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Wikipedia

Nausea

May 12, 2023

Not to be confused with malaise.
For other uses, see Nausea (disambiguation).

Nausea is a diffuse sensation of unease and discomfort, sometimes perceived as an urge to vomit.[1] While not painful, it can be a debilitating symptom if prolonged and has been described as placing discomfort on the chest, abdomen, or back of the throat.[2]

Nausea
A 1681 painting depicting a person vomiting
SpecialtyGastroenterology

Over 30 definitions of nausea were proposed in a 2011 book on the topic.[3]

Nausea is a non-specific symptom, which means that it has many possible causes. Some common causes of nausea are gastroenteritis and other gastrointestinal disorders, food poisoning, motion sickness, dizziness, migraine, fainting, low blood sugar, anxiety, hyperthermia, dehydration and lack of sleep. Nausea is a side effect of many medications including chemotherapy, or morning sickness in early pregnancy. Nausea may also be caused by disgust and depression.[1]

Medications taken to prevent and treat nausea and vomiting are called antiemetics. The most commonly prescribed antiemetics in the US are promethazine, metoclopramide, and the newer ondansetron. The word nausea is from Latin nausea, from Greek ναυσία – nausia,[4] "ναυτία" – nautia, motion sickness, "feeling sick or queasy".[5]

Causes

Gastrointestinal infections (37%) and food poisoning are the two most common causes of acute nausea and vomiting.[1] Side effects from medications (3%) and pregnancy are also relatively frequent.[1] There are many causes of chronic nausea.[1] Nausea and vomiting remain undiagnosed in 10% of the cases. Aside from morning sickness, there are no sex differences in complaints of nausea. After childhood, doctor consultations decrease steadily with age. Only a fraction of one percent of doctor visits by those over 65 are due to nausea.[6]

Gastrointestinal

Gastrointestinal infection is one of the most common causes of acute nausea and vomiting.[1] Chronic nausea may be the presentation of many gastrointestinal disorders, occasionally as the major symptom, such as gastroesophageal reflux disease, functional dyspepsia, gastritis, biliary reflux, gastroparesis, peptic ulcer, celiac disease, non-celiac gluten sensitivity, Crohn's disease, hepatitis, upper gastrointestinal malignancy, and pancreatic cancer.[1][7] Uncomplicated Helicobacter pylori infection does not cause chronic nausea.[1]

Food poisoning

Food poisoning usually causes an abrupt onset of nausea and vomiting one to six hours after ingestion of contaminated food and lasts for one to two days.[8] It is due to toxins produced by bacteria in food.[8]

Medications

Many medications can potentially cause nausea.[8] Some of the most frequently associated include cytotoxic chemotherapy regimens for cancer and other diseases, and general anaesthetic agents. An old cure for migraine, ergotamine, is well known to cause devastating nausea in some patients; a person using it for the first time will be prescribed an antiemetic for relief if needed.[citation needed]

Pregnancy

Nausea or "morning sickness" is common during early pregnancy but may occasionally continue into the second and third trimesters. In the first trimester nearly 80% of women have some degree of nausea.[9] Pregnancy should therefore be considered as a possible cause of nausea in any sexually active woman of child-bearing age.[8] While usually it is mild and self-limiting, severe cases known as hyperemesis gravidarum may require treatment.[10]

Disequilibrium

A number of conditions involving balance such as motion sickness and vertigo can lead to nausea and vomiting.[citation needed]

Gynecologic

Dysmenorrhea can cause nausea.[11]

Psychiatric

Nausea may be caused by depression, anxiety disorders and eating disorders.[12]

Potentially serious

While most causes of nausea are not serious, some serious conditions are associated with nausea. These include pancreatitis, small bowel obstruction, appendicitis, cholecystitis, hepatitis, Addisonian crisis, diabetic ketoacidosis, increased intracranial pressure, spontaneous intracranial hypotension, brain tumors, meningitis, heart attack, rabies[13] carbon monoxide poisoning and many others.[1]

Comprehensive list

Inside the abdomen

Obstructing disorders

Enteric infections

Inflammatory diseases

Sensorimotor dysfunction

Other

Outside the abdomen

Cardiopulmonary

Inner-ear diseases

Intracerebral disorders

Psychiatric illnesses

Other

Medications and metabolic disorders

Drugs

Endocrine/metabolic disease

Toxins

Pathophysiology

Research on nausea and vomiting has relied on using animal models to mimic the anatomy and neuropharmacologic features of the human body.[15] The physiologic mechanism of nausea is a complex process that has yet to be fully elucidated. There are four general pathways that are activated by specific triggers in the human body that go on to create the sensation of nausea and vomiting.[16]

