nausea and vomiting_dr lam chee loong

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

nausea and vomiting_dr lam chee loong

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