Definition
• The sensation of or act of ejecting stomach contents through the mouth
Approach
• Common sxs of many dz processes (eg, intra-abdominal dz, metabolic derangements, toxic ingestions, neurologic dz)
• Careful attention to ROS, PMH, previous abdominal surgeries
• Labs: Consider CBC, BMP, UA, LFTs, lipase, hCG
• Treat underlying cause: Antiemetics (eg, ondansetron, promethazine), IVF if not taking PO
Gastroenteritis
Definition: Irritation of the GI tract causing vomiting AND diarrhea usually caused by infections (viruses, bacteria, bacterial toxins, parasites) or due to medications or diet
History: Vomiting AND diarrhea, ±fever
Physical Findings: nl exam or mild diffuse abdominal ttp, tachycardia, dehydration
Evaluation: Consider BMP if clinical concern for significant electrolyte derangement
Management: Supportive care, antiemetics. IVF if not taking PO. Home when tolerating PO.
Pearl: Viral & bacterial toxins (food poisoning) are most common & typically resolve w/o tx in 48 h
Hyperemesis Gravidarum
Definition: Nausea & vomiting that result in weight loss or failure to gain weight
History: Pregnancy (1st trimester, usually week 8–12), nausea, vomiting, inability to PO
Physical Findings: Tachycardia, dehydration
Evaluation: Labs: Electrolytes, UA; often have ketosis & electrolyte derangements
Treatment: IV fluids (w/ dextrose), antiemetics (ondansetron, metoclopramide), Vit B6
Disposition: Home if tolerating PO