Chapter 039. Nausea, Vomiting, and Indigestion (Part 2) potx

Nausea, Vomiting, and Indigestion Part 2 Differential Diagnosis Nausea and vomiting are caused by conditions within and outside the gut as well as by drugs and circulating toxins Tabl

Chapter 039 Nausea, Vomiting,

and Indigestion

(Part 2)

Differential Diagnosis

Nausea and vomiting are caused by conditions within and outside the gut as well as by drugs and circulating toxins (Table 39-1)

Table 39-1 Causes of Nausea and Vomiting

Intraperitoneal Extraperitoneal Medications/Metabolic

Disorders

Obstructing Cardiopulmonary Drugs

disorders

Pyloric

obstruction

Small bowel

obstruction

Colonic

obstruction

Superior

mesenteric artery

syndrome

Enteric infections

Viral

Bacterial

Inflammatory

diseases

Cholecystitis

disease

Cardiomyopathy

Myocardial infarction

Labyrinthine disease

Motion sickness

Labyrinthitis

Malignancy

Intracerebral disorders

Malignancy

Hemorrhage

Abscess

Hydrocephalus

Cancer chemotherapy

Antibiotics

Cardiac antiarrhythmics

Digoxin

Oral hypoglycemics

Oral contraceptives

Endocrine/metabolic disease

Pregnancy

Uremia

Ketoacidosis

Thyroid and parathyroid disease

Adrenal insufficiency

Pancreatitis

Appendicitis

Hepatitis

Altered

sensorimotor function

Gastroparesis

Intestinal

pseudoobstruction

Functional

dyspepsia

Gastroesophageal

reflux

Chronic

idiopathic nausea

Functional

vomiting

Psychiatric illness

Anorexia and bulimia nervosa

Depression

Postoperative vomiting

Toxins

Liver failure

Ethanol

Cyclic vomiting

syndrome

Biliary colic

Abdominal

irradiation

Intraperitoneal Disorders

Visceral obstruction and inflammation of hollow and solid viscera may produce vomiting as the main symptom Gastric obstruction results from ulcer disease and malignancy, while small-bowel and colonic obstruction occur because

of adhesions, benign or malignant tumors, volvulus, intussusception, or inflammatory diseases such as Crohn's disease The superior mesenteric artery syndrome, occurring after weight loss or prolonged bed rest, results when the duodenum is compressed by the overlying superior mesenteric artery Abdominal irradiation impairs intestinal contractile function and induces strictures Biliary colic causes nausea via action on visceral afferent nerves Vomiting with pancreatitis, cholecystitis, and appendicitis is due to localized visceral irritation and induction of ileus Enteric infections with viruses or bacteria such as

Staphylococcus aureus and Bacillus cereus are common causes of acute vomiting,

especially in children Opportunistic infections such as cytomegalovirus or herpes simplex virus induce emesis in immunocompromised individuals