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Nausea / Vomiting

Overview

  • While nausea and vomiting classically occur in an attempt to expel the gastric contents, these symptoms are mediated by complex neurological, metabolic and gastrointestinal pathways. Clinical history can be used to assess the nature of the patient's symptoms and suggest an underlying cause.

Aetiology

    • Causes of Nausea / Vomiting

    • Gastrointestinal

    • Mechanical Obstruction - oesophageal stricture, gastric outlet obstruction, small / large bowel obstruction
    • Functional - gastroparesis, chronic intestinal pseudo-obstruction, irritable bowel syndrome, achalasia
    • Gastroenteritis - viral / bacterial / parasitic
    • Inflammation  - appendicitis, cholecystitis, hepatitis, pancreatitis, peritonitis, Crohn’s, mesenteric ischaemia
    • Pancreatic cancer
    • Peptic ulcer
    • Neurological

    • Raised intracranial pressure - ischaemic stroke, haemorrhage, tumour, meningitis, abscess, hydrocephalus
    • Vestibular - labyrinthitis, Meniere’s, motion sickness
    • Seizure disorder
    • Migraine
    • Other

    • Metabolic / endocrine - pregnancy, DKA, hypercalcaemia, hyponatraemia, hyperthyroidism, Addison’s, uraemia
    • Infection - pneumonia, UTI, otitis media
    • Psychiatric - anxiety, depression, anorexia nervosa, bulimia nervosa, severe pain
    • Medications - NSAIDs, opioids, chemotherapy, antigout, antiarrhythmics, OCP, certain antibiotics, antiepileptics, sulfasalazine, Parkinson’s meds
    • Alcohol - intoxication / withdrawal
    • Postoperative nausea / vomiting
    • Acute coronary syndrome

History of Presenting Complaint

    • Onset

      Whether the nausea / vomiting started suddenly or gradually, and in what situation it began.
    • Onset post alcohol ingestionSuggestive of alcohol intoxication or withdrawal
    • Onset post head injurySuggestive of post head injury headache
    • Post chemo or radiotherapySuggestive of chemotherapy / radiotherapy side effect
    • Vomitus

      The colour, consistency and volume of the vomitus.
    • Bilious (green) vomitusSuggestive of small bowel obstruction
    • Faeculant vomitingSuggestive of intestinal obstruction
    • Regurgitation of undigested foodSuggestive of oesophageal cause
    • Partially digested foodSuggestive of gastric outlet obstruction
    • Frank blood (haematemesis)Suggestive of upper GI bleed
    • Coffee ground vomitusSuggestive of upper GI bleed
    • Projectile vomitingCharacteristic of raised ICP
    • Associated Symptoms

      Whether the nausea / vomiting is associated with any other symptoms.
    • Abdominal painNon-specific symptom of gastrointestinal cause
    • Severe abdominal pain prior to vomitingSuggestive of small bowel obstruction
    • BloatingSuggestive of gastroparesis
    • DiarrhoeaSuggestive of viral gastroenteritis
    • Headache / other neurological symptomsSuggestive of neurological cause
    • VertigoSuggestive of vestibular cause
    • Weight lossSuggestive of malignancy
    • Severity

      How long the nausea / vomiting has been going on for; frequency and number of times vomited.
    • Worst first thing in the morningSuggestive of pregnancy, alcohol intake, uraemia or raised ICP
    • Vomiting 1-2 hours after eatingSuggestive of gastric outlet obstruction
    • Vomiting during mealsSuggestive of anorexia or bulimia nervosa
    • Whether the patient has been able to keep down any fluids, and how the nausea / vomiting is affecting their daily life.
    • Sick Contacts

    • Whether any friends, family or coworkers are sick with similar symptoms.Suggestive of gastroenteritis, particularly viral
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Associated Diseases
BETA

Ear, Nose & Throat
Endocrinology
Gastrointestinal
Gut
Gastric & Small Bowel
Hepatobiliary
Pancreatic
Neurological
Nutrition & Metabolic
Psychiatry
Renal & Urinary
Other
Cardiovascular
Non-ST Elevation Acute Coronary Syndrome
Drug and Alcohol
Infectious Diseases
Viral Hepatitis
Obstetrics & Gynaecology
Oncology
CNS Cancers
Respiratory
Neurological

Associated Drugs
BETA

Neurologic
Triptans
Cholinesterase Inhibitors
Anticonvulsants
Migraine Prophylaxis
Parkinson’s Disease Medications
Other
Anaesthetics
Ketamine
Psychiatry
Doxepin
Respiratory
Leukotriene Receptor Antagonists
Rheumatology
Gout Medications
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