Acute onset of severe pain and vomiting suggests what?
+ Peritoneal irritation
+ Acute gastric or intestinal obstruction
+ Pancreaticobiliary
... [Show More] disease
(McPhee p 588)
Persistent vomiting suggests what?
+ Pregnancy
+ Gastric outlet obstruction
+ Gastroparesis
+ Intestinal dysmotility
+ Psychogenic disorders
+ CNS or systemic disorders
(McPhee p 589)
Vomiting in the morning suggests what?
+ Pregnancy
+ Uremia
+ ETOH intake
+ ↑ ICP
Vomiting after meals suggests what?
+ Bulimia
+ Peptic ulcer disease
+ Other psychogenic causes
(McPhee p 589, Shimp p 373)
Vomiting of undigested food 1-2 hours after a meal suggests what?
+ Gastroparesis
+ Small bowel obstruction
+ Gastric outlet obstruction
NOTE: Sucussion splash often heard on auscultation
(McPhee p 589, Shimp p 373)
4 causes of nausea and vomiting
1) Visceral afferent stimulation (seratonin receptors)
2) Vestibular disorders (fibers ↑ in histamine and muscarinic receptors)
3) CNS disorders
4) Irritation of chemoreceptor trigger zone
(McPhee Table 15.1)
Ways to stimulate the chemoreceptor trigger zone and cause vomiting
1) Chemo
2) Medications and drugs
3) Radiation therapy
4) Systemic disorders
CNS disorders that can cause vomiting
1) Migraine
2) ↑ ICP
3) Infections (e.g. meningitis, encephalitis)
4) Psychogenic
Vestibular disorders that can cause vomiting
Labyrinthitis, Meniere syndrome, motion sickness
Define RETCHING
Strong, spasmodic, involuntary effort to vomit without bringing up emesis.
(McPhee and Shimp)
Define REGURGITATION
Effortless return of gas or small amounts of food from stomach (McPhee and Shimp)
Common causes of vomiting in infants
1) Any acute illness (esp gastroenteritis)
2) Hypertrophic pyloric stenosis (2 - 8 weeks of life, may feel an "olive" in epigastric
area after feeding)
3) Intussisception (6 - 18 months of life, sausage-shaped mass and "currant jelly"
stools)
4) Regurgitation ("spitting up") -- usually normal and usually resolves by 6 - 12
months.
(Shimp)
Medications associated with N/V
+ Antidepressants
--SSRIs
--venlafaxine
+ Cardiac meds
--antiarrhythmics
--anti-HTN meds (diuretics, beta blockers, CCBs)
-- ↓ CHO meds (statins, gemfibrozil, niacin)
-- Digoxin
+ Chemotherapy agents
+ GI meds
--sulfasalazine (for tx of UC)
--azathioprine (tx of Crohns or UC)
+ Meds to treat infectious diseases
-- Acyclovir
-- Anti-fungals
-- ABX
-- UTI meds
-- TB meds
+ Pain meds [Show Less]