오심, 구토의 원리

소개

nausea, vomitting 오심, 구토의 과학적인 기전

목차

Introduction
Mechanism
N/V의 control site
Types of nausea and vomiting
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본문내용

Introduction
Nausea
subjective feeling of a need to vomit
Vomiting
the oral expulsion of gastrointestinal contents resulting from contractions of gut and thoracoabdominal wall musculature
TACK J et al: Functional gastroduodenal disorders. Gastroenterology 130:1466, 2006

Nausea and Vomiting are biological defence mechanisms. The major physiological function of emesis (vomiting) is to remove toxic or harmful substances from the body after ingestion
Mitchelson F. Pharmacological agents affecting emesis. Part I. Drugs 43, 295-315 (1992).
Mitchelson F. Pharmacological agents affecting emesis. Part II. Drugs 43, 443-463 (1992).
Mechanism
vomiting
is coordinated by the brainstem
is effected by neuromuscular responses in the gut, pharynx, thoracoabdomianl wall
nausea
cerebral cortex 와 연관.
temporofontal cortical regions의 activation과 연관
1.coordination of emesis
brainstem nuclei로부터 시작
neurotransmitters(neurokinin NK1, serotonin




Phenothiazines
Chlorpromazine (Thorazine)-Uncommonly used for Nausea and Vomiting
Prochlorperazine(Compazine) -Nausea and vomiting
Benzamides
Metoclopramide(Reglan)-Gastroparesis
Bethanechol -Gastroparesis
Antihistamines motion sickness
Butyrophenones post op. nausea vomiting
5-HT3 receptor antagonists - post op. chemotherapy / chemotherapy
Anticholinergics motion sickness
Corticosteroids -drug-induced emesis
Benzodiazepines- psychological problem
Treatment
Postoperative and postchemotherapy nausea and vomiting
-there are few trials that identify an antiemetic of choice.
-prochlorperazine (Compazine),
promethazine (Phenergan),
metoclopramide (Reglan),
trimethobenzamide (Tigan).

참고자료

· American Gastroenterological Association, 2001. American Gastroenterological Association:Medical position statement: Nausea and vomiting.Gastroenterology2001;120(1):261-262.
· Anthony, 2004. AnthonyL:Nausea and vomiting.Conn`s Current Therapy2004.
· Hasler and Chung, 2005. Hasler WL, Chung O: Approach to the patient with gastrointestinal disease. Harrison`s Principles of Internal Medicine, 16th ed. 2005.
· McQuaid, 2006. McQuaidKR:Nausea and vomiting.Current Medical Diagnosis and Treatment2006.
· Miser, 2005. MiserWF:Nausea and vomiting.Conn`s Current Therapy2005
· Pasricha, 2005. Pasricha PJ: Treatment of disorders of bowel motility and water flux; antiemetics; agents used in biliary and pancreatic disease. Goodman and Gilman`s The Pharmacological Basis of Therapeutics, 11th ed. 2005.