Difference between revisions of "Nausea and vomiting"

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 +
==Work-Up==
 +
#CBC
 +
#Chemistry
 +
#Urine pregnancy
 +
#LFTs
 +
#Lipase
 +
#APAP, ASA, digoxin levels
 +
#UA
 +
#?Abd xray
 +
#?CT
 +
#?US
 +
 
== Complications ==
 
== Complications ==
 
 
#Hypovolemia
 
#Hypovolemia
 
#Metabolic alkalosis
 
#Metabolic alkalosis
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#Aspiration
 
#Aspiration
  
== DDX ==
+
== DDX by organ system ==
 +
===GI===
 +
#Peptic ulcer disease
 +
#Obstruction
 +
##Adhesion
 +
##SBO/LBO
 +
##Gastric outlet obstruction
 +
#Pancreatitis
 +
#Gastroparesis
 +
 
 +
#Appendicitis
 +
#Cholecystitis
 +
#Cholangitis
 +
#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
 +
===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===
 +
#Pregnancy
 +
#Hyponatremia
 +
#Adrenal insufficiency
 +
#DKA
 +
#Thyroid/parathyroid disorders
 +
#Uremia
 +
 
 +
===Miscellaneous===
 +
#ACS
 +
#Gonadal torsion
 +
#Nephrolithiasis
 +
#Pain
 +
#Acute glaucoma
 +
#Anorexia/bulimia
 +
#Depression
  
 +
==DDx by criticality==
 
=== Critical ===
 
=== Critical ===
 
 
#Boerhaave
 
#Boerhaave
 
#Ischemic bowel
 
#Ischemic bowel
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=== Emergent ===
 
=== Emergent ===
 
 
#Gastric outlet obstruction
 
#Gastric outlet obstruction
 
#Pancreatitis
 
#Pancreatitis
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#CO
 
#CO
 
#Electrolyte disorder
 
#Electrolyte disorder
 
+
===Nonemergent===
=== Nonemergent ===
 
 
 
 
#Gastritis
 
#Gastritis
 
#Gastroparesis
 
#Gastroparesis
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=== Peds ===
 
=== Peds ===
 
  
 
{| cellspacing="1" cellpadding="3" border="0" bgcolor="#666666" width="100%"
 
{| cellspacing="1" cellpadding="3" border="0" bgcolor="#666666" width="100%"
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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
 
|}
 
|}
 
  
 
== Source ==
 
== Source ==
 
+
*Rosen
Rosen, Tintinalli
+
*Tintinalli
  
 
[[Category:GI]]
 
[[Category:GI]]
 
[[Category:Peds]]
 
[[Category:Peds]]

Revision as of 02:44, 27 July 2011

Work-Up

  1. CBC
  2. Chemistry
  3. Urine pregnancy
  4. LFTs
  5. Lipase
  6. APAP, ASA, digoxin levels
  7. UA
  8. ?Abd xray
  9. ?CT
  10. ?US

Complications

  1. Hypovolemia
  2. Metabolic alkalosis
  3. Hypokalemia
  4. Mallory-Weiss (tear)
  5. Boerhaave (rupture)
  6. Aspiration

DDX by organ system

GI

  1. Peptic ulcer disease
  2. Obstruction
    1. Adhesion
    2. SBO/LBO
    3. Gastric outlet obstruction
  3. Pancreatitis
  4. Gastroparesis
  1. Appendicitis
  2. Cholecystitis
  3. Cholangitis
  4. Hepatitis
  5. IBD
  6. Intussusception
  7. Tumor
  8. Strangulated hernia
  9. Volvulus
  10. Mesenteric ischemia
  11. Esophageal disorders (e.g. achalasia)
  12. Functional disorders
    1. Psychogenic
    2. IBS
  13. Pyloric stenosis

Neurologic

  1. Head injury
  2. CVA
  3. Pseudotumor
  4. Hydrocephalus
  5. Mass lesion
  6. Meningitis
  7. Migraines
  8. Labyrinthitis
  9. Meniere disease
  10. Motion sickness

Infectious

  1. Bacterial toxins
  2. PNA
  3. SBP
  4. UTI
  5. Viruses (adeno, norwalk, rota

Drugs/Toxins

  1. Toxic doses
    1. Digoxin
    2. ASA
    3. APAP
  2. NSAIDs
  3. Opiates
  4. ETOH
  5. Anticonvulsants
  6. Abx
  7. Antiarrhythmics
  8. Toxins
    1. Organophosphates
    2. CO
    3. Ricin

Endocrine

  1. Pregnancy
  2. Hyponatremia
  3. Adrenal insufficiency
  4. DKA
  5. Thyroid/parathyroid disorders
  6. Uremia

Miscellaneous

  1. ACS
  2. Gonadal torsion
  3. Nephrolithiasis
  4. Pain
  5. Acute glaucoma
  6. Anorexia/bulimia
  7. Depression

DDx by criticality

Critical

  1. Boerhaave
  2. Ischemic bowel
  3. ICH
  4. Meningitis
  5. DKA
  6. AMI
  7. Sepsis

Emergent

  1. Gastric outlet obstruction
  2. Pancreatitis
  3. Cholecystitis
  4. Bowel obstruction/ileus
  5. Ruptured viscus
  6. Appendicitis
  7. Peritonitis
  8. Migraine
  9. CNS tumor
  10. raised ICP
  11. Adrenal insuffciency
  12. Hyperemesis gravidarum
  13. Tylenol
  14. Digoxin
  15. ASA
  16. Theophyline
  17. Gonadal torsion
  18. CO
  19. Electrolyte disorder

Nonemergent

  1. Gastritis
  2. Gastroparesis
  3. PUD
  4. Gastroenteritis
  5. Biliary colic
  6. Hepatitis
  7. Thyroid
  8. Pregnancy
  9. Erythromycin
  10. Ibuprofen
  11. Chemotherapy
  12. Narcotics/wdwl from
  13. ETOH
  14. UTI
  15. Renal colic
  16. Motion sickness
  17. Labyrinthitis

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

Source

  • Rosen
  • Tintinalli