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]] | ||
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| − | + | ==Clinical Features== | |
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== DDX by organ system == | == DDX by organ system == | ||
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*Motion sickness | *Motion sickness | ||
*Labyrinthitis | *Labyrinthitis | ||
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| + | ==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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| + | ==See Also== | ||
== References == | == References == | ||
Revision as of 15:30, 23 June 2015
Contents
Background
Clinical Features
DDX by organ system
GI
- Peptic ulcer disease
- Obstruction
- Adhesion
- Small bowel obstruction/LBO
- Gastric outlet obstruction
- 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
- Pseudotumor
- Hydrocephalus
- Mass lesion
- Meningitis
- Migraines
- Labyrinthitis
- Meniere disease
- Motion sickness
- Cannabinoid hyperemesis syndrome
Infectious
Drugs/Toxins
- Toxic doses
- Digoxin
- ASA
- APAP
- NSAIDs
- Opiates
- ETOH
- Anticonvulsants
- Abx
- Antiarrhythmics
- Toxins
- Organophosphates
- CO
- Ricin
Endocrine
- Pregnancy
- Hyponatremia
- Adrenal insufficiency
- DKA
- Thyroid/parathyroid disorders
- Uremia
Miscellaneous
- ACS
- Gonadal torsion
- Nephrolithiasis
- Pain
- Acute glaucoma
- Anorexia/bulimia
- Depression
DDx by Severity
Critical
- Boerhaave's
- Ischemic bowel
- ICH
- Meningitis
- DKA
- AMI
- Sepsis
Emergent
- Gastric outlet obstruction
- Pancreatitis
- Cholecystitis
- Bowel obstruction/ileus
- Ruptured viscus
- Appendicitis
- Peritonitis
- Migraine
- CNS tumor
- raised ICP
- Adrenal insuffciency
- Hyperemesis gravidarum
- Tylenol
- Digoxin
- ASA
- Theophyline
- Gonadal torsion
- CO
- Electrolyte Disorders
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 |