Difference between revisions of "Nausea and vomiting"

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{{Adult top}} [[nausea and vomiting (peds)]].''
 
==Background==
 
==Background==
 
[[File:Nausea_and_vomiting.png|thumb|Nausea and Vomiting Algorithm]]
 
[[File:Nausea_and_vomiting.png|thumb|Nausea and Vomiting Algorithm]]
  
 
==Clinical Features==
 
==Clinical Features==
 +
*Nausea and/or vomiting
 +
*Additional features of underlying process
  
 
==Differential Diagnosis==
 
==Differential Diagnosis==
 
{{Nausea and vomiting DDX}}
 
{{Nausea and vomiting DDX}}
 +
 
===By organ system===
 
===By organ system===
 
====GI====
 
====GI====
 
*[[Peptic ulcer disease]]
 
*[[Peptic ulcer disease]]
−
*Obstruction
+
*[[Bowel obstruction|Obstruction]]
 
**Adhesion
 
**Adhesion
 
**[[Small bowel obstruction]]/LBO
 
**[[Small bowel obstruction]]/LBO
 
***[[SMA syndrome]]
 
***[[SMA syndrome]]
 
**Gastric outlet obstruction
 
**Gastric outlet obstruction
 +
**[[Gastric volvulus]]
 
**[[Bezoar]]
 
**[[Bezoar]]
 
*[[Pancreatitis]]
 
*[[Pancreatitis]]
−
*Gastroparesis
+
*[[Gastroparesis]]
 
*[[Appendicitis]]
 
*[[Appendicitis]]
 
*[[Cholecystitis]]
 
*[[Cholecystitis]]
 
*[[Cholangitis]]
 
*[[Cholangitis]]
 
*[[Acute Hepatitis]]
 
*[[Acute Hepatitis]]
−
*IBD
+
*[[IBD]]
 
*[[Intussusception]]
 
*[[Intussusception]]
 
*Tumor
 
*Tumor
−
*Strangulated hernia
+
*Strangulated [[hernia]]
 
*[[Volvulus]]
 
*[[Volvulus]]
 
*[[Mesenteric ischemia]]
 
*[[Mesenteric ischemia]]
−
*Esophageal disorders (e.g. achalasia)
+
*Esophageal disorders (e.g. [[achalasia]])
 
*Functional disorders
 
*Functional disorders
 
**Psychogenic
 
**Psychogenic
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====Neurologic====
 
====Neurologic====
−
*Head injury
+
*[[Head injury]]
 
*[[CVA]]
 
*[[CVA]]
−
*Pseudotumor
+
*[[Idiopathic intracranial hypertension]]
−
*Hydrocephalus
+
*[[Hydrocephalus]]
−
*Mass lesion
+
*[[Intracranial mass|Mass lesion]]
 
*[[Meningitis]]
 
*[[Meningitis]]
−
*Migraines
+
*[[Migraine]]
 
*[[Labyrinthitis]]
 
*[[Labyrinthitis]]
−
*Meniere disease
+
*[[Meniere's disease]]
−
*Motion sickness
+
*[[Motion sickness]]
 
*[[Cannabinoid hyperemesis syndrome]]
 
*[[Cannabinoid hyperemesis syndrome]]
  
 
====Infectious====
 
====Infectious====
−
*Bacterial toxins
+
*[[Bacteria]]l toxins
−
*[[pneumonia]]
+
*[[Pneumonia]]
 
*[[SBP]]
 
*[[SBP]]
 
*[[UTI]]
 
*[[UTI]]
−
*Viruses (adeno, norwalk, rota
+
*Viruses ([[adenovirus]], [[norovirus]], [[rotavirus]])
 +
 
 
====Drugs/Toxins====
 
====Drugs/Toxins====
 
*Toxic doses
 
*Toxic doses
−
**Digoxin
+
**[[Digoxin toxicity]]
−
**ASA
+
**[[Aspirin toxicity]]
−
**APAP
+
**[[Acetaminophen toxicity]]
−
*NSAIDs
+
**[[Ipecac toxicity]]
−
*Opiates
+
*[[NSAIDs]]
−
*ETOH
+
*[[Opioids]]
−
*Anticonvulsants
+
*[[Alcohol]]
 +
*[[Anticonvulsants]]
 
