Vomiting and Nausea

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of ‍nausea and vomiting

Vomiting episodes occurred ‍ times ‍per dayoverall

Vomitus contains ‍undigested foodbileblood

Occurs most frequently during the ‍dayafter meals

Worsening factors: ‍none

Alleviating factors: ‍none, ‍effectiveineffective



Associated symptoms: *Try using right-click for negatives*

‍abdominal pain, ‍diffuse, ‍dull, ‍mild

‍diarrhea, ‍ episodes ‍per day, ‍

‍constipation

‍changes in bowel habits

‍bloating

‍dysphagia

‍heartburn

‍dyspepsia

‍loss of appetite

‍weight loss, ‍ ‍lbskg over ‍ ‍weeksmonths, ‍unintentionalintentional

‍fever, up to ‍°, over ‍ ‍hoursdays

‍chills

‍dehydration signs

‍headache, ‍diffuse, ‍persistentintermittent, ‍pressurethrobbing, ‍mild

‍vertigo

‍anxiety



Contributing factors:

‍contact with sick individuals

‍recent travel

‍untreated water drinking

‍suspected food poisoning

‍undercooked meat

‍heavy use of cannabis

no history of: ‍migraine, ‍peptic ulcer disease, ‍gastroesophageal reflux disease, ‍pancreatitis, ‍biliary colics, ‍pregnancy

no use of: ‍antibiotics, ‍chemotherapy, ‍new medication





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

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

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍guarding, bowel sounds ‍normal, ‍, ‍CVA tenderness ‍

Anorectal: DRE ‍normal, prostate ‍normal, ‍blood, ‍mass, anus ‍

Extremities: ‍warm, ‍dry, cap refill ‍< 3> 3 sec, pulses ‍intact, ‍edema ‍bilaterally, ‍

Neurologic: cranial nerves ‍intact, strength ‍intact 5/5, sensation ‍intact, reflexes ‍intact 2+, cerebellar function ‍intact, gait ‍steady





ASSESSMENT:

‍Viral gastroenteritis ‍likelysuspectedpossible

DDx: viral gastroenteritis, food poisoning, appendicitis, gastritis, GERD, pyloric stenosis, small bowel obstruction, urinary tract infection, concussion, intracranial pressure, metabolic disorders, medication side effects, toxin exposure, motion sickness, migraine, intussusception, pancreatitis, diabetic ketoacidosis, adrenal insufficiency, sepsis, meningitis, COVID-19, psychogenic vomiting, cannabinoid hyperemesis syndrome





PLAN:

Investigations:

- 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

Treatments:

- 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)

Further care:

- Referral to gastroenterologist

- Follow-up in ‍ ‍daysweeks

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