Gastroenterology Book

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Nausea CausesAka: Vomiting Causes

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  1. See Also
    1. Vomiting
    2. Vomiting Causes in Children
    3. Vomiting in Cancer
    4. Vomiting in Pregnancy
    5. Psychogenic Vomiting
    6. Medication Induced Vomiting
  2. General: Clinical Clues
    1. Associated Factors
      1. Weight Loss
        1. Malignancy
        2. Gastric outlet obstruction
        3. Peptic Ulcer Disease
      2. Adequate nutrition despite prolonged course
        1. Psychogenic Vomiting
      3. Diarrhea, viral prodrome, and contagious contacts
        1. Viral Gastroenteritis
      4. Fever with Emesis
        1. Acute Gastroenteritis (most common cause)
        2. Cholecystitis
        3. Appendicitis
        4. Hepatitis
      5. Headache, stiff neck and focal neurologic deficit
        1. Central neurologic causes
      6. Early satiety and postprandial bloating
        1. Gastroparesis
      7. Repetitive Migraine Headaches
        1. Cyclic Vomiting syndrome
    2. Onset
      1. Abrupt Onset
        1. Gastroenteritis or Food Poisoning
        2. Pancreatitis
        3. Cholecystitis
        4. Medication Induced Vomiting or Illicit Drugs
      2. Insidious Onset
        1. Gastroesophageal Reflux
        2. Gastroparesis
        3. Medication Induced Vomiting
        4. Metabolic Disorders
        5. Pregnancy
    3. Associated Pain
      1. Right upper quadrant pain
        1. Cholecystitis or other biliary tract disease
      2. Epigastric Pain
        1. Pancreatitis
        2. Peptic Ulcer Disease
      3. Severe pain
        1. Cholecystitis or other biliary tract disease
        2. Pancreatitis
        3. Peritonitis
        4. Small Bowel Obstruction (pain precedes Vomiting)
      4. Vomiting is Palliative of Pain
        1. Vomiting relieves Peptic Ulcer Disease pain
        2. Vomiting does not relieve pain of:
          1. Pancreatitis
          2. Cholecystitis
    4. Timing
      1. Vomiting prior to eating breakfast
        1. Alcoholism
        2. Uremia
        3. Chronic Obstructive Lung Disease
        4. Psychogenic Vomiting
        5. Increased Intracranial Pressure
        6. Vomiting in Pregnancy (Morning Sickness)
          1. Vomiting occurs throughout day in pregnancy
      2. During or immediately after eating
        1. Psychogenic Vomiting (most common)
        2. Peptic Ulcer Disease
        3. Pyloric stenosis
      3. One to four hours after a meal
        1. Gastric outlet obstruction
        2. Peptic Ulcer Disease
        3. Malignancy
        4. Gastroparesis
      4. Continuous Vomiting: Conversion Disorder
      5. Intermittent sporadic Vomiting: Major Depression
    5. Characteritics of Emesis
      1. Putrid or fecal odor (Stercoraceous Vomiting)
        1. Vomiting of fecal material
        2. Causes
          1. Intestinal Obstruction
          2. Gastrocolic fistula
          3. Gastric outlet obstruction (bacterial overgrowth)
      2. Regurgitation of undigested food
        1. Achalasia
        2. Esophageal Stricture
        3. Zenker's Diverticulum
      3. Large residues of gastric contents and particles
        1. Large volumes (>1.5 L/24h) suggests organic cause
        2. Gastroparesis
          1. Emesis delayed 1 hour or more after eating
        3. Gastric Outlet Obstruction
          1. Emesis delayed as much as 12 hours after eating
          2. Partially digested food without bile present
      4. Hematemesis (Coffee-ground Emesis or black Emesis)
        1. Suggests Gastrointestinal Bleeding
