Slide 1
  • Jamilah Alsaidan, Msc
  • Slide 2
  • The three consecutive phases of emesis are: Emesis NauseaRetchingVomiting
  • Slide 3
  • Inclination to vomit Feeling in throat or epigastric region alerting individual vomiting is imminent. Nausea Is the labored movement of the abdominal and thoracic muscles before vomiting Retching The forceful expulsion of gastric contents through the mouth due to GI retroperistalsis Vomiting
  • Slide 4
  • Vomiting is triggered by afferent impulses to the vomiting center, a nucleus of cells in the medulla Impulses are received from sensory centers, such as: the chemoreceptor trigger zone (CTZ), Cerebral cortex, visceral afferents from the pharynx and GI tract
  • Slide 5
  • Numerous neurotransmitter receptors are located in the vomiting center, CTZ, and GI tract Cholinergic, histaminic, dopaminergic, opiate, serotonergic, neurokinin, and benzodiazepine receptors Three main causes of vomiting Stimulation of chemoreceptor trigger zone in the 4 th ventricle Stimulation of the GI tract Sensory input and memory
  • Slide 6
  • Slide 7
  • Nausea and or / vomiting may be part of the symptom complex for a variety of gastrointestinal, cardiovascular, infectious, neurologic, metabolic or psychogenic processes
  • Slide 8
  • N & V may be a feature of such conditions as pregnancy, may follow operative procedures administration of certain medications such as those used in cancer chemotherapy or inhalation of noxious odors
  • Slide 9
  • General Depending on severity of symptoms, patients may present in mild to severe distress Symptoms Simple: Self-limiting, resolves spontaneously and requires only symptomatic therapy Complex: Not relieved after administration of antiemetics; progressive deterioration of patient secondary to fluid-electrolyte imbalances; usually associated with noxious agents or psychogenic events
  • Slide 10
  • Signs Simple: Patient complaint of queasiness or discomfort Complex: Weight loss; fever; abdominal pain Laboratory tests Simple: None Complex: Serum electrolyte concentrations; upper/lower GI evaluation
  • Slide 11
  • Other information Fluid input and output Medication history Recent history of behavioral or visual changes, headache, pain, or stress Family history positive for psychogenic vomiting
  • Slide 12
  • Gastrointestinal mechanisms Mechanical obstruction- e.g. Gastric outlet obstruction, Small bowel obstruction Functional gastrointestinal disorders- e.g.Gastroparesis, Nonulcer dyspepsia, Chronic intestinal pseudoobstruction, Irritable bowel syndrome Organic gastrointestinal disorders e.g Peptic ulcer disease,Pancreatitis, Pyelonephritis, Cholecystitis,Cholangitis, Hepatitis Acute gastroenteritis ( Viral, Bacterial)
  • Slide 13
  • Cardiovascular diseases Acute myocardial infarction Miscellaneous causes Pregnancy Noxious odors Operative procedures Neurologic processes Migraine headache Vestibular disorders
  • Slide 14
  • Metabolic disorders Diabetes mellitus (diabetic ketoacidosis) Renal disease (uremia) Psychiatric causes Anxiety disorders Anorexia nervosa Drug withdrawal Opiates Benzodiazepines Therapy-induced causes Cytotoxic chemotherapy Radiation therapy Anticonvulsant preparations Opiates Antibiotics
  • Slide 15
  • High Moderate Low Minimal
  • Slide 16
  • High (>90%) Carmustine Cisplatin Cyclophosphamide 1,500 mg/m2 Dacarbazine Dactinomycin Mechlorethamine Streptozotocin Moderate (3090%) Carboplatin Cytarabine >1 g/m2 Cyclophosphamide