Nausea and Vomiting in Childhood and Pregnancy

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Questions and Answers

What is the primary reason that nausea and vomiting are common in childhood?

Their immune systems are less developed

Increased exposure to infectious agents (correct)

Greater likelihood of gastrointestinal blockage

Higher susceptibility to toxins in food

Which condition is most frequently associated with nausea and vomiting according to the content?

Gastroenteritis (correct)

Acute appendicitis

Migraine

Diabetic ketoacidosis

What is the role of the chemoreceptor trigger zone (CTZ) in relation to vomiting?

It initiates the physical act of vomiting.

It produces hormones that suppress nausea.

It directly expels stomach contents through the mouth.

It receives signals from the gastrointestinal tract and other sources. (correct)

What is the process of retching?

The attempt to vomit without expelling contents Signup and view all the answers

Which of the following is NOT listed as a symptom accompanying nausea and vomiting?

Chest pain Signup and view all the answers

What is the leading cause of nausea and vomiting during pregnancy?

hCG from placental origin Signup and view all the answers

Which statement about pregnancy-related nausea is true?

It peaks between weeks 9 and 16. Signup and view all the answers

Which of the following is NOT a common trigger for motion sickness?

Intense physical exercise Signup and view all the answers

What factors are associated with an increased risk of nausea and vomiting during pregnancy?

Previous history of nausea Signup and view all the answers

What type of nausea is characterized by symptoms occurring immediately after eating?

Gastritis Signup and view all the answers

Which symptom suggests a potential need for medical referral regarding vomiting?

Blood in vomit Signup and view all the answers

What physiological change during pregnancy is linked to delayed gastric emptying?

Increased levels of progesterone Signup and view all the answers

During what time is pregnancy-related nausea most likely to occur?

Early morning Signup and view all the answers

Which medication class does Prochlorperazine belong to?

Dopamine antagonists Signup and view all the answers

What is one of the primary actions of Hyoscine?

It provides prophylaxis for motion sickness. Signup and view all the answers

What practical measure should be avoided to alleviate nausea?

Eating large meals Signup and view all the answers

What is an appropriate treatment guideline for pregnant individuals experiencing nausea and vomiting?

Rest and eat small, frequent bland meals. Signup and view all the answers

Which of the following is a common side effect associated with Hyoscine?

Drowsiness Signup and view all the answers

Which of the following motions is recommended to help alleviate nausea during travel?

Sleeping with eyes closed Signup and view all the answers

Which antiemetic is slightly less effective than Hyoscine but better tolerated?

Cinnarizine Signup and view all the answers

What is the recommended action for someone who feels nauseous due to motion sickness?

Focus on a fixed point ahead. Signup and view all the answers

Study Notes

Responding to Symptoms: Gastrointestinal Problems - Nausea & Vomiting

Nausea is a symptom of feeling near to vomiting.
Vomiting is the process where stomach contents are expelled through the mouth.
Retching is an effort to vomit, but nothing is expelled.
Regurgitation is the return of swallowed food back up the oesophagus.
Reflux is the return of stomach acid back up the oesophagus.

Other Symptoms

Sweating and cold sweats.
Increased saliva production.
Headaches.
Feeling cold.
Going pale (pallor).
Feeling weak.

Nausea & Vomiting - Epidemiology

Nausea and vomiting is common, especially in childhood.
Any age group can be affected.
Nausea and vomiting can be symptoms of other conditions.
Epidemiology might thus be determined by the condition.
Gastroenteritis is the most common cause.
Norovirus is the most common cause of gastroenteritis, (50%).
Rotavirus is a common cause in children (20%).
Adenovirus and Astrovirus can also cause gastroenteritis.

Nausea & Vomiting - Aetiology

The chemoreceptor trigger zone (CTZ) in the brain is stimulated by toxic substances.
The CTZ stimulates chemoreceptors.
The vomiting centre in the brainstem receives nerve signals from the CTZ and other pathways (such as the gut and liver).
The vomiting centre sends impulses to the pharynx, larynx, and gut, causing nausea and vomiting with other symptoms.

Nausea & Vomiting - Causes

Gastrointestinal causes include food poisoning, acute appendicitis, gastroesophageal reflux disease (GORD), blockages, and overindulgence.
Metabolic causes include diabetic ketoacidosis, and hypercalcaemia.
Neurological causes include head injury, meningitis, migraines, pain, and stress.
Ear disorders like labyrinthitis and infections.
Drug and chemical exposure (e.g., chemotherapy).
Post-operative effects (e.g., general anesthetic).
Psychiatric disorders like bulimia nervosa.
Pregnancy.
Movement (e.g., motion sickness).

