TAILIEUCHUNG - Chapter 039. Nausea, Vomiting, and Indigestion (Part 5)

Gastrointestinal Motor Stimulants Drugs that stimulate gastric emptying are indicated for gastroparesis (Table 39-2). Metoclopramide, a combined 5-HT4 agonist and D2 antagonist, exhibits efficacy in gastroparesis, but antidopaminergic side effects limit its use in 25% of patients. Erythromycin, a macrolide antibiotic, increases gastroduodenal motility by action on receptors for motilin, an endogenous stimulant of fasting motor activity. Intravenous erythromycin is useful for inpatients with refractory gastroparesis; however, oral forms also have some utility. Domperidone, a D 2 antagonist not available in the United States, exhibits prokinetic and antiemetic effects but does not cross into most other brain regions; thus, anxiety. | Chapter 039. Nausea Vomiting and Indigestion Part 5 Gastrointestinal Motor Stimulants Drugs that stimulate gastric emptying are indicated for gastroparesis Table 39-2 . Metoclopramide a combined 5-HT4 agonist and D2 antagonist exhibits efficacy in gastroparesis but antidopaminergic side effects limit its use in 25 of patients. Erythromycin a macrolide antibiotic increases gastroduodenal motility by action on receptors for motilin an endogenous stimulant of fasting motor activity. Intravenous erythromycin is useful for inpatients with refractory gastroparesis however oral forms also have some utility. Domperidone a D2 antagonist not available in the United States exhibits prokinetic and antiemetic effects but does not cross into most other brain regions thus anxiety and dystonic reactions are rare. The main side effects of domperidone relate to induction of hyperprolactinemia via effects on pituitary regions served by a porous blood-brain barrier. The 5-HT4 agonist tegaserod potently stimulates gastric emptying in patients with gastroparesis however its effects on symptoms of gastric retention are unproven. Patients with refractory upper gut motility disorders pose significant challenges. Liquid suspensions of prokinetic drugs may be beneficial as liquids empty from the stomach more rapidly than pills. Metoclopramide can be administered subcutaneously in patients unresponsive to oral drugs. Intestinal pseudoobstruction may respond to the somatostatin analogue octreotide which induces propagative small intestinal motor complexes. Pyloric injections of botulinum toxin are reported in uncontrolled studies to benefit patients with gastroparesis. Placement of a feeding jejunostomy reduces hospitalizations and improves overall health in some patients with gastroparesis who do not respond to drug therapy. Surgical options are limited for refractory cases but postvagotomy gastroparesis may improve with near-total resection of the stomach. Implanted gastric electrical .

• Y học thường thức
• Nausea
• Vomiting
• Indigestion
• bệnh học và điều trị
• bài giảng bệnh học
• tài liệu học ngành y
• Harrisons Internal Medicine
• BMC Pharmacology and Toxicology
• Dexamethasone against nausea
• Moderately emetogenic chemotherapy
• Gynecological cancers
• Acute nausea
• Postoperative nausea and vomiting
• Intravenous patient controlled analgesia
• Double blind trial
• 5 hydroxytryptamine3
• Meta analysis
• Prophylactic ondansetron
• Unique properties
• 5 HT3 receptor antagonists
• Chemotherapy induced nausea and vomiting
• Quality of life
• Chemotherapeutic agents
• BMC Cancer
• Pediatric patients
• Emetogenic chemotherapy
• Chemotherapy induced nausea
• Antiemetic prophylaxis
• Non interventional observation study
• Bone metastases
• Radiation induced nausea and vomiting
• Lung cancer
• Aggressive antiemetic prophylaxis
• Multivariate analysis
• Colorectal cancer
• Moderate emetic risk
• Female patients
• BMC Anesthesiology
• Oculocardiac reflex
• Strabismus surgery
• Anticholinergic agent
• Postoperative ileus
• Gastric ultrasound
• Gastric emptying
• Acute care surgery
• Emetic neuronal pathway
• Neurobiological mechanism
• Non vagotomy patients
• Clinical trial
• Selective outcome reporting
• Systematic review
• Trial registration
• Spinal blockade
• Perioperative factors
• Suboptimal prophylaxis
• Laparoscopic surgery
• Patient controlled analgesia
• High risk patient population
• Cross sectional studies
• Machine learning
• Cannabis legalization
• Spinal anesthesia
• Neuraxial anesthesia
• General anesthesia
• Overall incidence of PONV