  • Central nervous system (CNS): Stimuli can affect areas of the CNS including the cerebral cortex and the limbic system. These areas are activated by elevated intracranial pressure, irritation of the meninges (i.e. blood or infection), and extreme emotional triggers such as anxiety. The supratentorial region is also responsible for the sensation of nausea.[3]
  • Chemoreceptor trigger zone (CTZ): The CTZ is located in the area postrema in the floor of the fourth ventricle within the brain. This area is outside the blood brain barrier, and is therefore readily exposed to substances circulating through the blood and cerebral spinal fluid. Common triggers of the CTZ include metabolic abnormalities, toxins, and medications. Activation of the CTZ is mediated by dopamine (D2) receptors, serotonin (5HT3) receptors, and neurokinin receptors (NK1).
  • Vestibular system: This system is activated by disturbances to the vestibular apparatus in the inner ear. These include movements that cause motion sickness and dizziness. This pathway is triggered via histamine (H1) receptors and acetylcholine (ACh) receptors.
  • Peripheral Pathways: These pathways are triggered via chemoreceptors and mechanoreceptors in the gastrointestinal tract, as well as other organs such as the heart and kidneys. Common activators of these pathways include toxins present in the gastrointestinal lumen and distension of the gastrointestinal lumen from blockage or dysmotility of the bowels. Signals from these pathways travel via multiple neural tracts including the vagus, glossopharyngeal, splanchnic, and sympathetic nerves.

Signals from any of these pathways then travel to the brainstem, activating several structures including the nucleus of the solitary tract, the dorsal motor nucleus of the vagus, and central pattern generator.[17] These structures go on to signal various downstream effects of nausea and vomiting. The body's motor muscle responses involve halting the muscles of the gastrointestinal tract, and in fact causing reversed propulsion of gastric contents towards the mouth while increasing abdominal muscle contraction. Autonomic effects involve increased salivation and the sensation of feeling faint that often occurs with nausea and vomiting.

Pre-nausea pathophysiology

It has been described that alterations in heart rate can occur as well as the release of vasopressin from the posterior pituitary.[3]

Diagnosis

Patient history

Taking a thorough patient history may reveal important clues to the cause of nausea and vomiting. If the patient's symptoms have an acute onset, then drugs, toxins, and infections are likely. In contrast, a long-standing history of nausea will point towards a chronic illness as the culprit. The timing of nausea and vomiting after eating food is an important factor to pay attention to. Symptoms that occur within an hour of eating may indicate an obstruction proximal to the small intestine, such as gastroparesis or pyloric stenosis. An obstruction further down in the intestine or colon will cause delayed vomiting. An infectious cause of nausea and vomiting such as gastroenteritis may present several hours to days after the food was ingested.[14] The contents of the emesis is a valuable clue towards determining the cause. Bits of fecal matter in the emesis indicate obstruction in the distal intestine or the colon. Emesis that is of a bilious nature (greenish in color) localizes the obstruction to a point past the stomach. Emesis of undigested food points to an obstruction prior to the gastric outlet, such as achalasia or Zenker's diverticulum. If patient experiences reduced abdominal pain after vomiting, then obstruction is a likely etiology. However, vomiting does not relieve the pain brought on by pancreatitis or cholecystitis.[14]

Physical exam

It is important to watch out for signs of dehydration, such as orthostatic hypotension and loss of skin turgor. Auscultation of the abdomen can produce several clues to the cause of nausea and vomiting. A high-pitched tinkling sound indicates possible bowel obstruction, while a splashing "succussion" sound is more indicative of gastric outlet obstruction. Eliciting pain on the abdominal exam when pressing on the patient may indicate an inflammatory process. Signs such as papilledema, visual field losses, or focal neurological deficits are red flag signs for elevated intracranial pressure.[14]

Diagnostic testing

When a history and physical exam are not enough to determine the cause of nausea and vomiting, certain diagnostic tests may prove useful. A chemistry panel would be useful for electrolyte and metabolic abnormalities.[18] Liver function tests and lipase would identify pancreaticobiliary diseases.[18] Abdominal X-rays showing air-fluid levels indicate bowel obstruction, while an X-ray showing air-filled bowel loops are more indicative of ileus. More advanced imaging and procedures may be necessary, such as a CT scan, upper endoscopy, colonoscopy, barium enema, or MRI. Abnormal GI motility can be assessed using specific tests like gastric scintigraphy, wireless motility capsules, and small-intestinal manometry.[14]

Treatment

If dehydration is present due to loss of fluids from severe vomiting, rehydration with oral electrolyte solutions is preferred.[1] If this is not effective or possible, intravenous rehydration may be required.[1] Medical care is recommended if: a person cannot keep any liquids down, has symptoms more than 2 days, is weak, has a fever, has stomach pain, vomits more than two times in a day or does not urinate for more than 8 hours.[19]


Medications

Many pharmacologic medications are available for the treatment of nausea. There is no medication that is clearly superior to other medications for all cases of nausea.[20] The choice of antiemetic medication may be based on the situation during which the person experiences nausea. For people with motion sickness and vertigo, antihistamines and anticholinergics such as meclizine and scopolamine are particularly effective.[21] Nausea and vomiting associated with migraine headaches respond best to dopamine antagonists such as metoclopramide, prochlorperazine, and chlorpromazine.[21] In cases of gastroenteritis, serotonin antagonists such as ondansetron were found to suppress nausea and vomiting, as well as reduce the need for IV fluid resuscitation.[21] The combination of pyridoxine and doxylamine is the first line treatment for pregnancy-related nausea and vomiting.[21] Dimenhydrinate is an inexpensive and effective over the counter medication for preventing postoperative nausea and vomiting.[22] Other factors to consider when choosing an antiemetic medication include the person's preference, side-effect profile, and cost.

