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7/31/2019 Nausea and Vomiting_Dr Lam Chee Loong
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Nausea and VomitingDr Lam Chee Loong
Senior Lecturer in Palliative MedicineUniversity of Malaya
2nd June 2012
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Outline
Definitions
General approach
Patterns of nausea and vomiting
Treatments
NOT discussing bowel obstruction
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Definitions
Nausea
Vomiting
Retching
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General Approach
Simple measures
Set goals/manage expectations
What is causing the nausea and/or vomiting?
Can you modify it?
Where should treatment be targeted?
What treatment to use?
How to administer?
Review, review, review
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Gastric Stasis
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Gastric Stasis
Early satiety, bloating, fullness, discomfort,heartburn, belching, hiccups, nausea,vomiting
Remove the cause (if possible)
Treat with prokinetic (metoclopramide,domperidone)
If vomiting, give parenterally
If ineffective, increase the dose
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Chemoreceptor Trigger Zone
Part of the brain sensitive to bloodchemicals/toxins/metabolites
Nausea often greater than vomiting
Haloperidol normally preferred
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Vomiting Centre
Receives inputs from CTZ, cortex, vestibularand peripheral systems
Final common pathway to vomiting reflex
Antihistamine drugs normally used -
promethazine
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Other Situations
Fear/anxiety
Vestibular/motion
Drugs
Chemotherapy/radiotherapy
Gastritis/ulceration
Cough
Constipation
Bowel obstruction
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Summary
(Treat the cause where possible)
1. Is it gastric stasis, or something akin to it?
2. Is it toxic/metabolic (CTZ mediated)?
3. Try Vomiting Centre directed treatments