7.Nausea&vomiting

❓ What symptoms commonly occur with nausea?

💦 Salivation 😓 Sweating 😵 Dizziness ❤️ Fast heartbeat (tachycardia)

❓ Is nausea a disease?

❌ No. Nausea and vomiting are symptoms

❓ Which 5 areas can trigger vomiting?

🧠 GI tract 👂 Inner ear (vestibular system) ☣️ Chemoreceptor Trigger Zone (CTZ) 😊 Limbic system 🧠 Cerebral cortex

❓ What does the CTZ do?

☣️ Detects toxins/drugs in the blood and triggers vomiting

❓ What emotional state can trigger vomiting through the limbic system?

😰 Anxiety

❓ What sensory trigger can activate the cerebral cortex and cause vomiting?

👃 Strong smells

❓ What are the two major categories of N&V causes?

📂 GI-related and Non-GI related

❓ Give 3 GI-related causes

🦠 Gastroenteritis 🍽️ Gastroparesis 🚫 Bowel obstruction

❓ Give 5 non-GI causes

🚗 Motion sickness 💊 Drugs 🤰 Pregnancy 🤕 Migraine 👂 Meniere's disease

❓ What is motion sickness?

🚗 Nausea caused by movement during travel

❓ What theory explains motion sickness?

🧠 Sensory Conflict Theory (Neural Mismatch Theory)

❓ Which 3 sensory systems are involved?

👀 Visual 👂 Vestibular 💪 Proprioceptive

❓ Why does motion sickness occur?

⚠️ Signals from the eyes and body do not match signals from the inner ear

❓ Why do symptoms improve after repeated travel?

🧠 The brain adapts to the motion pattern

❓ What is morning sickness?

🤰 Nausea during pregnancy

❓ During which trimester is morning sickness most common?

1️⃣ First trimester

❓ Name 3 non-drug treatments for morning sickness

🌿 Ginger 🍪 Dry biscuits 🍞 Toast before getting up

❓ Which vitamin helps morning sickness?

💊 Pyridoxine (Vitamin B6)

❓ What is hyperemesis gravidarum?

🚨 Severe pregnancy vomiting requiring hospitalization

❓ Does every chemotherapy patient experience nausea and vomiting?

❌ No

❓ Which chemotherapy drug is highly emetogenic?

💉 Cisplatinum

❓ What patient factors increase risk of chemotherapy-induced N&V?

👩 Female 🎂 <50 years old 😰 Anxiety 🚗 History of motion sickness 📉 Previous poor control in menstrual cycle

❓ Can chemotherapy-induced N&V be prevented?

✅ Yes

❓ What is Meniere's disease?

👂 A chronic inner ear disorder

❓ What is the hallmark symptom of Meniere's disease?

🌪️ Vertigo

❓ List 4 symptoms of Meniere's disease

🌪️ Vertigo 👂 Hearing loss 🔔 Tinnitus ⚖️ Loss of balance

❓ Why do patients with Meniere's disease experience N&V?

🤢 Severe vertigo triggers nausea and vomiting

❓ Is nausea and vomiting usually serious?

🙂 No. Most cases are self-limiting and improve on their own

❓ What are 4 complications of prolonged vomiting?

💧 Dehydration 🍽️ Malnutrition ⚗️ Metabolic alkalosis 🧂 Electrolyte imbalance

❓ Which electrolytes may decrease during prolonged vomiting?

🧂 Sodium (Hyponatremia) 🍌 Potassium (Hypokalemia) 🧪 Chloride (Hypochloremia)

❓ Which group is most at risk of dehydration?

👶 Infants and children

❓ What are early signs of dehydration?

🥤 Increased thirst 👄 Dry lips 👅 Dry mouth

❓ What type of food should patients eat during nausea?

🍪 Bland foods such as crackers toast and plain biscuits

❓ What foods should be avoided?

🍟 Greasy foods 🍩 Very sweet foods 🍳 Fried foods 🌶️ Strong-flavoured foods

❓ Why is hydration important?

💧 To replace lost fluids and prevent dehydration

❓ What drinks may help?

🚰 Water 🍋 Lemonade 🫚 Ginger ale 🌿 Mint tea 🧂 ORS

❓ What does ORS do?

⚡ Replaces fluids and electrolytes

❓ What triggers should be avoided?

🍳 Cooking smells 🌸 Perfume 🚬 Smoke 💡 Flickering lights

❓ When should suspected food poisoning be referred?

🚨 Immediately

❓ Why is blood in vomit a red flag?

🩸 It may indicate upper GI bleeding

❓ What are two appearances of blood in vomit?

🩸 Bright red blood ☕ Coffee-ground appearance

❓ Severe abdominal pain may suggest what condition?

🚫 Bowel obstruction

❓ Headache + stiff neck may suggest what condition?

🧠 Meningitis

❓ When should vomiting duration trigger referral?

⏳ More than 24 hours

❓ What dehydration signs require referral?

👄 Dry mouth 🚽 Dark urine 🚫 Infrequent urination

❓ Why are neonates (<1 month old) always referred?