Nabilone is also indicated for this purpose.

Alternative medicine

In certain people, cannabinoids may be effective in reducing chemotherapy associated nausea and vomiting.[23][24] Several studies have demonstrated the therapeutic effects of cannabinoids for nausea and vomiting in the advanced stages of illnesses such as cancer and AIDS.[25][26]

In hospital settings topical anti-nausea gels are not indicated because of lack of research backing their efficacy.[27] Topical gels containing lorazepam, diphenhydramine, and haloperidol are sometimes used for nausea but are not equivalent to more established therapies.[27]

Ginger has also been shown to be potentially effective in treating several types of nausea.[28][29]

Prognosis

The outlook depends on the cause. Most people recover within few hours or a day. While short-term nausea and vomiting are generally harmless, they may sometimes indicate a more serious condition. When associated with prolonged vomiting, it may lead to dehydration or dangerous electrolyte imbalances or both. Repeated intentional vomiting, characteristic of bulimia, can cause stomach acid to wear away at the enamel in teeth.[30]

Epidemiology

Nausea and or vomiting is the main complaint in 1.6% of visits to family physicians in Australia.[6] However, only 25% of people with nausea visit their family physician.[1] In Australia, nausea, as opposed to vomiting, occurs most frequently in persons aged 15–24 years, and is less common in other age groups.[6]

