Nausea

Nausea, a common symptom experienced by many individuals, can be caused by a wide range of factors and its management depends on identifying the underlying cause. Here’s a comprehensive overview:

Causes of Nausea:

  • Gastrointestinal Disorders: Such as gastroenteritis, gastritis, peptic ulcer disease, GORD.
  • Central Nervous System Causes: Including migraine, vertigo, and brain injuries or tumors.
  • Medication Side Effects: Chemotherapy, antibiotics, NSAIDs, opioid analgesics.
  • Metabolic and Endocrine Disorders: Like diabetic ketoacidosis, hypercalcemia, uremia.
  • Pregnancy: Especially during the first trimester, known as morning sickness.
  • Psychogenic Causes: Anxiety, bulimia, anorexia nervosa.
  • Infections: Viral, bacterial, or parasitic infections, particularly those affecting the gastrointestinal system.
  • Motion Sickness: Caused by repeated motion such as waves or spinning.

Diagnosis:

  • History:
    • Onset and Duration: Acute vs. chronic nausea.
    • Associated Symptoms: Vomiting, diarrhea, abdominal pain, fever, headache, dizziness.
    • Medication History: Recent changes or initiation of new medications.
    • Dietary History: Recent food intake, alcohol or toxin exposure.
    • Travel History: Exposure to new environments or infectious agents.
    • Pregnancy Status: In women of childbearing age.
  • Physical Examination:
    • General Examination: Signs of dehydration, jaundice, weight loss.
    • Abdominal Examination: Tenderness, distension, bowel sounds.
    • Neurological Examination: Focal neurological deficits, signs of increased intracranial pressure.
    • ENT Examination: For vertigo-related causes.
  • Investigations:
    • Laboratory Tests: CBC, electrolytes, liver and renal function tests, pregnancy test.
    • Imaging: Abdominal ultrasound or CT scan, brain imaging if CNS pathology is suspected.
    • Endoscopy: If GI pathology is suspected and not elucidated by imaging.

Differential Diagnosis (DDx):

  • Gastroenteritis
  • Migraine or Headache Disorders
  • Appendicitis
  • Pancreatitis
  • Cholecystitis
  • Meniere’s Disease
  • Acute Intoxication or Withdrawal
  • Psychogenic Causes like Anxiety

Management:

  • Identifying and Treating the Underlying Cause: E.g., antibiotics for infection, discontinuation of offending medications.
  • Symptomatic Relief: Antiemetics like ondansetron, metoclopramide, or prochlorperazine
  • Dietary Modifications: Small, frequent meals, avoiding fatty or spicy foods.
  • Hydration: Oral rehydration solutions or IV fluids in severe cases.
  • Lifestyle Modifications: For causes like GORD or motion sickness.
  • Alternative Therapies: Acupuncture, ginger supplements.
  • Psychotherapy: If the cause is psychogenic.
  • Regular Monitoring: For chronic conditions or in cases where treatment may have significant side effects.

Referral:

  • Specialist Referral: Gastroenterologist, neurologist, or endocrinologist based on suspected underlying condition.
  • Emergency Referral: If signs of dehydration, significant electrolyte imbalances, or suspected serious conditions like appendicitis.

In all cases, the approach to nausea should be individualized, considering the patient’s overall health status, the likelihood of specific causes, and the response to initial treatment interventions.