Nausea, Vomiting, Heartburn, and Dyspepsia Flashcards

Vocabulary flashcards for Nausea, Vomiting, Heartburn, and Dyspepsia lecture.

Nausea

Subjective feeling of a need to vomit

Vomiting

Rapid, forceful expulsion of GI contents (emesis)

Retching

Involuntary rhythmic diaphragmatic and abdominal contractions

Chemoreceptor Trigger Zone

Area located outside the BBB; triggered by toxins, medications; key receptors include 5-HT3 and D2

Vestibular Apparatus

Detects motion and body position which causes motion sickness; key receptors – H₁ (histamine), ACh (muscarinic)

Visceral Afferent Nerves (GI tract)

Detects GI irritants, stretch, etc; Key receptors – 5-HT₃, D₂, H₁, ACh

Central Nervous System (Cerebral Cortex)

Inputs from sight, smell, memory; e.g. anxiety or anticipatory nausea

Mallory-Weiss tears

Esophageal tears from forceful vomiting

Oral Rehydration Salts (ORS)

Balanced glucose–electrolyte solutions that optimize fluid absorption in the gut

Acupressure

Holding pressure onto specific forearm location point (P6)

Antihistamines used for N/V

Agents used for motion sickness, vertigo

Bismuth subsalicylate

Agent used in N/V for indigestion, nausea associated with overindulgence

Pyridoxine

Agent used in N/V for pregnancy N/V +/- doxylamine

Dimenhydrinate

Antihistamine that may be used for the adjunctive treatment of pregnancy- associated nausea and vomiting

Meclizine

Antihistamine - The least sedating of the choices

Phosphorated Carbohydrate Solutions (PCS)

Provide relief in mild nausea/upset stomach, especially for viral gastroenteritis or food indiscretion.

Ginger

Complementary therapy for N/V - Capsules or ginger tea can help reduce nausea in motion sickness, pregnancy, and chemotherapy-induced N/V

Peppermint oil (aromatherapy)

Complementary therapy for N/V - The scent of peppermint or peppermint tea can have a soothing effect on nausea

NVP

Nausea and Vomiting of Pregnancy (Morning sickness)

Hyperemesis Gravidarum

Severe, intractable vomiting during pregnacy

Vitamin B6 + doxylamine

Treatment of NVP that is safe & effective and should be considered first-line

GERD

Stomach acid backing up into esophagus due to LES relaxation, increases in intra-abdominal pressure, or anatomical issues

Dyspepsia

Delayed gastric emptying, sensitivity of stomach lining, H. pylori infection, or associated with GERD/peptic ulcer.

Water brash

Sudden filling of the mouth with clear, salty fluid secreted by salivary glands

Odynophagia

Painful swallowing

Organic Dyspepsia

Dyspepsia that has an identifiable cause, ie - PUD, GERD, celiac disease etc

Functional Dyspepsia

Dyspepsia that has no identifiable cause

Antacids

Weak bases that neutralize gastric acid, lowering the acidity in stomach

H2RAs

Reduce gastric acid secretion by inhibiting histamine on the histamine 2 receptor of the parietal cell

PPIs

Antisecretory drug - inhibits the H+/K+ ATPase (the proton pump), irreversibly blocking the final step in gastric acid secretion

Bismuth Subsalicylate

Soothes stomach with a topical effect on the stomach mucosa

Doxylamine

Antihistamine used to treat nausea, often combined with pyridoxine in pregnancy

Pyridoxine (Vitamin B6)

Vitamin used to treat nausea, often combined with doxylamine in pregnancy

Rebound acid hypersecretion

Occurs upon discontinuation of long-term PPIs

Esophageal Defense Mechanisms

Include anti-reflux barriers (LES, diaphragmatic crura, Angle of His), Esophageal acid clearance, and Tissue resistance

Anticholinergic effects

Side effects of antihistamines: Dry mouth, dry eyes, constipation, urinary retention.

Proton pump

The H+/K+ ATPase, irreversibly blocked by PPIs, leading to decreased acid secretion

Ginger for N/V Dose

250–500 mg ginger by mouth 3-4 times daily (max ~2 g/day)

Dramamine

Brand name for dimenhydrinate, an antihistamine

Dramamine Less Drowsy

Brand name for meclizine, an antihistamine

Dysphagia

Difficulty swallowing

Lifestyle modifications for heartburn

Weight loss, avoid trigger foods, smaller meals, no eating 2-3 hours before bed, elevate head of bed, tobacco cessation

Antacids - duration of action

Empty stomach – relief lasts 20-60 minutes, 1 hour after a meal – duration up to 3 hours

Cimetidine

H2RA - avoid because it inhibits CYP450

PPI Administration

Should be taken 30-60 minutes before a meal – preferably before breakfast

Children - treatment for N/V

Oral rehydration with ORS is first-line, avoid adult antiemetics

Pregnancy - treatment for N/V

Daily multivitamin, Vitamin B6 + doxylamine is first line

Heartburn

Burning feeling in the chest, rising toward neck/throat

Diclegis

RX: doxylamine 10 mg / pyridoxine 10 mg ER, used for pregnancy

Antacids MOA

Act as buffering agent in the lower esophagus, gastric lumen and duodenal bulb.