        2. Upper Respiratory tract can also be bleeding source
      5. Bilious Emesis suggests Small Bowel Obstruction
        1. Emesis stained green with bile
        2. Confirms patency of gastric outlet
  3. Neurologic Causes
    1. Migraine Headache
    2. Vertigo
      1. Meniere's Disease
      2. Motion Sickness
      3. Labyrinthitis or Vestibular Neuronitis
    3. Meningitis
    4. Seizure disorder
    5. Demyelinating disease
    6. Increased Intracranial Pressure
      1. Cerebral Lesion (often Projectile Vomiting)
      2. Congenital malformation
      3. Hydrocephalus
      4. Pseudotumor Cerebri
      5. Intracranial Hemorrhage
      6. Closed Head Injury
  4. Metabolic Causes
    1. Renal Failure (Uremia)
    2. Liver Failure or Cirrhosis
    3. Metabolic Acidosis
    4. Adrenal Insufficiency (Addison's Disease)
    5. Acute intermittent porphyria
    6. Poisoning or Medication induced
      1. See Medication Induced Vomiting
      2. Carbon Monoxide Poisoning
      3. Radiation exposure
      4. Arsenic Poisoning
      5. Ricin Poisoning
      6. Organophosphate Poisoning
    7. Thyroid and Parathyroid conditions
      1. Hyperthyroidism
      2. Hypoparathyroidism
      3. Hyperparathyroidism
    8. Diabetes Mellitus
      1. Diabetic Ketoacidosis
    9. Pregnancy
      1. See Vomiting in Pregnancy (Morning Sickness)
      2. See Hyperemesis Gravidarum
    10. Electrolyte Abnormalities
      1. Hyponatremia
      2. Hypercalcemia
      3. Hyperkalemia
  5. Gastrointestinal Causes
    1. Obstruction
      1. Gastric Outlet Obstruction or pyloric stenosis
      2. Small Bowel Obstruction
      3. Intussusception
      4. Strangulated Hernia
      5. Volvulus
    2. Functional Conditions
      1. Paralytic Ileus
      2. Irritable Bowel Syndrome
      3. Gastroparesis
      4. Non-ulcer Dyspepsia
      5. Gastroesophageal Reflux Disease (GERD)
    3. Acute inflammatory or infectious conditions
      1. Appendicitis
      2. Ruptured viscus
      3. Peritonitis
      4. Cholecystitis or Biliary Colic
      5. Acute Pancreatitis
      6. Peptic Ulcer Disease
    4. Post-operative gastric surgery changes
      1. Bariatric Surgery
      2. Nissen Fundoplication
    5. Miscellaneous Conditions
      1. Gastroenteritis (Adenovirus, Norwalk, Rotavirus)
      2. Food Poisoning
      3. Acute Hepatitis
      4. Cirrhosis
      5. Crohn's Disease
      6. Pancreatic Cancer
      7. Mesenteric Ischemia
  6. Psychogenic Causes
    1. See Psychogenic Vomiting
    2. Mood Disorder (e.g. Anxiety Disorder or Depression)
    3. Eating Disorder (e.g. Anorexia or Bulimia)
    4. Conversion Disorder
  7. Miscellaneous Causes
    1. Pregnancy
    2. Febrile illness
    3. Myocardial Infarction
    4. Congestive Heart Failure
    5. Myocardial Ischemia or infarction
    6. Otitis Media
    7. Chronic Obstructive Pulmonary Disease
    8. Acute Glaucoma
    9. Sepsis
    10. Cyclic Vomiting (abdominal Migraine)
    11. Postoperative Nausea and Vomiting
  8. Genitourinary Causes
    1. Acute Nephritis
    2. Urinary Tract Infection including Pyelonephritis
    3. Nephrolithiasis
    4. Testicular Torsion
    5. Ovarian Torsion
  9. References
    1. Degowin (1987) Diagnostic Exam, Macmillan, p. 526-7
    2. Feldman (1998) Sleisenger Gastrointestinal, p. 117-126
    3. Friedman (1991) Medical Diagnosis, Little Brown, p. 174
    4. Heilenbach in Marx (2002) Rosen's Emergency Med, p. 178
    5. Quigley (2001) Gastroenterology 120(1):263
    6. Scorza (2007) Am Fam Physician 76:76

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