👶 High risk of serious illness

❓ Examples of causes that should be identified?

🤰 Pregnancy 🤕 Migraine 😰 Anxiety 💊 Drug-induced nausea 🦠 Infection

❓ What must always be ensured before treatment?

💧 Adequate hydration

❓ What is the goal of antiemetic therapy?

🎯 Relieve symptoms and prevent complications

❓ Which neurotransmitters are involved in nausea and vomiting?

🧠 Histamine 💜 Dopamine 💙 Serotonin (5HT3) 💚 Acetylcholine ❤️ NK1 🟡 GABA

❓ Which antihistamine is commonly used for motion sickness?

💊 Dimenhydrinate (Novomin)

❓ Which anticholinergic is used for motion sickness?

💊 Hyoscine (Scopolamine)

❓ Name 2 dopamine antagonists

💊 Domperidone 💊 Metoclopramide

❓ Name 2 serotonin (5HT3) antagonists

💊 Ondansetron 💊 Granisetron

❓ Which NK1 antagonist is used for chemotherapy-induced nausea?

💊 Aprepitant

❓ Which corticosteroid can be used as an antiemetic?

💊 Dexamethasone

❓ Which benzodiazepine may help chemotherapy-induced nausea?

💊 Lorazepam

❓ First-line drugs for motion sickness?

🚗 First-generation antihistamines such as Dimenhydrinate and Meclozine

❓ Why are second-generation antihistamines ineffective for motion sickness?

🚫 They do not cross the blood-brain barrier

❓ Drugs used for morning sickness?

🤰 Antihistamines and Pyridoxine (Vitamin B6)

❓ Which drug class is most important in chemotherapy-induced nausea?

💊 5HT3 antagonists

❓ Which drug is preferred for gastroparesis?

💊 Metoclopramide

❓ Which drug class is commonly used for opioid-induced postoperative nausea?

💊 5HT3 antagonists

❓ Is motion sickness easier to prevent or treat?

✅ Prevent

❓ Which drug class is commonly used OTC for motion sickness prevention ?

💊 Antihistamines have sedating effects

❓ What common side effect do antihistamines cause?

😴 Drowsiness (sedation)

❓ When should antihistamines be taken before travelling?

⏰ 30–60 minutes before travel

❓ What is Novomin?

💊 Dimenhydrinate tablet taken 30 minutes before travel

❓ What is Veloxin?

💊 Meclozine + Pyridoxine taken 1 hour before travel

❓ What should you look at while travelling?

👀 Look outside the window

❓ Best seat in a car?

🚗 Driver seat or front passenger seat

❓ Best seat on a train?

🚆 Front-facing seat near a window

❓ Best seat on an airplane?

✈️ Near the wing

❓ Best place on a ship?

🚢 Front or middle near water level

❓ What activities should be avoided while travelling?

📖 Reading 📱 Using phone/tablet 🍔 Excessive eating 🍺 Alcohol

❓ What smells should be avoided?

🚬 Tobacco smoke 🍲 Food smells

❓ What is acupressure?

✋ A drug-free method using pressure on specific points

❓ Which pressure point helps nausea and vomiting?

✋ P6 (Nei-Kuan) point

❓ How does acupressure help?

🚫 Blocks signals that trigger nausea

❓ What natural remedy is commonly used for nausea?

🫚 Ginger

❓ What forms of ginger can be used?

🍵 Ginger tea 🍪 Ginger biscuits 💊 Ginger supplements

❓ Besides motion sickness what else can ginger help?

🤰 Morning sickness during pregnancy

❓ Why is medication history important?

💊 Some drugs can cause nausea and vomiting

❓ What red flag requires urgent referral?

🩸 Vomiting blood

❓ What are signs of severe dehydration?

👀 Sunken eyes 👄 Dry mouth 🚽 Reduced urination 😵 Dizziness

❓ When is vomiting considered persistent?

⏳ Adults >24 hours and Children >12 hours

❓ Which high-risk groups require extra caution?

👶 Infants 👴 Elderly 🤰 Pregnant women with hyperemesis gravidarum

❓ OTC antihistamines used for motion sickness?

💊 Dimenhydrinate and Meclozine

❓ OTC natural option for nausea?

🫚 Ginger

❓ What are 3 important lifestyle recommendations?

💧 Hydration 🍞 Bland diet 😴 Rest

❓ What important warning should be given with antihistamines?

😴 They may cause drowsiness

❓ When should patients seek medical care?

🚨 If vomiting lasts longer than 24 hours

❓ First-line treatment for pregnancy-related nausea?

🤰 Ginger and Pyridoxine (Vitamin B6)

❓ Should pregnant women self-medicate with OTC antiemetics?

❌ No unless approved by a doctor

❓ Main focus of treatment in children?

💧 Hydration

❓ Should antiemetics routinely be used in children?

❌ No unless prescribed

❓ What should be monitored carefully in elderly patients?

👴 Dehydration and drug interactions

❓ What are the two major categories of causes?

📂 GI causes and Non-GI causes

❓ What is the main principle of management?

🎯 Treat the underlying cause