Nausea and Vomiting

Question 1

With regards to nausea and vomiting, what factors is it important to identify in the history?

Answer 1

• Relation to meals and timing
• Associated symptoms e.g. dyspepsia and abdominal pain
  
  • Is the abdominal pain relieved by vomiting?
• Appearance e.g. bile-stained, blood-stained or faeculent
• Associated weight loss
• Patient medications

Question 2

How does dyspepsia present?

Answer 2

Epigastric pain or burning, early satiety and post-prandial fullness, belching, bloating, nausea, or discomfort in the upper abdomen.

Vomiting is not present.

Question 3

How does obstuction distal to the pylorus present?

Answer 3

Bile-stained vomit

Question 4

How does pyloric stenosis present?

Answer 4

Projectile vomiting of large volumes of gastric content that is not bile-stained.

Question 5

What may cause faeculent vomiting of small bowel contents?

Answer 5

Late feature of distal small bowel or colonic obstruction

Question 6

Give examples of various causes of vomiting

Answer 6

• Gastroenteritis
• Cholecystitis
• Pancreatitis
• Hepatitis

Question 7

Give examples of non-GI related causes of nausea and vomiting

Answer 7

• Drugs e.g. alcohol, opioids, digoxin, cytotoxic agents and anti-depressants
• Pregnancy
• DKA
• Renal or liver failure
• Hypercalcaemia
• Addison’s disease
• Raised intracranial pressure e.g. meningitis or brain tumour)
• Vestibular disoirders (e.g. labrythinitis or Meniere’s disease)