Nausea and vomiting

Background

Nausea and Vomiting Algorithm

DDX by organ system

GI

• Peptic ulcer disease
• Obstruction
  • Adhesion
  • Small bowel obstruction/LBO
  • Gastric outlet obstruction
• Pancreatitis
• Gastroparesis
• Appendicitis
• Cholecystitis
• Cholangitis
• Acute Hepatitis
• IBD
• Intussusception
• Tumor
• Strangulated hernia
• Volvulus
• Mesenteric ischemia
• Esophageal disorders (e.g. achalasia)
• Functional disorders
  • Psychogenic
  • IBS
• Pyloric Stenosis

Neurologic

• Head injury
• CVA
• Pseudotumor
• Hydrocephalus
• Mass lesion
• Meningitis
• Migraines
• Labyrinthitis
• Meniere disease
• Motion sickness
• Cannabinoid hyperemesis syndrome

Infectious

• Bacterial toxins
• PNA
• SBP
• UTI
• Viruses (adeno, norwalk, rota

Drugs/Toxins

• Toxic doses
  • Digoxin
  • ASA
  • APAP
• NSAIDs
• Opiates
• ETOH
• Anticonvulsants
• Abx
• Antiarrhythmics
• Toxins
  • Organophosphates
  • CO
  • Ricin

Endocrine

• Pregnancy
• Hyponatremia
• Adrenal insufficiency
• DKA
• Thyroid/parathyroid disorders
• Uremia

Miscellaneous

• ACS
• Gonadal torsion
• Nephrolithiasis
• Pain
• Acute glaucoma
• Anorexia/bulimia
• Depression

DDx by Severity

Critical

• Boerhaave's
• Ischemic bowel
• ICH
• Meningitis
• DKA
• AMI
• Sepsis

Emergent

• Gastric outlet obstruction
• Pancreatitis
• Cholecystitis
• Bowel obstruction/ileus
• Ruptured viscus
• Appendicitis
• Peritonitis
• Migraine
• CNS tumor
• raised ICP
• Adrenal insuffciency
• Hyperemesis gravidarum
• Tylenol
• Digoxin
• ASA
• Theophyline
• Gonadal torsion
• CO
• Electrolyte Disorders

Nonemergent

• Gastritis
• Gastroparesis
• PUD
• Gastroenteritis
• Biliary colic
• Hepatitis
• Thyroid
• Pregnancy
• Erythromycin
• Ibuprofen
• Chemotherapy
• Narcotics/wdwl from
• ETOH
• UTI
• Renal colic
• Motion sickness
• Labyrinthitis

Diagnosis

Work-Up

• CBC
• Chemistry
• Urine pregnancy
• LFTs
• Lipase
• APAP, ASA, digoxin levels
• UA
• ?Abd xray
• ?CT
• ?US

Complications

• Hypovolemia
• Metabolic alkalosis
• Hypokalemia
• Mallory-Weiss (tear)
• Boerhaave (rupture)
• Aspiration

See Also

• Nausea and vomiting (peds)