GASTROENTEROLOGY ARTICLE OF THE WEEK

March 1, 2001 

AGA Position Statement.  Nausea and Vomiting.  Gastroenterology 2001;120:261-288.

 1.  Vomiting not associated with pain that occurs soon after a meal suggests which of the following etiologies

            a.  gastroparesis

            b.  anorexia nervosa

            c.  gastric outlet obstruction

            d.  bulimia

            e.  intestinal obstruction

 2.  Principles in the management of morning sickness and hyperemesis gravidarum include:

            a.  Antiemetics are generally not prescribed during the first 12 weeks of pregnancy

b.   Thiamine supplementation and antihistamines or phenothiazines may be used in severe cases.

            c.  Ginger may help control nausea and vomiting

            d.  Ondansetron is better than promethazine

 True or False

 3.  Emesis caused by CNS causes is not associated with nausea and is always projectile.

 4.  Chronic nausea is defined as nausea lasting > 14 days.

 5.  Opiates and other drugs used for pain control causes nausea in 40% to 70% of cancer patients.

 6.  CNS imaging for the work up of nausea and vomiting should include posterior fossa and brainstem views, MRI is the preferred modality

 7.  Cis-platinum evoked acute vomiting is mediated by serotonin release and responds to 5-HT3 receptor antagonists, while delayed vomiting is not associated with serotonin release and does not respond to 5-HT3 receptor antagonist therapy.

 8.  Nausea associated with vertigo or motion sickness responds better to H1 receptor antagonists than to 5-HT3 receptor antagonist therapy, because histamine mediates the activation of the brain stem nuclei leading to emesis in motion sickness.

 9.  Nausea related to myocardial infarction is related to infract size rather than location, and nausea related to CHF is probably related to passive congestion of liver and gut.

 10.  Surgical therapy for gastroparesis is a reasonable option for patients who have developed gastroparesis after partial gastrectomy, it should not be used for patients with gastroparesis and intact stomachs.

 11.  The preferred option to prevent acute post-chemotherapy nausea is:

            a.  phenothiazines

            b.  hydroxyzine + metoclopramide

            c.  5-HT3 antagonist and dexamethasone

            d.  Domperidone

 

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