Nausea, having to the uncomfortable feeling vomit, consists in the awareness of afferent stimuli (incl. An increased parasympathetic tone) to the medullary vomiting center. Vomiting is the powerful ejection of the stomach contents caused by the involuntary contraction of abdominal muscles while the gastric fundus and the lower esophageal sphincter are relaxed.

(Nausea and vomiting in infants and children is discussed elsewhere.) Nausea, the uncomfortable feeling of having to vomit, is in the awareness of afferent stimuli (incl. An increased parasympathetic tone) to the medullary vomiting center. Vomiting is the powerful ejection of the stomach contents caused by the involuntary contraction of abdominal muscles while the gastric fundus and the lower esophageal sphincter are relaxed. Vomiting must be distinguished from regurgitation, the regurgitation of gastric contents without associated nausea or forceful contraction of the abdominal muscles. Patients with achalasia, Ruminationssyndrom or a Zenker’s diverticulum may regurgitate undigested food without nausea. Complications Severe vomiting (typically a metabolic alkalosis with hypokalemia) or rarely to partially (Mallory-Weiss) or complete (Boerhaave syndrome) lead to symptomatic dehydration and electrolyte imbalance crack the esophagus. Chronic vomiting leading to malnutrition, weight loss and metabolic disorders. Etiology nausea and vomiting occur in response to events that affect the vomiting center on. The causes may lie in the gastrointestinal tract or in the CNS or result from a number of systemic conditions (see table: Some causes of nausea and vomiting). The most common causes of nausea and vomiting are: gastroenteritis drug toxins Cyclic vomiting (cyclic vomiting syndrome, CVS) is rare, it is characterized by severe, regardless occurring bouts of vomiting, sometimes just bouts of nausea that at varying intervals with completely symptom-free interim periods and occur without demonstrable structural changes. in childhood, it is most common (mean age 5 years) and decreases in adulthood. Cyclic vomiting in adults is often associated with chronic marijuana (cannabis) consumption. Some causes of nausea and vomiting cause suspicious findings * Diagnostic procedure Gastrointestinal disorders intestinal obstruction constipation, flatulence, bloat often bilious vomiting, surgical scars on the abdomen or inguinal hernia abdominal plain in lying and upright position gastroenteritis vomiting, diarrhea abdominal examination Clinical examination Gastroparesis or ileus vomiting of partially digested food a few hours after admission often in diabetics or after abdominal surgery abdominal plain in lying and upright position Plätschergeräusch hepatitis Mild to moderate nausea over many days, sometimes vomiting jaundice, loss of appetite, malaise Sometimes slight tenderness of the liver, serum aminotransferase, bilirubin, viral Hepatitistiter Perforated intestine or acute abdomen (eg. As appendicitis, cholecystitis, pancreatitis) Excessive abdominal pain usually signs of peritoneal irritation Acute abdomen pain intoxication (numerous) Usually obvious in the history Varies with substance CNS disorders Closed brain trauma Obviously, because of the history of Skull CT CNS bleeding sudden onset of headache, changes through nts of mental status often meningeal symptoms CT scan lumbar puncture when CT findings are without CNS infection Gradual onset of headache often meningeal symptoms, changes in mental status, if necessary petechial rash * due to meningococcemia Skull CT lumbar puncture Increased intracranial pressure (eg., caused by a hematoma or a tumor) headache, change in mental status Sometimes focal neurological deficits Skull CT labyrinthitis vertigo, nystagmus, symptoms worsen with movement Sometimes tinnitus dizziness (dizziness) and dizziness (vertigo) migraine headaches sometimes go a neurological aura or photophobia vo out or which often accompanies similar recurrent attacks in the history in patients with known migraine is a development of other CNS disorders possible Clinical examination In unclear examination findings CT scan and lumbar puncture should be taken into account sickness Obviously, based on history Clinical examination psychogenic disorders occurs in conjunction with stress on intake of food repugnant Clinical investigation Systemic conditions Advanced cancer Obviously Diabetic (regardless of chemotherapy or bowel obstruction) due to the history Clinical examination ketoacidosis polyuria, polydipsia often considerable dehydration with or without diabetes in the history of serum glucose, electrolytes, ketones Adverse drug effects or intoxication Obviously, based on history Varies with substance liver or kidney failure Often obviously based on history often jaundice in advanced liver disease, uremic smell in renal laboratory tests of liver and kidney function pregnancy often occurring in the morning or triggered by foods Benign investigation (possibly dehydration) pregnancy test radiation exposure Obviously, based on history Clinical examination severe pain (eg. For example, by a kidney stone) Varies with cause Clinical examination * Sometimes leads severe vomiting (caused by a disorder or disease) to petechiae on the upper body and face, which may resemble those with meningococcemia. Patients with meningococcemia are very ill, while those against it have with vomiting caused by petechiae a good general condition generally. Clarification of history, the history of existing disease should query frequency and duration of vomiting, which related to possible triggers such as taking medication or the ingestion of toxins, head injuries and movement (eg. As car, plane, boat rides) and whether the (bitter, yellow-green) or blood (red or coffee-ground-like material) contained vomit bile. Important associated symptoms include abdominal pain and diarrhea, the last stools and bloating as well as headaches and dizziness, or both. The examination of the body systems research for signs of underlying disorders such as amenorrhea and swelling of the breasts (pregnancy), polyuria and polydipsia (diabetes) and hematuria and flank pain (kidney stones). The history should known causes such as pregnancy, diabetes, migraines, liver or kidney disease, cancer (including the timing of chemotherapy or radiation) and previous abdominal surgery (the intestinal