See also

References

  1. ^ a b c d e f g h i j k l Metz A, Hebbard G (September 2007). "Nausea and vomiting in adults--a diagnostic approach" (PDF). Australian Family Physician (Review). Royal Australian College of General Practitioners. 36 (9): 688–92. PMID 17885699. 
  2. ^ "Nausea".
  3. ^ a b c Balaban CD, Yates BJ (January 2017). "What is nausea? A historical analysis of changing views". Autonomic Neuroscience. 202: 5–17. doi:10.1016/j.autneu.2016.07.003. PMC 5203950. PMID 27450627.
  4. ^ Liddell, Henry George; Scott, Robert. "ναυσία". A Greek-English Lexicon – via Perseus.tufts.edu.
  5. ^ Liddell, Henry George; Scott, Robert. "ναυτία". A Greek-English Lexicon – via perseus.tufts.edu.
  6. ^ a b c Britt H, Fahridin S (September 2007). (PDF). Australian Family Physician. 36 (9): 682–3. PMID 17885697. Archived from the original (PDF) on 2019-03-26. Retrieved 2010-02-15.
  7. ^ Volta U, Caio G, Karunaratne TB, Alaedini A, De Giorgio R (January 2017). "Non-coeliac gluten/wheat sensitivity: advances in knowledge and relevant questions". Expert Review of Gastroenterology & Hepatology (Review). 11 (1): 9–18. doi:10.1080/17474124.2017.1260003. PMID 27852116. S2CID 34881689. A lower proportion of NCG/WS patients (from 30% to 50%) complain of upper gastrointestinal tract manifestations, e.g. vomiting, nausea, gastroesophageal reflux disease, aerophagia and aphthous stomatitis. (NCG/WS: Non-coeliac gluten/wheat sensitivity)
  8. ^ a b c d Scorza K, Williams A, Phillips JD, Shaw J (July 2007). "Evaluation of nausea and vomiting". American Family Physician. 76 (1): 76–84. PMID 17668843.
  9. ^ Koch KL, Frissora CL (March 2003). "Nausea and vomiting during pregnancy". Gastroenterology Clinics of North America. 32 (1): 201–34, vi. doi:10.1016/S0889-8553(02)00070-5. PMID 12635417.
  10. ^ Sheehan P (September 2007). "Hyperemesis gravidarum--assessment and management". Australian Family Physician. 36 (9): 698–701. PMID 17885701.
  11. ^ Osayande AS, Mehulic S (March 2014). "Diagnosis and initial management of dysmenorrhea". American Family Physician. 89 (5): 341–6. PMID 24695505.
  12. ^ Singh P, Yoon SS, Kuo B (January 2016). "Nausea: a review of pathophysiology and therapeutics". Therapeutic Advances in Gastroenterology (Review). 9 (1): 98–112. doi:10.1177/1756283X15618131. PMC 4699282. PMID 26770271.
  13. ^ O'Connor RE, Brady W, Brooks SC, Diercks D, Egan J, Ghaemmaghami C, et al. (November 2010). "Part 10: acute coronary syndromes: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care". Circulation. 122 (18 Suppl 3): S787-817. doi:10.1161/circulationaha.110.971028. PMID 20956226.
  14. ^ a b c d e f Hasler WL. Nausea, Vomiting, and Indigestion. In: Kasper D, Fauci A, Hauser S, Longo D, Jameson J, Loscalzo J. eds. 'Harrison's Principles of Internal Medicine, 19e. New York, NY: McGraw-Hill; 2015.
  15. ^ Andrews PL, Horn CC (April 2006). "Signals for nausea and emesis: Implications for models of upper gastrointestinal diseases". Autonomic Neuroscience. 125 (1–2): 100–15. doi:10.1016/j.autneu.2006.01.008. PMC 2658708. PMID 16556512. Retrieved 2015-01-11.
  16. ^ Lien, C (2012). Principles and Practice of Hospital Medicine. New York, NY: McGraw HIll. pp. Chapter 217: Domains of Care: Physical Aspects of Care.
  17. ^ Bashashati M, McCallum RW (January 2014). "Neurochemical mechanisms and pharmacologic strategies in managing nausea and vomiting related to cyclic vomiting syndrome and other gastrointestinal disorders". European Journal of Pharmacology. 722: 79–94. doi:10.1016/j.ejphar.2013.09.075. PMID 24161560.
  18. ^ a b Porter, Ryan. (PDF). Med.unc.edu. American College of Gastroenterology. Archived from the original (PDF) on 28 March 2017. Retrieved 24 January 2018.
  19. ^ "When you have nausea and vomiting: MedlinePlus Medical Encyclopedia". Nlm.nih.gov. Retrieved 2014-03-20.
  20. ^ Furyk JS, Meek RA, Egerton-Warburton D (September 2015). "Drugs for the treatment of nausea and vomiting in adults in the emergency department setting". The Cochrane Database of Systematic Reviews. 9 (9): CD010106. doi:10.1002/14651858.cd010106.pub2. PMC 6517141. PMID 26411330.
  21. ^ a b c d Flake ZA, Linn BS, Hornecker JR (March 2015). "Practical selection of antiemetics in the ambulatory setting". American Family Physician. 91 (5): 293–6. PMID 25822385. Retrieved 10 November 2015.
  22. ^ Kranke P, Morin AM, Roewer N, Eberhart LH (March 2002). "Dimenhydrinate for prophylaxis of postoperative nausea and vomiting: a meta-analysis of randomized controlled trials". Acta Anaesthesiologica Scandinavica. 46 (3): 238–44. doi:10.1034/j.1399-6576.2002.t01-1-460303.x. PMID 11939912. S2CID 22229281.
  23. ^ Tramèr MR, Carroll D, Campbell FA, Reynolds DJ, Moore RA, McQuay HJ (July 2001). "Cannabinoids for control of chemotherapy induced nausea and vomiting: quantitative systematic review". BMJ. 323 (7303): 16–21. doi:10.1136/bmj.323.7303.16. PMC 34325. PMID 11440936.
  24. ^ Drug Policy Alliance (2001). . Archived from the original on 2007-08-05. Retrieved 2007-08-02.
  25. ^ World health Organization, Cannabis - epidemiology. http://www.who.int/substance_abuse/facts/cannabis/en/
  26. ^ Whiting PF, Wolff RF, Deshpande S, Di Nisio M, Duffy S, Hernandez AV, et al. (2015-06-23). "Cannabinoids for Medical Use: A Systematic Review and Meta-analysis". JAMA. 313 (24): 2456–73. doi:10.1001/jama.2015.6358. PMID 26103030.
  27. ^ a b American Academy of Hospice and Palliative Medicine, "Five Things Physicians and Patients Should Question", Choosing Wisely: an initiative of the ABIM Foundation, American Academy of Hospice and Palliative Medicine, retrieved August 1, 2013, which cites
    • Smith TJ, Ritter JK, Poklis JL, Fletcher D, Coyne PJ, Dodson P, Parker G (May 2012). "ABH gel is not absorbed from the skin of normal volunteers". Journal of Pain and Symptom Management. 43 (5): 961–6. doi:10.1016/j.jpainsymman.2011.05.017. PMID 22560361.
    • Weschules DJ (December 2005). "Tolerability of the compound ABHR in hospice patients". Journal of Palliative Medicine. 8 (6): 1135–43. doi:10.1089/jpm.2005.8.1135. PMID 16351526.
  28. ^ Marx WM, Teleni L, McCarthy AL, Vitetta L, McKavanagh D, Thomson D, Isenring E (April 2013). (PDF). Nutrition Reviews. 71 (4): 245–54. doi:10.1111/nure.12016. PMID 23550785. S2CID 19187673. Archived from the original (PDF) on 2020-05-07. Retrieved 2019-12-12.
  29. ^ Ernst E, Pittler MH (March 2000). "Efficacy of ginger for nausea and vomiting: a systematic review of randomized clinical trials". British Journal of Anaesthesia. 84 (3): 367–71. doi:10.1093/oxfordjournals.bja.a013442. PMID 10793599.
  30. ^ . WebMD. Archived from the original on 25 July 2012. Retrieved 26 July 2012.