*[[Antibiotics]]
 
*[[Antibiotics]]
−
*Antiarrhythmics
+
*[[Antiarrhythmics]]
 
*Toxins
 
*Toxins
−
**Organophosphates
+
**[[Organophosphates]]
−
**CO
+
**[[Carbon monoxide]]
−
**Ricin
+
**[[Ricin]]
 
*[[Acute radiation syndrome]]
 
*[[Acute radiation syndrome]]
  
 
====Endocrine====
 
====Endocrine====
−
*Pregnancy
+
*[[Pregnancy]], [[hyperemesis gravidarum]]
 
*[[Hyponatremia]]
 
*[[Hyponatremia]]
−
*Adrenal insufficiency
+
*[[Adrenal insufficiency]]
 
*[[DKA]]
 
*[[DKA]]
−
*Thyroid/parathyroid disorders
+
*[[Thyroid]]/parathyroid disorders
 
*[[Uremia]]
 
*[[Uremia]]
  
 
====Miscellaneous====
 
====Miscellaneous====
 
*[[ACS]]
 
*[[ACS]]
−
*Gonadal torsion
+
*[[Ovarian torsion|ovarian]]/[[testicular torsion]]
 
*[[Nephrolithiasis]]
 
*[[Nephrolithiasis]]
 
*Pain
 
*Pain
−
*Acute glaucoma
+
*[[Acute angle-closure glaucoma]]
−
*Anorexia/bulimia
+
*[[Anorexia nervosa]]/[[bulimia nervosa]]
−
*Depression
+
*[[Depression]]
  
 
==Evaluation==
 
==Evaluation==
−
===Work-Up===
+
''Varies widely depending on clinical presentation''
 
*CBC
 
*CBC
 
*Chemistry
 
*Chemistry
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*APAP, ASA, digoxin levels
 
*APAP, ASA, digoxin levels
 
*[[Urinalysis]]
 
*[[Urinalysis]]
−
*?Abdominal xray
+
*?[[Abdominal xray]]
 
*?CT
 
*?CT
 
*?[[Ultrasound]]
 
*?[[Ultrasound]]
−
 
−
===Evaluation===
 
  
 
==Management==
 
==Management==
 +
*Treat underlying pathology
 +
*Address [[electrolyte derangements]] and [[dehydration]] as needed
 +
*[[Antiemetics]]
  
 
==Disposition==
 
==Disposition==
 +
*Depends on cause
 +
*Most non-specific episodes of acute nausea and vomiting may be discharged, if:
 +
**No emergent/urgent cause identified or suspected
 +
**Patient tolerating fluids after treatment
  
 
==Complications==
 
==Complications==
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==See Also==
 
==See Also==
 
*[[Nausea and vomiting (peds)]]
 
*[[Nausea and vomiting (peds)]]
 +
 +
==External Links==
  
 
==References==
 
==References==
 
<references/>
 
<references/>
 +
 
[[Category:GI]]
 
[[Category:GI]]
−
[[Category:Pediatrics]]
 
 
[[Category:Symptoms]]
 
[[Category:Symptoms]]

Latest revision as of 05:59, 14 May 2020

This page is for adult patients. For pediatric patients, see: nausea and vomiting (peds).

Background

Nausea and Vomiting Algorithm

Clinical Features

  • Nausea and/or vomiting
  • Additional features of underlying process

Differential Diagnosis

Nausea and vomiting

Critical

Emergent

Nonemergent

By organ system

GI

Neurologic

Infectious

Drugs/Toxins

Endocrine

Miscellaneous

Evaluation

Varies widely depending on clinical presentation

Management

Disposition

  • Depends on cause
  • Most non-specific episodes of acute nausea and vomiting may be discharged, if:
    • No emergent/urgent cause identified or suspected
    • Patient tolerating fluids after treatment

Complications

See Also

External Links

References

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