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Pathophysiology of Vomiting01:22

Pathophysiology of Vomiting

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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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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: Neurokinin-1 Receptor Antagonists01:28

Chemotherapy-Induced Nausea and Vomiting: Neurokinin-1 Receptor Antagonists

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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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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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Assessment of the Gastrointestinal System I: Subjective Data01:17

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Assessing the gastrointestinal (GI) system is a complex process that begins with collecting subjective data. This data, collected through patient interviews, provides crucial insights into the patient's health history, perception patterns, and lifestyle habits, all contributing significantly to GI health.
Health History
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Chemotherapy-Induced Nausea and Vomiting: Cannabinoids01:21

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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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Chronic nausea and vomiting: a diagnostic approach.

Madunil A Niriella1,2, Hiruni Jayasena3, Maduri Withanage4

  • 1Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.

Expert Review of Gastroenterology & Hepatology
|March 19, 2022
PubMed
Summary

Diagnosing chronic nausea and vomiting (CNV) is challenging, especially when the cause is unclear. A tailored diagnostic approach, guided by clinical assessment, is crucial for effective evaluation and management of CNV.

Keywords:
Chronicdiagnostic approachevaluationgastric emptyingnauseavomiting

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Area of Science:

  • Gastroenterology
  • Internal Medicine
  • Diagnostic Medicine

Background:

  • Chronic nausea and vomiting (CNV) are prevalent symptoms encountered in clinical practice.
  • CNV can indicate various gastrointestinal and non-gastrointestinal disorders.
  • Diagnosing CNV presents a significant challenge, particularly in cases lacking an obvious underlying cause.

Purpose of the Study:

  • To review the diagnostic approach to chronic nausea and vomiting (CNV).
  • To highlight the epidemiology, pathophysiology, causes, and evaluation methods for CNV.
  • To emphasize the importance of tailored investigations based on clinical assessment.

Main Methods:

  • Comprehensive review of existing literature on CNV diagnosis.
  • Discussion of clinical history and physical examination as foundational diagnostic tools.
  • Analysis of various diagnostic modalities and their appropriate application.

Main Results:

  • A thorough clinical evaluation is essential for guiding diagnostic work-up.
  • Patient-specific investigations, informed by clinical assessment, are more effective than broad screening.
  • Current research into CNV diagnostic modalities is limited.

Conclusions:

  • CNV diagnosis requires a systematic approach, prioritizing clinical evaluation.
  • Further research is needed to develop novel, accessible, and non-invasive diagnostic tools for CNV.
  • Advancements in research may lead to improved diagnostic and therapeutic strategies for CNV.