External links

  •   The dictionary definition of nausea at Wiktionary

May 12, 2023
nausea, confused, with, malaise, other, uses, disambiguation, diffuse, sensation, unease, discomfort, sometimes, perceived, urge, vomit, while, painful, debilitating, symptom, prolonged, been, described, placing, discomfort, chest, abdomen, back, throat, 1681,. Not to be confused with malaise For other uses see Nausea disambiguation Nausea is a diffuse sensation of unease and discomfort sometimes perceived as an urge to vomit 1 While not painful it can be a debilitating symptom if prolonged and has been described as placing discomfort on the chest abdomen or back of the throat 2 NauseaA 1681 painting depicting a person vomitingSpecialtyGastroenterologyOver 30 definitions of nausea were proposed in a 2011 book on the topic 3 Nausea is a non specific symptom which means that it has many possible causes Some common causes of nausea are gastroenteritis and other gastrointestinal disorders food poisoning motion sickness dizziness migraine fainting low blood sugar anxiety hyperthermia dehydration and lack of sleep Nausea is a side effect of many medications including chemotherapy or morning sickness in early pregnancy Nausea may also be caused by disgust and depression 1 Medications taken to prevent and treat nausea and vomiting are called antiemetics The most commonly prescribed antiemetics in the US are promethazine metoclopramide and the newer ondansetron The word nausea is from Latin nausea from Greek naysia nausia 4 naytia nautia motion sickness feeling sick or queasy 5 Contents 1 Causes 1 1 Gastrointestinal 1 2 Food poisoning 1 3 Medications 1 4 Pregnancy 1 5 Disequilibrium 1 6 Gynecologic 1 7 Psychiatric 1 8 Potentially serious 1 9 Comprehensive list 1 9 1 Inside the abdomen 1 9 2 Outside the abdomen 1 9 3 Medications and metabolic disorders 2 Pathophysiology 2 1 Pre nausea pathophysiology 3 Diagnosis 3 1 Patient history 3 2 Physical exam 3 3 Diagnostic testing 4 Treatment 4 1 Medications 4 2 Alternative medicine 5 Prognosis 6 Epidemiology 7 See also 8 References 9 External linksCauses EditGastrointestinal infections 37 and food poisoning are the two most common causes of acute nausea and vomiting 1 Side effects from medications 3 and pregnancy are also relatively frequent 1 There are many causes of chronic nausea 1 Nausea and vomiting remain undiagnosed in 10 of the cases Aside from morning sickness there are no sex differences in complaints of nausea After childhood doctor consultations decrease steadily with age Only a fraction of one percent of doctor visits by those over 65 are due to nausea 6 Gastrointestinal Edit Gastrointestinal infection is one of the most common causes of acute nausea and vomiting 1 Chronic nausea may be the presentation of many gastrointestinal disorders occasionally as the major symptom such as gastroesophageal reflux disease functional dyspepsia gastritis biliary reflux gastroparesis peptic ulcer celiac disease non celiac gluten sensitivity Crohn s disease hepatitis upper gastrointestinal malignancy and pancreatic cancer 1 7 Uncomplicated Helicobacter pylori infection does not cause chronic nausea 1 Food poisoning Edit Food poisoning usually causes an abrupt onset of nausea and vomiting one to six hours after ingestion of contaminated food and lasts for one to two days 8 It is due to toxins produced by bacteria in food 8 Medications Edit Many medications can potentially cause nausea 8 Some of the most frequently associated include cytotoxic chemotherapy regimens for cancer and other diseases and general anaesthetic agents An old cure for migraine ergotamine is well known to cause devastating nausea in some patients a person using it for the first time will be prescribed an antiemetic for relief if needed citation needed Pregnancy Edit Nausea or morning sickness is common during early pregnancy but may occasionally continue into the second and third trimesters In the first trimester nearly 80 of women have some degree of nausea 9 Pregnancy should therefore be considered as a possible cause of nausea in any sexually active woman of child bearing age 8 While usually it is mild and self limiting severe cases known as hyperemesis gravidarum may require treatment 10 Disequilibrium Edit A number of conditions involving balance such as motion sickness and vertigo can lead to nausea and vomiting citation needed Gynecologic Edit Dysmenorrhea can cause nausea 11 Psychiatric Edit Nausea may be caused by depression anxiety disorders and eating disorders 12 Potentially serious Edit While most causes of nausea are not serious some serious conditions are associated with nausea These include pancreatitis small bowel obstruction appendicitis cholecystitis hepatitis Addisonian crisis diabetic ketoacidosis increased intracranial pressure spontaneous intracranial hypotension brain tumors meningitis heart attack rabies 13 carbon monoxide poisoning and many others 1 Comprehensive list Edit Inside the abdomen Edit Obstructing disorders Gastric outlet obstruction Small bowel obstruction Colonic obstruction Superior mesenteric artery syndromeEnteric infections Viral infection Bacterial infectionInflammatory diseases Celiac disease Cholecystitis Pancreatitis Appendicitis HepatitisSensorimotor dysfunction