Nausea and vomiting at the end of life

From IDWiki

Differential Diagnosis

  • Head
    • Increased ICP
    • Meningeal irritation
    • Anxiety
    • Vestibular disorders
  • Gastrointestinal
    • Esophageal: GERD, thrush
    • Gastric
      • Gastric irritation
      • Gastric stasis
    • Obstruction
    • Infection
  • Organ failure
    • Renal failure
    • Liver failure
  • Other causes

Pathophysiology

  • Four pathways
    • Vestibular system
      • Causes: motion, labyrinth disorders
      • Receptors: muscarinic acetylcholinergic and H1 histamine receptors
    • Chemoreceptor trigger zone (area outside blood-brain barrier)
      • Causes: drugs, metabolic products, bacterial toxins
      • Receptors: central D2 dopamine receptors (most important), 5HT3 serotonin receptors, and NK1 receptors
    • Cortex
      • Causes: sensory input, anxiety, meningeal irritation, increased ICP
    • Peripheral pathways
      • Causes: mechanical stretch, chemotherapy, radiotherapy, GERD, Candida, metastases, local drugs or toxins
      • Receptors: 5HT3 serotonin receptors (GI tract), mechanoreceptors and chemoreceptors in GI tract

Management