Pregnancy

Nausea and vomiting usually starts between weeks 4-7 of pregnancy.
It typically peaks between weeks 9-16 and resolves between weeks 16-20.
“Morning sickness” is a misnomer, since nausea and vomiting can occur at any time of the day.
Hyperemesis gravidarum is a more severe form of morning sickness.

Pregnancy - Causes

Human chorionic gonadotropin (hCG) -originating from the placenta- and high oestrogen levels.
Evolution of increasing hormone levels.
The prevention of eating harmful foods.
Gastric dysfunction.
Increased progesterone levels lead to smooth muscle relaxation, this impairs the small bowel motility, leads to delayed gastric emptying.
It is often multifactorial, with various factors involved.

Motion Sickness

Motion sickness is caused by repeated movements.
Examples are: going over bumps in a car, moving up and down in a boat or aeroplane, train rides, or going in circles.
Inner ear sends different signals to the brain than those the eyes see/perception.
This confusion causes nausea.
It can affect everyone but is more common in children and women.
Nausea may continue post-motion, sometimes called "mal de debarquement".

N & V - Questions & Relevance - Age

Common in children.
Refer under 1 year.
Risk of dehydration in very young and very old.
Refer to a medical professional if needed

N & V - Questions & Relevance - Onset

Gastroenteritis - within 48 hours of eating contaminated food, some cases appear within hours.

N & V - Questions & Relevance - Time

Early morning (pregnancy).
Immediately after eating (gastritis).
1-2 hours after eating (gastroenteritis, peptic ulcer).

N & V - Questions & Relevance - Other Symptoms

Viral infection (presence of blood in vomit).
Middle ear (tinnitus/dizziness).
Migraine (headache/aura).

Referral

Symptoms suggesting a heart attack (chest pain, radiating pain, shortness of breath) accompanying nausea and vomiting warrant referral.
Pregnancy-related nausea (hyperemesis gravidarum)
Suspected GI bleed (blood in vomit).
Bilious vomiting (dark green vomit - possible GI obstruction, appendicitis).
Severe dehydration
Possible secondary cause (e.g., head injury, sepsis, eating disorder).

Vomiting - Treatment

Not much can be done once vomiting has started.
Stay hydrated.
Rehydration therapy may be needed.
Treatment depends on the cause.
Anti-emetics potentially harmful if cause is unknown).
Over-the-counter medications (e.g., Pepto-Bismol, aspirin-like salicylates).
Prokinetic medications (POMS).

Anti-emetics

Prochlorperazine (dopamine antagonist, phenothiazine).
Buccal tabs only in cases related to migraine.
Can be prescribed in other cases.

Anti-emetics - Motion Sickness

Prophylaxis (e.g., Hyoscine, which is an anti-muscarinic agent with central and peripheral actions.
Available as patches or tablets for motion sickness.
Often a sedative effect, ADR's need consideration.
Alternative sedative antihistamines are: -Cinnarizine (e.g., Stugeron®) -Promethazine (e.g., Phenergen®)
- Cyclizine - slightly less effective than hyoscine, better tolerated.

Practical Measures (Nausea)

What to do: Fresh air, distractions (music, TV), regular sips of cold drinks, ginger or peppermint tea, ginger foods, smaller more frequent meals, avoid strong smells.
What not to do: Eat or cook strong-smelling food, hot, fried, greasy food, eat too quickly, have a large drink or meal, lie down immediately after meals, tight clothes.

N & V - Treatment - Motion Sickness - Prevention

Strategies for motion sickness include sitting in the front of the car or in the middle of the boat, not reading or watching a film, looking at a fixed point ahead on the horizon, closing your eyes, sleeping, and breathing slowly.
Other strategies are focusing on breathing, being in the fresh air (open window), avoid heavy meals or alcohol, avoid long journeys, get fresh air/drink water/walk, take anti-emetics, try acupressure or ginger.

N & V - Treatment - Pregnancy

Strategies for pregnancy-related nausea and vomiting include rest and frequent, small meals that include bland, protein-rich foods that are low in carbohydrates and fat.
Avoid caffeine, alcohol and foods/smells that trigger nausea.
Try ginger, acupressure devices and other therapies as appropriate, as first-line treatments.
Refer if necessary.

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Description

Explore the key factors and physiological mechanisms behind nausea and vomiting, particularly in children and pregnant women. This quiz covers common triggers, symptoms, and medical considerations related to this condition. Test your knowledge on the underlying causes and related risks associated with nausea and vomiting.