An overview of the etiologies and evaluation of an adult patient presenting with nausea and vomiting for 1 week or less. Included is a brief overview of the physiology of the vomiting reflex. #ClinicalReasoning #MedicalSchool #Nausea
A few notes: Although this is verbally mentioned in the video, it might not be clear from the on-screen diagnostic algorithm viewed in isolation: A relatively healthy patient who presents with acute nausea & vomiting, but who has an unremarkable physical exam, normal or near normal metabolic panel (and negative pregnancy test, if relevant), and whose only other symptom is modest epigastric or generalized abdominal pain, may not require any additional work-up at all: food poisoning or viral gastroenteritis are the likely etiologies here, both of which are self-limited and require supportive care only (e.g. hydration, antiemetics). As pointed out by viewer, Dr. Peter Johns, @<a href="#" class="seekto" data-time="894">14:54</a>, the Dix Hallpike maneuver should be reserved for patients whose vertigo and nausea is elicited by head movement but who do *not* have nystagmus at rest. Apologies for the confusion. Also, whenever I refer to "women of reproductive age" (or use a similar phrase), I'm referring to individuals with a uterus/ovaries/vagina - acknowledging that not all individuals in this category identify as women, or have an externally feminine appearance or feminine gender expression. An Approach to Chronic Nausea and Vomiting will be posted next week.
I can't believe that I was searching for this topic today and coincidently I found this video uploaded 2 hours ago..... I like you Dr This is a great channel that make medicine easy to follow and approach
Loved your approach, as always. A relevant toxin that you could have mentioned was marijuana. Cannabinoid vomiting syndrome is becoming more relevant, even if only from its bigger attention since MJ legalization. Also, I'd add migraines as a noteworthy cause. Many times patients will endorse nausea/vomiting as their chief complaint rather than the headache, either because it's more bothersome or that they're so used to having headaches that they don't link the two symptoms together.
Thanks for the comment! I have both cannabis hyperemesis syndrome and migraines in my chronic/episodic nausea and vomiting video, hoping getting posted in a few days.
Thank you so much all your videos are very informative and helpful Regarding nausea and vomiting one of most cause in practice is UTI W/or w/o renal stone Urine analysis should be included even without urology symptoms
As always a very informative and well researched video - thanks Doc. As a Paramedic I have found in my practice that Cannabinoid Hyperemesis Syndrome (CHS) is becoming a lot more prevalent. A bit of a giveaway is that most of these patients are located under a hot shower when arriving on scene. They all report that this is the only home treatment that helps.
I never even heard of it until 4-5 years ago, and then didn't see my first patient admitted to the hospital with it until this past year. I'd hypothesize an anecdotal uptick in cases here in the US is due to widespread legalization, but supposedly it's most common in people who've been heavy users for many years. Maybe just increased awareness & recognition? IDK. ¯\_(ツ)_/¯
The only utility that I've found of bilious vs non-bilious vomiting is in hematochezia. If there is bilious vomiting in that setting you can be sure that the bleeding is not from an upper GI source and forego the PPIs and upper endoscopies and whatnot. Otherwise, I think its only purpose is for gensurg attendings have one more thing to criticize about the medical student's presentation.
If mnemonics work well for you, think GRAPES for your ddx: GI (SBO, proximal mouth to anus inflammation and accessory organ inflammation - namely HPB) ; Rx ; ACS ; Pregnant ; Ears ; Substance abuse