Gastroparesis Intestinal pseudo obstruction Gastroesophageal reflux disease Irritable bowel syndrome Cyclic vomiting syndromeOther Non celiac gluten sensitivity Biliary colic Kidney stone Cirrhosis Abdominal irradiation 14 Outside the abdomen Edit Cardiopulmonary Cardiomyopathy Myocardial infarction heart attack Paroxysmal coughInner ear diseases Motion sickness Labyrinthitis MalignancyIntracerebral disorders Malignancy Hemorrhage Abscess Hydrocephalus Meningitis Encephalitis RabiesPsychiatric illnesses Anorexia and bulimia nervosa DepressionOther Post operative vomiting 14 NociceptionMedications and metabolic disorders Edit Drugs Chemotherapy Antibiotics Antiarrhythmics Digoxin Oral hypoglycemic medications Oral contraceptivesEndocrine metabolic disease Pregnancy Uremia Ketoacidosis Thyroid and parathyroid disease Adrenal insufficiencyToxins Liver failure AlcoholPathophysiology EditResearch on nausea and vomiting has relied on using animal models to mimic the anatomy and neuropharmacologic features of the human body 15 The physiologic mechanism of nausea is a complex process that has yet to be fully elucidated There are four general pathways that are activated by specific triggers in the human body that go on to create the sensation of nausea and vomiting 16 Central nervous system CNS Stimuli can affect areas of the CNS including the cerebral cortex and the limbic system These areas are activated by elevated intracranial pressure irritation of the meninges i e blood or infection and extreme emotional triggers such as anxiety The supratentorial region is also responsible for the sensation of nausea 3 Chemoreceptor trigger zone CTZ The CTZ is located in the area postrema in the floor of the fourth ventricle within the brain This area is outside the blood brain barrier and is therefore readily exposed to substances circulating through the blood and cerebral spinal fluid Common triggers of the CTZ include metabolic abnormalities toxins and medications Activation of the CTZ is mediated by dopamine D2 receptors serotonin 5HT3 receptors and neurokinin receptors NK1 Vestibular system This system is activated by disturbances to the vestibular apparatus in the inner ear These include movements that cause motion sickness and dizziness This pathway is triggered via histamine H1 receptors and acetylcholine ACh receptors Peripheral Pathways These pathways are triggered via chemoreceptors and mechanoreceptors in the gastrointestinal tract as well as other organs such as the heart and kidneys Common activators of these pathways include toxins present in the gastrointestinal lumen and distension of the gastrointestinal lumen from blockage or dysmotility of the bowels Signals from these pathways travel via multiple neural tracts including the vagus glossopharyngeal splanchnic and sympathetic nerves Signals from any of these pathways then travel to the brainstem activating several structures including the nucleus of the solitary tract the dorsal motor nucleus of the vagus and central pattern generator 17 These structures go on to signal various downstream effects of nausea and vomiting The body s motor muscle responses involve halting the muscles of the gastrointestinal tract and in fact causing reversed propulsion of gastric contents towards the mouth while increasing abdominal muscle contraction Autonomic effects involve increased salivation and the sensation of feeling faint that often occurs with nausea and vomiting Pre nausea pathophysiology Edit It has been described that alterations in heart rate can occur as well as the release of vasopressin from the posterior pituitary 3 Diagnosis EditPatient history Edit Taking a thorough patient history may reveal important clues to the cause of nausea and vomiting If the patient s symptoms have an acute onset then drugs toxins and infections are likely In contrast a long standing history of nausea will point towards a chronic illness as the culprit The timing of nausea and vomiting after eating food is an important factor to pay attention to Symptoms that occur within an hour of eating may indicate an obstruction proximal to the small intestine such as gastroparesis or pyloric stenosis An obstruction further down in the intestine or colon will cause delayed vomiting An infectious cause of nausea and vomiting such as gastroenteritis may present several hours to days after the food was ingested 14 The contents of the emesis is a valuable clue towards determining the cause Bits of fecal matter in the emesis indicate obstruction in the distal intestine or the colon Emesis that is of a bilious nature greenish in color localizes the obstruction to a point past the stomach Emesis of undigested food points to an obstruction prior to the gastric outlet such as achalasia or Zenker s diverticulum If patient experiences reduced abdominal pain after vomiting then obstruction is a likely etiology However vomiting does not relieve the pain brought on by pancreatitis or cholecystitis 14 Physical exam Edit It is important to watch out for signs of dehydration such as orthostatic hypotension and loss of skin turgor Auscultation of the abdomen can produce several clues to the cause of nausea and vomiting A high pitched tinkling sound indicates possible bowel obstruction while a splashing