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Pathophysiology of Vomiting01:22

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Vomiting is a complex physiological response to expel harmful or irritating substances from the body. It's a defensive mechanism triggered by stimuli like poisons, microbial toxins, cytotoxic drugs, and mechanical abdominal distension. The process is centrally coordinated by the vomiting (or emetic) center located in the medulla of the brainstem. This area, rich in muscarinic M1, histamine H1, neurokinin 1 (NK1), and serotonin 5-HT3 receptors, coordinates the act of vomiting through...
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Bile01:19

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Tetrahydrocannabinol (THC) is a phytocannabinoid that primarily interacts with the CB1 receptor, a type of G protein-coupled receptor (GPCR) predominantly in and around the chemoreceptor trigger zone (CTZ) and emetic center. THC also blocks the serotonin receptor activity in the dorsal vagal complex (DVC) by inhibiting serotonin release. THC exerts its anti-emetic effects through these interactions, which are beneficial for patients undergoing chemotherapy.
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Chemotherapy-Induced Nausea and Vomiting: 5-HT3 Receptor Antagonists01:27

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5-HT3 receptor antagonists, such as dolasetron, granisetron (Kytril), ondansetron (Zofran), and palonosetron (Axoli), are crucial in managing chemotherapy-induced nausea and vomiting (CINV) and postoperative nausea. These drugs selectively block 5-HT3 receptors in the visceral vagal and spinal afferent nerves, chemoreceptor trigger zone, and the vomiting center. They have a rapid onset of action and can be given as a single dose before chemotherapy. Ondansetron and granisetron, in particular,...
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Chemotherapy-Induced Nausea and Vomiting: Dopamine Receptor Antagonists01:29

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Dopamine receptor antagonists, also known as antipsychotic agents, are critical in managing chemotherapy-induced vomiting. These antiemetic agents block dopamine receptors in the chemoreceptor trigger zone (CTZ), inhibiting signal transmission to the vomiting center. Antipsychotic agents encompass phenothiazines (PTZ), butyrophenones, benzamides, and thienobenzodiazepines (Zyprexa), which are utilized for their antiemetic and sedative properties.
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Chemotherapy-Induced Nausea and Vomiting: Neurokinin-1 Receptor Antagonists01:28

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Neurokinin 1 (NK1) receptors are distributed across the GI tract, vagal afferents, and key CNS regions including the central vomiting center and chemoreceptor trigger zone (CTZ) Chemotherapy agents stimulate enterochromaffin cells in the gastrointestinal (GI) tract to release large amounts of substance P (SP). SP is a neuropeptide released by specific sensory nerves in response to many different stressors, including those in the GI mucosa affected by chemotherapy.  SP binds and activates...
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Laparoscopic Common Bile Duct Exploration Followed by Primary Suture Using a Modified Bile Duct Incision
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Bile vomiting in paediatrics: what do we really know?

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Area of Science:

  • Pediatric Medicine
  • Surgical Emergencies

Background:

  • Bilious vomiting in neonates and children often signifies intestinal obstruction.
  • Accurate identification is crucial for timely intervention.

Purpose of the Study:

  • To evaluate nursing staff's ability to identify bilious vomiting.
  • To assess the effectiveness of educational posters in improving this identification.

Main Methods:

  • A two-part audit was conducted at a children's hospital.
  • Educational posters were used between the primary and secondary audits.
  • Knowledge of various medical professionals was compared in the second audit.

Main Results:

  • Initial audit showed only 41% of nurses correctly identified bile vomit color.
  • Post-intervention, 70% correctly identified dark-green bile and 64% linked it to intestinal obstruction.
  • Significant improvement in knowledge was observed after poster distribution.

Conclusions:

  • A knowledge gap exists among nursing staff regarding bilious vomiting recognition.
  • Educational posters are an effective tool for improving nurses' ability to identify bilious vomiting.
  • Enhanced recognition can lead to earlier detection of potential surgical emergencies in children.