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

Differential DiagnosisNausea 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 VomitingIntraperitonealExtraperitonealMedications/Metabolic DisordersObstructingCardiopulmonaryDrugsdisordersdiseaseCancer chemotherapyPyloric obstructionCardiomyopathyAntibioticsMyocardial Small obstruction Labyrinthine Colonic obstruction Motion sickness disease bowel infarctionCardiac antiarrhythmicsDigoxinOral hypoglycemicsOral contraceptives Superior Labyrinthitis mesenteric syndrome artery Malignancy Endocrine/metabolic diseaseEnteric infectionsIntracerebral disordersPregnancyViral Malignancy Bacterial Hemorrhage Inflammatory diseases AbscessUremiaKetoacidosisThyroid parathyroid diseaseandCholecystitisHydrocephalusAdrenal insufficiency ...
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Chapter 039. Nausea, Vomiting, and Indigestion (Part 2) Chapter 039. Nausea, Vomiting, and Indigestion (Part 2) Differential Diagnosis Nausea and vomiting are caused by conditions within and outside the gut aswell as by drugs and circulating toxins (Table 39-1). Table 39-1 Causes of Nausea and Vomiting Intraperitoneal Extraperitoneal Medications/Metabolic Disorders Obstructing Cardiopulmonary Drugsdisorders disease Cancer chemotherapy Pyloric Cardiomyopathy Antibioticsobstruction Myocardial Cardiac Small bowel infarction antiarrhythmicsobstruction Labyrinthine Digoxin Colonic disease Oral hypoglycemicsobstruction Motion sickness Oral contraceptives Superior Labyrinthitismesenteric artery Endocrine/metabolicsyndrome Malignancy disease Enteric infections Intracerebral Pregnancy disorders Viral Uremia Malignancy Bacterial Ketoacidosis Hemorrhage Inflammatory Thyroid anddiseases Abscess parathyroid disease Cholecystitis Hydrocephalus Adrenal insufficiency Pancreatitis Psychiatric Toxins illness Appendicitis Liver failure Anorexia and Hepatitis Ethanol bulimia nervosa Altered Depressionsensorimotor function Postoperative Gastroparesis vomiting Intestinalpseudoobstruction Functionaldyspepsia Gastroesophagealreflux Chronicidiopathic nausea Functionalvomiting Cyclic vomitingsyndrome Biliary colic Abdominalirradiation Intraperitoneal Disorders Visceral obstruction and inflammation of hollow and solid viscera mayproduce vomiting as the main symptom. Gastric obstruction results from ulcerdisease and malignancy, while small-bowel and colonic obstruction occur becauseof adhesions, benign or malignant tumors, volvulus, intussusception, orinflammatory diseases such as Crohns disease. The superior mesenteric arterysyndrome, occurring after weight loss or prolonged bed rest, results when theduodenum is compressed by the overlying superior mesenteric artery. Abdominalirradiation impairs intestinal contractile function and induces strictures. Biliarycolic causes nausea via action on visceral afferent nerves. Vomiting withpancreatitis, cholecystitis, and appendicitis is due to localized visceral irritationand induction of ileus. Enteric infections with viruses or bacteria such asStaphylococcus aureus and Bacillus cereus are common causes of acute vomiting,especially in children. Opportunistic infections such as cytomegalovirus or herpessimplex virus induce emesis in immunocompromised individuals.