succussion sound is more indicative of gastric outlet obstruction Eliciting pain on the abdominal exam when pressing on the patient may indicate an inflammatory process Signs such as papilledema visual field losses or focal neurological deficits are red flag signs for elevated intracranial pressure 14 Diagnostic testing Edit When a history and physical exam are not enough to determine the cause of nausea and vomiting certain diagnostic tests may prove useful A chemistry panel would be useful for electrolyte and metabolic abnormalities 18 Liver function tests and lipase would identify pancreaticobiliary diseases 18 Abdominal X rays showing air fluid levels indicate bowel obstruction while an X ray showing air filled bowel loops are more indicative of ileus More advanced imaging and procedures may be necessary such as a CT scan upper endoscopy colonoscopy barium enema or MRI Abnormal GI motility can be assessed using specific tests like gastric scintigraphy wireless motility capsules and small intestinal manometry 14 Treatment EditIf dehydration is present due to loss of fluids from severe vomiting rehydration with oral electrolyte solutions is preferred 1 If this is not effective or possible intravenous rehydration may be required 1 Medical care is recommended if a person cannot keep any liquids down has symptoms more than 2 days is weak has a fever has stomach pain vomits more than two times in a day or does not urinate for more than 8 hours 19 Medications Edit Many pharmacologic medications are available for the treatment of nausea There is no medication that is clearly superior to other medications for all cases of nausea 20 The choice of antiemetic medication may be based on the situation during which the person experiences nausea For people with motion sickness and vertigo antihistamines and anticholinergics such as meclizine and scopolamine are particularly effective 21 Nausea and vomiting associated with migraine headaches respond best to dopamine antagonists such as metoclopramide prochlorperazine and chlorpromazine 21 In cases of gastroenteritis serotonin antagonists such as ondansetron were found to suppress nausea and vomiting as well as reduce the need for IV fluid resuscitation 21 The combination of pyridoxine and doxylamine is the first line treatment for pregnancy related nausea and vomiting 21 Dimenhydrinate is an inexpensive and effective over the counter medication for preventing postoperative nausea and vomiting 22 Other factors to consider when choosing an antiemetic medication include the person s preference side effect profile and cost Nabilone is also indicated for this purpose Alternative medicine Edit In certain people cannabinoids may be effective in reducing chemotherapy associated nausea and vomiting 23 24 Several studies have demonstrated the therapeutic effects of cannabinoids for nausea and vomiting in the advanced stages of illnesses such as cancer and AIDS 25 26 In hospital settings topical anti nausea gels are not indicated because of lack of research backing their efficacy 27 Topical gels containing lorazepam diphenhydramine and haloperidol are sometimes used for nausea but are not equivalent to more established therapies 27 Ginger has also been shown to be potentially effective in treating several types of nausea 28 29 Prognosis EditThe outlook depends on the cause Most people recover within few hours or a day While short term nausea and vomiting are generally harmless they may sometimes indicate a more serious condition When associated with prolonged vomiting it may lead to dehydration or dangerous electrolyte imbalances or both Repeated intentional vomiting characteristic of bulimia can cause stomach acid to wear away at the enamel in teeth 30 Epidemiology EditNausea and or vomiting is the main complaint in 1 6 of visits to family physicians in Australia 6 However only 25 of people with nausea visit their family physician 1 In Australia nausea as opposed to vomiting occurs most frequently in persons aged 15 24 years and is less common in other age groups 6 See also EditCancer and nausea VasodilationReferences Edit a b c d e f g h i j k l Metz A Hebbard G September 2007 Nausea and vomiting in adults a diagnostic approach PDF Australian Family Physician Review Royal Australian College of General Practitioners 36 9 688 92 PMID 17885699 Nausea a b c Balaban CD Yates BJ January 2017 What is nausea A historical analysis of changing views Autonomic Neuroscience 202 5 17 doi 10 1016 j autneu 2016 07 003 PMC 5203950 PMID 27450627 Liddell Henry George Scott Robert naysia A Greek English Lexicon via Perseus tufts edu Liddell Henry George Scott Robert naytia A Greek English Lexicon via perseus tufts edu a b c Britt H Fahridin S September 2007 Presentations of nausea and vomiting PDF Australian Family Physician 36 9 682 3 PMID 17885697 Archived from the original PDF on 2019 03 26 Retrieved 2010 02 15 Volta U Caio G Karunaratne TB Alaedini A De Giorgio R January 2017 Non coeliac gluten wheat sensitivity advances in knowledge and relevant questions Expert Review of Gastroenterology amp Hepatology Review 11 1 9 18 doi 10 1080 17474124 2017 1260003 PMID 27852116 S2CID 34881689 A lower proportion of NCG WS patients from 30 to 50 complain of upper gastrointestinal tract