Effect of vomiting including gastric outlet obstruction

Effects of Vomiting

  • Significant Loss of Fluids and Electrolytes

    • Salivary glands and stomach secrete 1-2L of fluid per day

    • Contains sodium, hydrochloric acid, and potassium

    • Decreased oral intake contributes to fluid loss

    • Retching and forceful vomiting create pressure changes in the thorax and abdomen

Complications of Vomiting

  • Dehydration

  • Electrolyte Disturbances

  • Acid-base Imbalance

  • Malnutrition

  • Pulmonary Aspiration

  • Pneumothorax

  • Esophageal Rupture

  • Dental Enamel Erosion

Gastric Outlet Obstruction (GOO)

  • Definition: Clinical syndrome caused by various conditions

  • Causes:

    • Motor disorders

    • Benign pyloric strictures

    • Malignant disease

    • Inflammatory causes (e.g., gastroduodenal Crohn's disease)

    • Rare causes like bezoars and large gastric polyps

  • Clinical Features:

    • Nausea and vomiting, epigastric pain

    • Early satiety, weight loss, succussion splash

Electrolyte Disturbances in GOO

  • Common Disturbances:

    • Hypokalemia

    • Hypochloremia

    • Hyponatremia

    • Metabolic alkalosis

  • Mechanism:

    • Disturbances occur due to loss of gastric juice:

    • Mucus secretion (pH 7.7, components include Na+, K+, Ca+, Cl-, HCO3-)

    • Acid secretions, typically isotonic with plasma; contains H and Cl (\text{(equates to pure HCl)})

    • Vomiting leads to increased HCO3- in plasma as H is lost

    • Loss of Na+ and Cl- exacerbates issues, hypokalemia occurs from renal conservation of H+

Treatment of GOO

  • General Strategy: Based on the underlying cause

    • Medical Therapy: Fluid resuscitation with normal saline and correction of electrolyte imbalances

    • Benign Fibrotic Strictures: Treat with endoscopic balloon dilation (EBD) or surgery

    • Crohn's Disease: Use steroids or medical therapy, EBD/surgery when necessary

    • Malignant Strictures: Employ EBD and stenting, surgical resection, chemo-radiation

Postoperative Nausea and Vomiting (PONV)

  • Definition: Vomiting occurring 24-48 hours post-surgery

  • Incidence: Affects 30-80% of patients

  • Complications:

    • Aspiration

    • Suture rupture and wound dehiscence

    • Delay in resumption of oral intake

    • Prolonged hospital stays, decreased patient satisfaction

Malnutrition Related to Chemotherapy-Induced Nausea and Vomiting (CINV)

  • Impact of CINV:

    • Reduces oral intake leading to significant weight loss

    • Affects 21-35% of chemotherapy patients

    • Major cause of morbidity and mortality in cancer, decreases response to therapy

    • Adverse effects on absorption, metabolism and elimination of chemotherapeutic drugs

Pregnancy and Vomiting

  • Prevalence: Affects 70-80% of pregnant women

  • Onset: Typically in the first trimester

  • Risks Associated:

    • Increased risk of hypertension and pre-eclampsia

    • Higher rates of depression

    • Adverse effects on employment and family dynamics

    • In most cases, mild condition is linked to favorable outcomes for the fetus

Hyperemesis Gravidarum

  • Definition: Severe form of pregnancy-related vomiting

  • Prevalence: Affects 0.3-2% of pregnant women

  • Consequences:

    • Significant maternal morbidity and adverse birth outcomes

    • Leads to dehydration, electrolyte, and acid-base imbalances

    • Increases risk of vitamin and mineral deficiencies

    • Poor adverse psychosocial impacts are noted

    • Neonatal risks: low birth weight, preterm birth, small for gestational age, increased fetal death risk

Esophageal Injury Related to Vomiting

  • Mallory-Weiss Syndrome: Mucosal tears at the esophagogastric junction due to recurrent vomiting

  • Boerhaave's Syndrome: Full thickness spontaneous esophageal rupture induced by forceful retching

    • Considered an emergency with significant morbidity and mortality risks

    • Leads to contamination of mediastinal and pleural spaces

Economic Impact of Vomiting

  • Consequences:

    • Increased length of hospital stay

    • Higher rates of postoperative complications

    • Additional require for dietetic management

    • Loss of productivity and income for patients

    • Elevates overall hospital care costs