Difference between revisions of "Nausea and vomiting"

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==Background==
 
==Background==
 
[[File:Nausea_and_vomiting.png|thumb|Nausea and Vomiting Algorithm]]
 
[[File:Nausea_and_vomiting.png|thumb|Nausea and Vomiting Algorithm]]
==Work-Up==
+
 
*CBC
+
==Clinical Features==
*Chemistry
 
*Urine pregnancy
 
*LFTs
 
*Lipase
 
*APAP, ASA, digoxin levels
 
*UA
 
*?Abd xray
 
*?CT
 
*?US
 
  
 
== DDX by organ system ==
 
== DDX by organ system ==
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*Motion sickness
 
*Motion sickness
 
*Labyrinthitis
 
*Labyrinthitis
 +
 +
==Diagnosis==
 +
===Work-Up===
 +
*CBC
 +
*Chemistry
 +
*Urine pregnancy
 +
*LFTs
 +
*Lipase
 +
*APAP, ASA, digoxin levels
 +
*UA
 +
*?Abd xray
 +
*?CT
 +
*?US
 +
 +
===Evaluation==
 +
 +
==Management==
 +
 +
==Disposition==
  
 
== Complications ==
 
== Complications ==
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| valign="top" bgcolor="*ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | Ileus, gastroesophageal reflux, post-tussive, peritonitis, drug overdose, appendicitis, pancreatitis, gastritis, Crohn disease, pregnancy, psychogenic, cyclic vomiting syndrome
 
| valign="top" bgcolor="*ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | Ileus, gastroesophageal reflux, post-tussive, peritonitis, drug overdose, appendicitis, pancreatitis, gastritis, Crohn disease, pregnancy, psychogenic, cyclic vomiting syndrome
 
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|}
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==See Also==
  
 
== References ==
 
== References ==

Revision as of 15:30, 23 June 2015

Background

Nausea and Vomiting Algorithm

Clinical Features

DDX by organ system

GI

Neurologic

Infectious

  • Bacterial toxins
  • PNA
  • SBP
  • UTI
  • Viruses (adeno, norwalk, rota

Drugs/Toxins

  • Toxic doses
    • Digoxin
    • ASA
    • APAP
  • NSAIDs
  • Opiates
  • ETOH
  • Anticonvulsants
  • Abx
  • Antiarrhythmics
  • Toxins
    • Organophosphates
    • CO
    • Ricin

Endocrine

Miscellaneous

DDx by Severity

Critical

Emergent

Nonemergent

  • Gastritis
  • Gastroparesis
  • PUD
  • Gastroenteritis
  • Biliary colic
  • Hepatitis
  • Thyroid
  • Pregnancy
  • Erythromycin
  • Ibuprofen
  • Chemotherapy
  • Narcotics/wdwl from
  • ETOH
  • UTI
  • Renal colic
  • Motion sickness
  • Labyrinthitis

Diagnosis

Work-Up

  • CBC
  • Chemistry
  • Urine pregnancy
  • LFTs
  • Lipase
  • APAP, ASA, digoxin levels
  • UA
  • ?Abd xray
  • ?CT
  • ?US

=Evaluation

Management

Disposition

Complications

  • Hypovolemia
  • Metabolic alkalosis
  • Hypokalemia
  • Mallory-Weiss (tear)
  • Boerhaave (rupture)
  • Aspiration

Peds

Newborn 
Obstructive intestinal anomalies Esophageal stenosis/atresia, pyloric stenosis, intestinal stenosis/atresia, malrotation ± volvulus, incarcerated hernia, meconium ileus/plug, Hirschsprung disease, imperforate anus, enteric duplications
Neurologic Intracranial bleed/mass, hydrocephalus, cerebral edema, kernicterus
Renal Urinary tract infection, obstructive uropathy, renal insufficiency
Infectious Viral illness, gastroenteritis, meningitis, sepsis
Metabolic/endocrine Inborn errors of metabolism (urea cycle, amino/organic acid, carbohydrate), congenital adrenal hyperplasia
Miscellaneous Ileus, gastroesophageal reflux, necrotizing enterocolitis, milk allergy, GI perforation
Infant (<12 mo) 
Obstructive intestinal anomalies Pyloric stenosis, malrotation ± volvulus, incarcerated hernia, Hirschsprung disease, enteric duplications, intussusception, foreign body, bezoars, Meckel diverticulum
Neurologic Intracranial bleed/mass, hydrocephalus, cerebral edema
Renal Urinary tract infection, obstructive uropathy, renal insufficiency
Infectious Viral illness, gastroenteritis, meningitis, sepsis, otitis media, pneumonia, pertussis, hepatitis
Metabolic/endocrine Inborn errors of metabolism, adrenal insufficiency, renal tubular acidosis
Miscellaneous Ileus, gastroesophageal reflux, post-tussive, peritonitis, drug overdose
Child (>12 mo)   
Obstructive intestinal anomalies Malrotation ± volvulus, incarcerated hernia, Hirschsprung disease, intussusception, foreign body, bezoars, Meckel diverticulum, acquired esophageal stricture, peptic ulcer disease, adhesions, superior mesenteric artery syndrome
Neurologic Intracranial bleed/mass, cerebral edema, postconcussive, migraine
Renal Urinary tract infection, obstructive uropathy, renal insufficiency
Infectious Viral illness, gastroenteritis, meningitis, sepsis, otitis media, pneumonia, hepatitis, streptococcal pharyngitis
Metabolic/endocrine Inborn errors of metabolism, adrenal insufficiency, renal tubular acidosis, diabetes mellitus, Reye syndrome, porphyria
Miscellaneous Ileus, gastroesophageal reflux, post-tussive, peritonitis, drug overdose, appendicitis, pancreatitis, gastritis, Crohn disease, pregnancy, psychogenic, cyclic vomiting syndrome

See Also

References