Nausea, Vomiting, Indigestion

Question 0

Causes of nausea and vomiting

Answer 0

Causes: conditions within and outside the gut as well as by drugs and circulating toxins

INTRAPERITONEAL
A. Obstructing disorders 
Pyloric obstruction
Small bowel obstruction
Colonic obstruction
Superior mesenteric artery syndrome

B. Enteric infections Viral Bacterial

C. Inflammatory diseases
Cholecystitis
Pancreatitis
Appendicitis
Hepatitis

D. Altered sensorimotor function
Gastroparesis
Intestinal pseudoobstruction
Gastroesophageal reflux
Chronic idiopathic nausea
Functional vomiting
Cyclic vomiting syndrome

E. Biliary colic
F. Abdominal irradiation

EXTRAPERITONEAL
A. Cardiopulmonary disease
Cardiomyopathy
Myocardial infarction

B. Labyrinthine disease
Motion sickness
Labyrinthitis
Malignancy

C. Intracerebral disorders
Malignancy
Hemorrhage
Abscess
Hydrocephalus

D. Psychiatric illness
Anorexia and bulimia nervosa
Depression

E. Postoperative vomiting

MEDICATIONS/METABOLIC DISORDERS
A. Drugs Cancer chemotherapy
Antibiotics
Cardiac antiarrhythmics
Digoxin
Oral hypoglycemics
Oral contraceptives

B. Endocrine/metabolic disease
Pregnancy
Uremia
Ketoacidosis

C. Thyroid and parathyroid disease
Adrenal insufficiency

D. Toxins
Liver failure
Ethanol

Question 1

Differentiate

a. Nausea
b. Vomiting
c. Regurgitation
d. Rumination
e. Indigestion

Answer 1

Nausea is the subjective feeling of a need to vomit

Vomiting (emesis) is the oral expulsion of gastrointestinal contents resulting from contractions of gut and thoracoabdominal wall musculature.

Regurgitation is the effortless passage of gastric contents into the mouth.

Rumination is the repeated regurgitation of stomach contents, which may be rechewed and reswallowed. In contrast to vomiting, these phenomena often exhibit volitional control.

Indigestion is a nonspecific term that encompasses a variety of upper abdominal complaints including nausea, vomiting, heartburn, regurgitation, and dyspepsia (the presence of symptoms thought to originate in the gastroduodenal region).

Question 2

Causes of Indigestion

Answer 2

a. Gastroesophageal reflux
b. Gastric motor dysfunction
c. Visceral afferent hypersensitivity
d. Helicobacter pylori

Question 3

DDX for Indigestion/Dyspepsia

Answer 3

a. GERD
b. Functional dyspepsia:
≥3 months of bothersome postprandial fullness, early satiety, or epigastric pain or burning with symptom onset at least 6 months before diagnosis in the absence of organic cause
c. Ulcer disease
d. Malignancy
e. Others:
-Opportunistic fungal or viral esophageal infections
-Intestinal lactase deficiency produces gas, bloating, discomfort, and diarrhea after lactose ingestion
-Pancreatic disease (chronic pancreatitis and malignancy), hepato- cellular carcinoma, celiac disease, Ménétrier’s disease, infiltrative diseases (sarcoidosis and eosinophilic gastroenteritis), mesenteric ischemia, thyroid and parathyroid disease, and abdominal wall strain cause dyspepsia
-Extraperitoneal etiologies of indigestion include congestive heart failure and tuberculosis.

Question 4

Alarm Symptoms in GERD

Answer 4

Odynophagia
Unexplained weight loss
Recurrent vomiting
Occult or gross gastrointestinal bleeding
Jaundice
Palpable mass or adenopathy
Family history of gastrointestinal malignancy

*Odynophagia suggests esophageal infection, while dysphagia is worrisome for a benign or malignant esophageal blockage.