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EVALUATION OF VOMITING

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MANAGEMENT OF NAUSEA AND VOMITING

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Vomiting has many causes originating inside and outside the gastrointestinal (GI) system, and may be age specific. Common causes in all ages are viral gastroenteritis and medication side effects. In infants, vomiting may be due to overfeeding or gastroesophageal reflux disease (GERD). However, other conditions may be present: projectile vomiting suggests pyloric stenosis, bilious/green vomiting may be present in obstructive conditions such as midgut volvulus. Associated intermittent abdominal pain and altered mentation suggests intussusception. Associated bloody diarrhea suggests bowel necrosis, invasive bowel infections, or in older children, inflammatory bowel disease (IBD). See Table 36–1 for lists of other causes to be considered.

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Table 36–1.Pediatric causes of vomiting.
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Adults with vomiting have additional differential considerations often related to medication use, acquired diseases, pregnancy and substance abuse (Table 36–2). Hematemesis and GI bleed are discussed in Chapter 16.

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Table Graphic Jump Location
Table 36–2.Adult causes of vomiting.
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Physical Examination
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Fever may be present in infection, toxicologic causes (aspirin, MDMA, bath salts), and systemic conditions. Tachycardia may be present with dehydration, pain, blood loss, infection/sepsis syndromes. Assess for signs of decreased perfusion due to intravascular volume depletion (cool, pale skin; altered mentation; prolonged capillary refill, decreased urinary output; dry mucous membranes). Point-of-care ultrasound (POCUS) of the inferior vena cava (IVC) may demonstrate intravascular volume status.

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Severe, diffuse tenderness suggests peritonitis. Point ...

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