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Nausea
Define Symptom:
> Unpleasant sensation of impending vomiting
> A/w
>> Hyper-salivation (water brash)
>> Sweating
>> Anxiety
Vomiting/Emesis
Define Symptom:
Forceful expelling of intestinal contents via mouth
> Type of Reverse esophageal motility
Regurgitation
Define Symptom:
Effortless and spontaneous reflux of gastric contents into or out through the mouth
> Type of Reverse esophageal motility
Rumination
Define Symptom:
Repetitive effortless regurgiation of recent ingested food into mouth, followed by re-chewing and re-swallowing
> Functional Disorder
> Type of Reverse esophageal motility
Vomiting Center
What part in the brainstem (specifically in the Medulla Oblongata) triggers vomiting?
Brainstem Activation d/t Pregnancy, Toxins, Meds, or Metabolic Disorders
Morning vomiting on an empty stomach implies what cause?
Surgery
Bilious vomiting may often happen after what?
Intestinal Obstruction
Feculent vomiting implies what cause?
Bowel Obstruction
Abdominal Distenstion + Abdominal Tenderness + Vomiting hours after eating all imply what cause?
Vestibular/Middle Ear Issue
N/V + Nystagmus + Vertigo imply what cause?
Intracranial event
Abrupt vomiting WITHOUT NAUSEA implies what cause?
> Sepsis signs (Fever, Tachycardia, Hypotension + elevated WBCs)
> Hematemesis
> Melena
> Hematochezia
> Abd guarding, rebound tenderness
> Imaging (free air, obstruction)
> Acute Renal Failure
What are ALARM Sx that may accompany N/V?
Mallory-Weis Tear
Identify this complication of N/V:
Mucosal Tear at EG Junction
Boerhaaves Syndrome
Identify this complication of N/V:
Trans-mucosal tear with perforation
**CATASTROPHIC**
-PE:
> Subcutaneous crepitus
> Emphysema
-Dx: (CXR)
> Free air in mediastinum
> Malnutrition
> Fluid/Electrolyte & Metabolic Alterations
> Aspiration Pneumonia
What are some other complications of N/V?
Acute Vomiting
Identify the Sx you are Assessing:
-Possible Causes/Hx:
> Infex (Pancreatitis)
> Post-Op
> Neuro (Migraine, Meningitis, Middle Ear issues)
> Gastric Outlet Obstruction (ulcers, malignancies)
> Intestinal obstruction (bowel ischemia, neoplasia, adhesions)
> Organ Perforation
> Toxins
-Labs:
> CBC
> CMP
> Lipase
-Imaging:
> KUB
> Abd US
> CT
-Concerns:
> Shock
> Hypotension
> Dehydration
Pregnancy
What should be r/o with Acute Vomiting?
Gastroparesis
Define Condition causing N/V:
Type of Motility Disorder in which stomach becomes "paralyzed"
-Hx:
> MC = Idiopathic or Diabetes
> Meds
>> Opiates
>> Anti-Cholinergics
>> Dopamine agonists
>> Cannabinoid agonists
>> Glucagon-like peptide agonists
> Past Surgery
> CTDs
> Vascular Disorders
> Malignancy
> Radiation
> Other (Previous Infex, Endocrine Disorders, Neuro Disorders, Chronic Pancreatitis)
Cannabinoid Hyperemesis Syndrome
Define Condition:
-Hx:
> Regular Marijuana use
-Sx:
> Abdominal pain & Regular Nausea/Vomiting (Sx relieved w/ hot baths and showers)
-Dx: (+) Drug Screen
-Tx: Cessation of THC
Cyclic Vomiting Syndrome (CVS)
Define Condition:
Clustered, recurrent episodes of N/V - Asx btwn episodes
-Hx:
> White Males
> Hx of FHx of Migraines
-Sx:
> Episodes < 1 wk
Functional Vomiting
Define Condition:
Vomtiing x1/w for 3 mo - Dx of Exclusion
-Hx:
> Onset = 6 mo prior
-Sx:
> Heartburn
> Regurgitation