Nausea and Vomiting in Palliative Care

Nausea is an unpleasant feeling of needing to vomit and is often accompanied by autonomic symptoms as pallor and salivation Vomiting is the forceful expulsion of gastric contents through the mouth Regurgitation is the passive expulsion of material from the pharynx or oesophagus through the mouth Retching -is rhythmic , labored , spasmodic movements of the diaphragm and abdominal muscles usually occurring in the presence of N/V and often resulting in vomiting N+V affects up to 70 % of patients with advanced cancer Many involved mechanisms , patterns and treatments More common in certain groups ie < 65 yrs age , females and certain malignancies as gastric and breast cancer

History-When did it start and how ? triggers , volume , pattern any relation to recent treatment ? aggravating & relieving factors ? colour , nature and frequency constipation ? bowel habit medications try and distinguish between vomiting , expectoration and regurgitation

Examination -eye ? jaundice oral cavity ? candida fundi ? papilloedema abdomen bowel sounds hepatomegaly rectal examination - if constipation / obstruction is suspected signs of dehydration , sepsis , toxicity pulse , temp , respiration

Causes -drugs biochemical constipation radiotherapy liver failure gastric stasis bowel obstruction raised...