Vomiting and Nausea

HISTORY:

‍Nausea and vomiting for ‍ ‍hoursdays

Vomiting episodes: ‍ times ‍per dayoverall

Vomitus: ‍undigested foodbileblood

Worsening factors: ‍none

Treatments tried: ‍none, ‍effectiveineffective

‍abdominal pain, ‍diffuse, ‍dull, ‍mild

‍diarrhea, ‍ episodes ‍per day, ‍

‍constipation

‍changes in bowel habits

‍dyspepsia

‍loss of appetite

‍weight loss, ‍ ‍lbskg over ‍ ‍weeksmonths, ‍unintentionalintentional

‍fever, up to ‍°, over ‍ ‍hoursdays

‍chills

‍dehydration signs

‍headache

‍vertigo

‍anxiety



EXAM:

General appearance: ‍well-appearing

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Neck: ‍normallymphadenopathy

Heart: ‍RRR, ‍normal S1 and S2

Lungs: ‍clearabnormal sounds, ‍retractions

Abdomen: ‍softsemi-softtense, ‍non-tender ‍, ‍non-distended, ‍

Extremities: ‍edema, ‍warm, cap refill ‍< 3 sec> 3 sec, pulses ‍normal, ‍

Neurologic: cranial nerves ‍normal, strength ‍5/5 throughout, sensation ‍normal, reflexes ‍2+ throughout, cerebellar function ‍normal, gait ‍stable



ASSESSMENT:

‍Viral gastroenteritis ‍likelysuspectedpossible

DDx: ‍



PLAN:

- Blood work: ‍CBC, ‍electrolytes, ‍creatinine, ‍glucose, ‍LFTs, ‍lipase, ‍β-hCG

- Urinalysis

- Abdominal ultrasound

- Upper GI endoscopy

- CT scan of the abdomen

- CT scan of the head

- Dietary modifications: ‍small frequent meals, ‍avoid spicy foods, ‍avoid fatty foods, ‍avoid alcohol, ‍avoid caffeine

- Stop medications that may contribute to nausea

- ‍Antiemetics

- ‍PPIs

- ‍H2 blockers

- ‍Domperidone

- Vestibular rehabilitation exercises

- Stop cannabis (hyperemesis syndrome)

- Referral to gastroenterologist

- Follow-up in ‍ ‍daysweeks

- Return if develops persistent vomiting, weight loss, or abdominal pai