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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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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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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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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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The inner ear assumes dual functionalities of auditory perception and equilibrium maintenance. The vestibule is the organ responsible for balance. This organ contains mechanoreceptors, specifically hair cells, endowed with stereocilia, which aid in deciphering information regarding the position and motion of our heads. Two intrinsic components, the utricle and saccule, help perceive head position, while the semicircular canals track head movement. Neurological messages initiated in the...
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Cyclic vomiting syndrome in children.

Ran D Goldman

    Canadian Family Physician Medecin De Famille Canadien
    |November 13, 2021
    PubMed
    Summary

    Cyclic vomiting syndrome causes severe, episodic vomiting in children, often requiring emergency care. Currently, limited evidence supports specific preventive treatments for pediatric cases.

    Area of Science:

    • Pediatric Gastroenterology
    • Neurogastroenterology

    Background:

    • Cyclic vomiting syndrome (CVS) is characterized by severe, episodic vomiting lasting hours to days, interspersed with symptom-free periods.
    • This condition significantly impacts children's quality of life, often necessitating emergency department visits for intravenous rehydration.
    • The underlying gut-brain interaction in CVS is poorly understood, making diagnosis challenging.

    Purpose of the Study:

    • To review the current understanding of cyclic vomiting syndrome in children.
    • To explore potential prophylactic treatments for pediatric CVS.
    • To highlight the limitations in current evidence for pediatric treatment guidelines.

    Main Methods:

    • Literature review of cyclic vomiting syndrome.
    • Analysis of diagnostic challenges and supportive care measures.

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  • Examination of prophylactic treatment options used in adults and their applicability to children.
  • Main Results:

    • CVS presents with intense vomiting, lethargy, abdominal pain, anorexia, and nausea in children.
    • Approximately 50% of affected children require intravenous rehydration.
    • Supportive care includes hydration, rest, quiet environments, antiemetics, and sedatives.

    Conclusions:

    • While prophylactic treatments like amitriptyline and topiramate are considered for adults, robust pediatric data is lacking.
    • Current evidence does not support specific prophylactic therapies for children with CVS.
    • Further research is needed to establish effective preventive strategies for pediatric cyclic vomiting syndrome.