Nausea & Vomiting

Key Features

Essentials of Diagnosis

• Nausea is a vague, intensely disagreeable sensation of sickness or "queasiness"

• Distinguished from anorexia (a loss of appetite)

• Retching (spasmodic respiratory and abdominal movements) often follows

• Vomiting may or may not follow

• Vomiting should be distinguished from regurgitation, the effortless reflux of liquid or solid (food) stomach contents, and from rumination, the chewing and swallowing of food that is regurgitated volitionally after meals

General Considerations

• May be caused by wide variety of conditions that stimulate the vagal afferent receptors, the brainstem vomiting center, or the chemoreceptor trigger zone (Table 15–1)

• May lead to serious complications, including electrolyte disturbances (hypokalemia, metabolic alkalosis), dehydration, aspiration pneumonia, Mallory-Weiss tear, and esophageal rupture

Clinical Findings

Symptoms and Signs

• Acute symptoms without abdominal pain suggest

  • Food poisoning

  • Infectious gastroenteritis

  • Drugs

  • Systemic illness

• Vomiting with acute pain suggests

  • Peritoneal irritation

  • Acute gastric or intestinal obstruction

  • Pancreaticobiliary disease

• Persistent vomiting suggests

  • Pregnancy

  • Gastric outlet obstruction

  • Gastroparesis

  • Intestinal dysmotility

  • Psychogenic disorders

  • CNS or systemic disorders

• Vomiting that occurs in the morning before breakfast is common with

  • Pregnancy

  • Uremia

  • Alcohol intake

  • Increased intracranial pressure

• Vomiting immediately after meals suggests bulimia or psychogenic causes

• Vomiting of undigested food suggests gastroparesis or a gastric outlet obstruction; physical examination reveals a succussion splash

  • Inquire about neurologic symptoms such as

  • Headaches

  • Stiff neck

  • Vertigo

  • Focal paresthesias or weakness

Differential Diagnosis

• Visceral afferent stimulation (...