N&V Presentation.ppt

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nausea and vomiting

Health & Medicine

Definitions
• Nausea
unpleasant sensation
• Regurgitation
passive
gravity
raised intra-abdominal pressure
• Retching
reverse peristalsis
• Vomiting
active reflex action
‘unstoppable’

Vomiting
• Vagus
Oesophagus
Cardiac sphincter
Body of stomach
Pyloric part
• Spinal nerves
Abdominal muscles
• Phrenic nerve
Diaphragm
Relax
Contracts strongly
Contract
Contracts Descends

PONV Pre Operative Factors
• Individual
predisposition
• History of motion
sickness
• Raised ICP
• Female>Male
• Children>Adults
• Obesity
• Constipation
• Distended Stomach
• Metabolic disturbance
• Drug toxicity
• Alcohol
• Prolonged fasting
• Renal failure

PONV – Types of Surgery
• Bowel obstruction and ileus
• Appendicitis
• ENT
Ear Surgery
Blood in Stomach
• Uterine procedures
• Mauling of GIT
• Strabismus surgery
• IV radiological contrast media

PONV – Anaesthetic Factors
• Inflation of stomach
• Hypotension (neural blockade)
• Opioids
• Ether

PONV – Post-Op
• Opioids
• Pain
• Hypoxia
• Sights and Sounds
• Malodour
• Anxiety
• Hypovolaemia
• Head down
• Movement stimulating
the vestibular
apparatus

Higher Cortical
Centres
Sensory input
(Pain, Smell, Sight)
Memory, Fear,
Anticipation
Chemoreceptor
Trigger
Zone
Chemotherapy
Opioids
Anaesthetics
Stomach,
Small Intestine
Chemotherapy
Surgery
Radiotherapy
Vomiting
Centre
Labyrinths
Surgery
VOMITING
REFLEX
Neuronal pathways
Factors which can cause N&V

Prevention/Treatment
• Avoid opioid premedication
• Avoid prolonged pre-op fasting
• Avoid dehydration & hypovolaemia
• Good pain control
• Avoid vestibular stimulation
• Well oxygenated
• Diminish psychological factors
• Anti-emetics

Delayed Gastric Emptying
• Physiological
- Pain, Anxiety
• Pathological
- GI tract obstruction, Acute gastritis, Electrolyte
imbalance, DM
• Pharmacological
- e.g. Opioids

Drug induced N&V
• GI irritation
- NSAID’s, FeSO, Antibiotics, Alcohol
• Gastric stasis
- Opioids, Tricyclics
• CTZ stimulation
- Opioids, Digoxin, Antibiotics, Cytotoxics
• 5HT3 receptors
- cytotoxics

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