Nausea and vomiting: Difference between revisions
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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]] | ||
* | *[[Idiopathic intracranial hypertension]] | ||
*Hydrocephalus | *[[Hydrocephalus]] | ||
*Mass lesion | *[[Intracranial mass|Mass lesion]] | ||
*[[Meningitis]] | *[[Meningitis]] | ||
* | *[[Migraine]] | ||
*[[Labyrinthitis]] | *[[Labyrinthitis]] | ||
*Meniere disease | *[[Meniere's disease]] | ||
*Motion sickness | *[[Motion sickness]] | ||
*[[Cannabinoid hyperemesis syndrome]] | *[[Cannabinoid hyperemesis syndrome]] | ||
====Infectious==== | ====Infectious==== | ||
* | *[[Bacteria]]l toxins | ||
*[[ | *[[Pneumonia]] | ||
*[[SBP]] | *[[SBP]] | ||
*[[UTI]] | *[[UTI]] | ||
*Viruses ( | *Viruses ([[adenovirus]], [[norovirus]], [[rotavirus]]) | ||
====Drugs/Toxins==== | ====Drugs/Toxins==== | ||
*Toxic doses | *Toxic doses | ||
**Digoxin | **[[Digoxin toxicity]] | ||
** | **[[Aspirin toxicity]] | ||
** | **[[Acetaminophen toxicity]] | ||
*NSAIDs | **[[Ipecac toxicity]] | ||
* | *[[NSAIDs]] | ||
* | *[[Opioids]] | ||
*Anticonvulsants | *[[Alcohol]] | ||
*[[Anticonvulsants]] | |||
*[[Antibiotics]] | *[[Antibiotics]] | ||
*Antiarrhythmics | *[[Antiarrhythmics]] | ||
*Toxins | *Toxins | ||
**Organophosphates | **[[Organophosphates]] | ||
** | **[[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]] | ||
* | *[[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== | ||
''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]] | ||
==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== | ||
| Line 115: | Line 127: | ||
==See Also== | ==See Also== | ||
*[[Nausea and vomiting (peds)]] | *[[Nausea and vomiting (peds)]] | ||
==External Links== | |||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:GI]] | [[Category:GI]] | ||
[[Category:Symptoms]] | [[Category:Symptoms]] | ||
Revision as of 05:59, 14 May 2020
This page is for adult patients. For pediatric patients, see: nausea and vomiting (peds).
Background
Clinical Features
- Nausea and/or vomiting
- Additional features of underlying process
Differential Diagnosis
Nausea and vomiting
Critical
Emergent
- Acute radiation syndrome
- Acute gastric dilation
- Adrenal insufficiency
- Appendicitis
- Bowel obstruction/ileus
- Carbon monoxide poisoning
- Cholecystitis
- CNS tumor
- Electrolyte abnormalities
- Elevated ICP
- Gastric outlet obstruction, gastric volvulus
- Hyperemesis gravidarum
- Medication related
- Pancreatitis
- Peritonitis
- Ruptured viscus
- Testicular torsion/ovarian torsion
Nonemergent
- Acute gastroenteritis
- Biliary colic
- Cannabinoid hyperemesis syndrome
- Chemotherapy
- Cyclic vomiting syndrome
- ETOH
- Gastritis
- Gastroenteritis
- Gastroparesis
- Hepatitis
- Labyrinthitis
- Migraine
- Medication related
- Motion sickness
- Narcotic withdrawal
- Thyroid
- Pregnancy
- Peptic ulcer disease
- Renal colic
- UTI
By organ system
GI
- Peptic ulcer disease
- Obstruction
- Adhesion
- Small bowel obstruction/LBO
- Gastric outlet obstruction
- Gastric volvulus
- Bezoar
- Pancreatitis
- Gastroparesis
- Appendicitis
- Cholecystitis
- Cholangitis
- Acute Hepatitis
- IBD
- Intussusception
- Tumor
- Strangulated hernia
- Volvulus
- Mesenteric ischemia
- Esophageal disorders (e.g. achalasia)
- Functional disorders
- Psychogenic
- IBS
- Pyloric Stenosis
Neurologic
- Head injury
- CVA
- Idiopathic intracranial hypertension
- Hydrocephalus
- Mass lesion
- Meningitis
- Migraine
- Labyrinthitis
- Meniere's disease
- Motion sickness
- Cannabinoid hyperemesis syndrome
Infectious
Drugs/Toxins
- Toxic doses
- NSAIDs
- Opioids
- Alcohol
- Anticonvulsants
- Antibiotics
- Antiarrhythmics
- Toxins
- Acute radiation syndrome
Endocrine
- Pregnancy, hyperemesis gravidarum
- Hyponatremia
- Adrenal insufficiency
- DKA
- Thyroid/parathyroid disorders
- Uremia
Miscellaneous
- ACS
- ovarian/testicular torsion
- Nephrolithiasis
- Pain
- Acute angle-closure glaucoma
- Anorexia nervosa/bulimia nervosa
- Depression
Evaluation
Varies widely depending on clinical presentation
- CBC
- Chemistry
- Urine pregnancy
- LFTs
- Lipase
- APAP, ASA, digoxin levels
- Urinalysis
- ?Abdominal xray
- ?CT
- ?Ultrasound
Management
- Treat underlying pathology
- Address electrolyte derangements and dehydration as needed
- Antiemetics
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
- Hypovolemia
- Metabolic alkalosis
- Hypokalemia
- Mallory-Weiss (tear)
- Boerhaave (rupture)
- Aspiration