obstruction due to adhesions cause) determined. All recently ingested drugs and substances should be obtained; certain substances show their toxicity until several days after ingestion (z. B. paracetamol, some fungi). Repeated vomiting in the family history should observe werden.Körperliche investigation In the investigation of vital signs should be paid special attention to the presence of fever and signs of hypovolemia (z. B. tachycardia, hypotension, or both). The general examination should look for signs of jaundice and rash. In the examination of the abdomen, the doctor should pay attention to a bloated abdomen and surgical scars; He should assess presence and quality of bowel sounds (eg. as normal, high tones) and examine using the percussion to bloat as well as tenderness, Peritonitiszeichen (z. B. guarding, hardened abdominal wall and knocking pain) and masses, organ enlargement or hernias scan. Rectal and gynecological (in women) investigation are essential to locate tenderness, masses and bleeding. The neurological examination should pay particular attention to the mental state of nystagmus, meningism (z. B. neck stiffness, Kernig characters or brudzi?ski’s sign) and ocular symptoms of increased intracranial pressure (eg. As papilledema, the lack of venous pulse, paralysis the third cranial nerve) or subarachnoid hemorrhage (retinal bleeding) .Warnhinweise the following findings are of particular importance: a sign of hypovolemia headache, stiff neck or changes in mental status signs of peritoneal irritation Bloated, tympanitic belly interpretation of the findings Many findings indicate a cause or a group of causes (see table: Some causes of nausea and vomiting). Vomiting that occurs shortly after the medication or the ingestion of toxins or exposure to movements in a patient with otherwise bland neurological and abdominal findings can be confidently attributed to these causes, as well as vomiting in a woman with a known pregnancy and inconspicuous examination findings , Acute and accompanied by diarrhea vomiting is most likely due to an infectious gastroenteritis in an otherwise healthy patients with no abnormalities in the investigation; further investigation may be postponed. Vomiting that occurs or at the thought of food does not temporally correlated with food intake, suggests a psychogenic cause, as well as the presence of functional nausea and vomiting in the personal or family history. Patients should be closely questioned about gaps with possible links between the vomiting and stressful episodes, because it is possible that they do not recognize this association or not to admit disgust in these situations to empfinden.Testverfahren In women of childbearing age is carried out a pregnancy test in the urine. In patients with severe vomiting, vomiting, which consists more than a day, or signs of dehydration other laboratory diagnostics is performed (z. B. electrolytes, urea, creatinine, glucose, urine analysis, possibly liver function tests). In patients with suspicious findings should symptoms proper investigations are carried out (see Table: Some causes of nausea and vomiting). The evaluation of chronic vomiting also typically includes a laboratory tests listed above and the endoscopic examination of the upper GIT, X-ray examinations of the small intestine and tests for the detection of gastric emptying and the motility antralduodenalen. Specific treatment conditions such as dehydration treatment. But even without the presence of significant dehydration i.v. leads Fluid administration (0.9% saline or 1 l 20 ml / kg in children) is often an improvement in symptoms. In adults, different antiemetics are effective (see table: some medicines for vomiting). The choice of the agent will vary somewhat with the cause and severity of symptoms. A typical application is as follows: sickness: antihistamines, Scopolaminpflaster or both Mild to moderate symptoms: prochlorperazine or metoclopramide Heavy or refractory vomiting and vomiting associated with chemotherapy: 5-HT3 antagonists course at actively vomiting patient parenterally administered drugs should be used. In psychogenic vomiting a soothing therapy indicates to the patient that you take his suffering serious and has the desire to achieve an improvement in symptoms, regardless of their cause. Comments like “everything is fine” or “Your problem is emotional” should be avoided in any case. The attempt at a short symptomatic treatment with antiemetics can be made. Is a long-term treatment necessary supporting regular office visits may be helpful in solving the underlying problem. Some medications for vomiting drug Usual dose Comments antihistamines dimenhydrinate 50 mg p.o. every 4-6 h Used to treat vomiting labyrinthine origin (z. B., motion sickness, labyrinthitis) meclizine 25 mg p.o. every 8 h 5-HT3 antagonists dolasetron 12.5 mg i.v. upon the occurrence of nausea and vomiting is used to treat severe or refractory vomiting or vomiting in chemotherapy Possible side effects: constipation, diarrhea, abdominal pain granisetron 1 mg po or iv 3 times daily. Ondansetron 4-8 mg p.o. or iv every 8 h palonosetron for the prophylaxis: 0.25 mg i.v. as a single dose 30 min Aprepitant 125 mg p.o. before chemotherapy Other drugs 1 hour prior to chemotherapy treatment on Day 1, then 80 mg p.o. When applied daily in the morning on days 2 and 3 with ondansetron 32 mg iv 30 min, when applied with dexamethasone before chemotherapy on day 1, 12 mg p.o. 30 min p.o. before chemotherapy on day 1 and 8 mg Employed daily in the morning on days 2, 3 and 4 at highly emetogenous chemotherapy regimens Possible side effects: po drowsiness, fatigue, hiccups metoclopramide 5-20 mg or iv 3 to 4 times daily. Serves as initial therapy for mild vomiting perphenazine 5-10 mg i.m. or 8-16 mg p.o. . Daily in divided doses, the maximum dose is 24 mg / day – prochlorperazine 5-10 mg i.v. or 25 mg rectally – scopolamine patch containing 1 mg is taken up to 72 hours is used to treat motion sickness Possible side effects: decreased sweating, dry skin Key Points Many episodes have an obvious cause, are benign in nature and require only symptomatic treatment. Alarming are signs of an acute abdomen or significant intracranial disease. In women of childbearing age is always thinking about getting pregnant.

Health Life Media Team

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