Professional Documents
Culture Documents
Antihistamines
Several drugs inhibit the action of histamine at the H 1synaptic
pathways, which are predominantly involved in signalling from the
vestibular centre, but only cyclizine is used to treat postoperative
nausea and vomiting. Has few side effects. Common mild side
effects are a consequence of its antimuscarinic actions and include
sedation and dry mouth.
Steroids
Steroids such as dexamethasone may be given preoperatively as
prophylaxis in patients with a high risk of nausea and vomiting.
Steroids act by reducing inflammatory oedema and altering central
and peripheral responsiveness to proemetic compounds such as
anaesthetics and analgesics.They can also be used as a last line
rescue treatment.
Dopamine antagonists
These pharmaceuticals, for example prochlorperazine, haloperidol, and
metoclopramide, have been used as antiemetics for many years. They
work by inhibiting the activity of dopamine at the D 2receptor in the
chemoreceptor trigger zone, thereby limiting the emetic input to the
medullary vomiting centre.
Certain other antipsychotics, especially haloperidol, are often used in
palliative care to treat nausea and vomiting caused by malignancy. Low
doses of haloperidol, such as 1 mg once a day, are effective and are the
treatment of choice for nausea and vomiting caused by intestinal
obstruction.
Metoclopramide closely resembles the phenothiazines but has a limited
role as an antiemetic for postoperative nausea and vomiting. It is
effective in certain settings, such as emesis associated with hepatic
disease, but has been shown to be ineffective in many trials for the
treatment of postoperative nausea and vomiting and should not be
considered without senior input. Because it also increases gastrointestinal
motility, it should never be considered in patients where bowel
obstruction is possible.
Serotonin antagonists
Ondansetron, granitetron, and tropisetron inhibit the action of serotonin
at the 5-hydroxytryptamine 3 (5-HT3) receptor in the small bowel, vagus
nerve, and chemoreceptor trigger zone. They therefore decrease afferent
visceral and chemoreceptor trigger zone stimulation of the medullary
vomiting centre. These drugs were developed for use with chemotherapy
and have been shown in trials to be the most effective of the currently
available agents for both prevention and treatment of postoperative
nausea and vomiting.
Diagnostic Tests and Clinical Suspicion for Patients with Nausea and Vomiting
Test Clinical suspicion
Laboratory tests
Complete blood count Leukocytosis in an inflammatory process, microcytic anemia from a
mucosal process
Electrolytes Consequences of nausea and vomiting (e.g., acidosis, alkalosis, azotemia,
hypokalemia)
Erythrocyte sedimentation rate Inflammatory process
Pancreatic/liver enzymes For patients with upper abdominal pain or jaundice
Pregnancy test For any female of childbearing age
Protein/albumin Chronic organic illness or malnutrition
Specific toxins Ingestion or use of potentially toxic medications
Thyroid-stimulating hormone For patients with signs of thyroid toxicity or unexplained nausea and
vomiting
Radiographic testing
Supine and upright abdominal radiography Mechanical obstruction
Further testing
Esophagogastroduodenoscopy Mucosal lesions (ulcers), proximal mechanical obstruction
Upper gastrointestinal radiography with barium Mucosal lesions and higher-grade obstructions; evaluates for proximal
contrast media lesions
Small bowel follow-through Mucosal lesions and higher-grade obstructions; evaluates the small bowel
to the terminal ileum
Enteroclysis Small mucosal lesions, small bowel obstructions, small bowel cancer
Computed tomography with oral and Obstruction, optimal technique to localize other abdominal pathology
intravenous contrast media
Gastric emptying scintigraphy Gastroparesis (suggestive)
Cutaneous electrogastrography Gastric dysrhythmias
Antroduodenal manometry Primary or diffuse motor disorders
Abdominal ultrasonography Right upper quadrant pain associated with gallbladder, hepatic, or
pancreatic dysfunction
Magnetic resonance imaging of the brain Intracranial mass or lesion
Complication
Excessive vomiting can lead to large
losses from the stomach of the water
and salts that normally would be
absorbed in the small intestine. This
can result in severe dehydration,
upset the bodys salt balance, and
produce circulatory problems due to
a decrease in plasma volume.
The loss of acid from vomiting results
in a metabolic alkalosis.
Occult Bleeding
Occult bleeding
The digestive or gastrointestinal (GI)
tract includes the esophagus, stomach,
small intestine, large intestine or colon,
rectum, and anus. Bleeding can come
from one or more of these areas, that
is, from a small area such as an ulcer
on the lining of the stomach or from a
large surface such as an inflammation
of the colon. Bleeding can sometimes
occur without the person noticing it.
This type of bleeding is called occult or
hidden. Fortunately, simple tests can
detect occult blood in the stool.
Four ways LGI bleeding can be
revealed in
(1) hematochezia, that is, the passage of bright red blood
per rectum, either isolated or mixed with stools,
indicating an origin low in the gastrointestinal tract, most
commonly the colon.
(2) melena, that is, the passage per rectum of black, tarry,
and foul-smelling stools, indicating a source of bleeding
from above the ileocecal valve. Melena can also be seen
in cases of bleeding from the proximal large bowel
provided that the colonic transit time is slow;
(3) occult gastrointestinal bleeding, with symptoms limited
to pallor or fatigue, detected by discovery of iron
deficiency or iron deficiency anemia or by testing for the
presence of fecal blood;
(4) symptoms of severe blood loss such as malaise,
tachycardia, or even profound shock without any
objective sign of bleeding.
Commont cause
Eshopagus Small intestine
ulcers hemorrhoids
inflammation (gastritis) infections
cancer inflammation (ulcerative
colitis)
colorectal polyps
colorectal cancer
diverticular disease
Mucous in the stool
Mucous in the stool
The mucus in the stool because where there's mucus,
there's inflammation and probably colitis. The colitis can be
due to a bacterial infection such as Salmonella, Shigella,
Campylobacter, or Clostridium difficile. Hirschsprung's
disease is another possibility because it can present as
colitis.
Type 3
Symptoms develop after more than 20
hours, or even days after intake of large
volumes of CM.
Symptoms include diarrhoea, with or
without respiratory or skin reactions.
Preventive Education
Goat's milk, rice milk, or almond milks
are not safe and are not
recommended for infants.
People with lactosa intolerance should
know about food high lactosa,ex :
Bread and other baked goods,
Processed breakfast cereals , Instant
potatoes, soups, and breakfast drinks ,
Margarine , Lunch meats (except those
that are kosher) , Salad dressings ,
Candies and other snacks , Mixes for
pancakes, biscuits, and cookies
Suggestion
We suggest Rosas mother, Mrs. Melati,
to return to exclusive breastfeeding
and to stop giving cows milk formula
for Rosa.