Evaluation of nausea and vomiting in adults

Diseases

Summary

Nausea and vomiting are extremely common symptoms and may be caused by a vast array of medical conditions.[1][2] The presentation can be acute or chronic and ranges from a mildly annoying symptom to a condition that impairs quality of life or is a marker of a life-threatening disease.

There are 2 general mechanisms of nausea and vomiting:

Central neurologic

Stimulation of the area postrema, which "senses" noxious chemical agents (e.g., poisons, chemotherapy agents, digoxin) and subsequently stimulates the vagal nuclei, which evokes nausea and coordinates the emesis reflex.
Diseases of the central nervous system (CNS), such as infections or brain tumors, stimulate CNS structures and elicit nausea and vomiting, ultimately through vagal pathways.

Peripheral neurologic

Diseases and disorders that originate in peripheral organ systems, such as the gastrointestinal tract, stimulate vagal or spinal afferent nerves that connect with the vagal sensory (tractus solitarius) and vagal efferent motor nuclei. Ultimately, cortical centers where nausea is perceived and the efferent pathways that mediate vomiting are stimulated.
Tumors, infections, and drugs in the periphery may cause local dysfunction in a variety of organ systems that is sensed as nausea that, when severe, evokes vomiting.

Library

Plain abdominal x-ray showing dilated centrally placed bowel loops with valvulae conniventes (white arrows). No dilated large bowel segments can be seen, representing small bowel obstruction. The black arrow shows an incidental ring pessary
Large bowel obstruction as seen on x-ray

Citations

Key Articles

Quigley EM, Hasler WL, Parkman HP. AGA technical review on nausea and vomiting. Gastroenterology. 2001 Jan;120(1):263-86.[Abstract][Full Text]
Intagliata N, Koch KL. Gastroparesis in type 2 diabetes mellitus: prevalence, etiology, diagnosis, and treatment. Curr Gastroenterol Rep. 2007 Aug;9(4):270-9.[Abstract]
American College of Gastroenterology. Clinical guideline: gastroparesis. Aug 2022 [internet publication].[Full Text]

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