manifestations e g vomiting nausea gastroesophageal reflux disease aerophagia and aphthous stomatitis NCG WS Non coeliac gluten wheat sensitivity a b c d Scorza K Williams A Phillips JD Shaw J July 2007 Evaluation of nausea and vomiting American Family Physician 76 1 76 84 PMID 17668843 Koch KL Frissora CL March 2003 Nausea and vomiting during pregnancy Gastroenterology Clinics of North America 32 1 201 34 vi doi 10 1016 S0889 8553 02 00070 5 PMID 12635417 Sheehan P September 2007 Hyperemesis gravidarum assessment and management Australian Family Physician 36 9 698 701 PMID 17885701 Osayande AS Mehulic S March 2014 Diagnosis and initial management of dysmenorrhea American Family Physician 89 5 341 6 PMID 24695505 Singh P Yoon SS Kuo B January 2016 Nausea a review of pathophysiology and therapeutics Therapeutic Advances in Gastroenterology Review 9 1 98 112 doi 10 1177 1756283X15618131 PMC 4699282 PMID 26770271 O Connor RE Brady W Brooks SC Diercks D Egan J Ghaemmaghami C et al November 2010 Part 10 acute coronary syndromes 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Circulation 122 18 Suppl 3 S787 817 doi 10 1161 circulationaha 110 971028 PMID 20956226 a b c d e f Hasler WL Nausea Vomiting and Indigestion In Kasper D Fauci A Hauser S Longo D Jameson J Loscalzo J eds Harrison s Principles of Internal Medicine 19e New York NY McGraw Hill 2015 Andrews PL Horn CC April 2006 Signals for nausea and emesis Implications for models of upper gastrointestinal diseases Autonomic Neuroscience 125 1 2 100 15 doi 10 1016 j autneu 2006 01 008 PMC 2658708 PMID 16556512 Retrieved 2015 01 11 Lien C 2012 Principles and Practice of Hospital Medicine New York NY McGraw HIll pp Chapter 217 Domains of Care Physical Aspects of Care Bashashati M McCallum RW January 2014 Neurochemical mechanisms and pharmacologic strategies in managing nausea and vomiting related to cyclic vomiting syndrome and other gastrointestinal disorders European Journal of Pharmacology 722 79 94 doi 10 1016 j ejphar 2013 09 075 PMID 24161560 a b Porter Ryan Nausea and Vomiting PDF Med unc edu American College of Gastroenterology Archived from the original PDF on 28 March 2017 Retrieved 24 January 2018 When you have nausea and vomiting MedlinePlus Medical Encyclopedia Nlm nih gov Retrieved 2014 03 20 Furyk JS Meek RA Egerton Warburton D September 2015 Drugs for the treatment of nausea and vomiting in adults in the emergency department setting The Cochrane Database of Systematic Reviews 9 9 CD010106 doi 10 1002 14651858 cd010106 pub2 PMC 6517141 PMID 26411330 a b c d Flake ZA Linn BS Hornecker JR March 2015 Practical selection of antiemetics in the ambulatory setting American Family Physician 91 5 293 6 PMID 25822385 Retrieved 10 November 2015 Kranke P Morin AM Roewer N Eberhart LH March 2002 Dimenhydrinate for prophylaxis of postoperative nausea and vomiting a meta analysis of randomized controlled trials Acta Anaesthesiologica Scandinavica 46 3 238 44 doi 10 1034 j 1399 6576 2002 t01 1 460303 x PMID 11939912 S2CID 22229281 Tramer MR Carroll D Campbell FA Reynolds DJ Moore RA McQuay HJ July 2001 Cannabinoids for control of chemotherapy induced nausea and vomiting quantitative systematic review BMJ 323 7303 16 21 doi 10 1136 bmj 323 7303 16 PMC 34325 PMID 11440936 Drug Policy Alliance 2001 Medicinal Uses of Marijuana Nausea Emesis and Appetite Stimulation Archived from the original on 2007 08 05 Retrieved 2007 08 02 World health Organization Cannabis epidemiology http www who int substance abuse facts cannabis en Whiting PF Wolff RF Deshpande S Di Nisio M Duffy S Hernandez AV et al 2015 06 23 Cannabinoids for Medical Use A Systematic Review and Meta analysis JAMA 313 24 2456 73 doi 10 1001 jama 2015 6358 PMID 26103030 a b American Academy of Hospice and Palliative Medicine Five Things Physicians and Patients Should Question Choosing Wisely an initiative of the ABIM Foundation American Academy of Hospice and Palliative Medicine retrieved August 1 2013 which cites Smith TJ Ritter JK Poklis JL Fletcher D Coyne PJ Dodson P Parker G May 2012 ABH gel is not absorbed from the skin of normal volunteers Journal of Pain and Symptom Management 43 5 961 6 doi 10 1016 j jpainsymman 2011 05 017 PMID 22560361 Weschules DJ December 2005 Tolerability of the compound ABHR in hospice patients Journal of Palliative Medicine 8 6 1135 43 doi 10 1089 jpm 2005 8 1135 PMID 16351526 Marx WM Teleni L McCarthy AL Vitetta L McKavanagh D Thomson D Isenring E April 2013 Ginger Zingiber officinale and chemotherapy induced nausea and vomiting a systematic literature review PDF Nutrition Reviews 71 4 245 54 doi 10 1111 nure 12016 PMID 23550785 S2CID 19187673 Archived from the original PDF on 2020 05 07 Retrieved 2019 12 12 Ernst E Pittler MH March 2000 Efficacy of ginger for nausea and vomiting a systematic review of randomized clinical trials British Journal of Anaesthesia 84 3 367 71 doi 10 1093 oxfordjournals bja a013442 PMID 10793599 Bulimia Nervosa Topic Overview WebMD Archived from the original on 25 July 2012 Retrieved 26 July 2012 External links Edit The dictionary definition of nausea at Wiktionary Retrieved from https en wikipedia org w index php title Nausea amp oldid 1150809589, wikipedia, wiki, book, books, library,

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