Evaluation of nausea and vomiting, adults

Last reviewed: September 2018

Last updated: June 2018

Summary

Nausea and vomiting are extremely common symptoms and may be caused by a vast array of medical conditions. [1] [2] [3] 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:

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.
CNS diseases such as infections or brain tumors stimulate CNS structures and elicit nausea and vomiting, ultimately through vagal pathways.

Peripheral

Diseases and disorders that originate in peripheral organ systems, such as the GI 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, and severe nausea eventually evokes vomiting.

Differentials

Common

Gastritis
Gastroesophageal reflux disease
Peptic ulcer disease
Acute gastroenteritis
Food poisoning
Chronic postviral nausea and vomiting
Migraine
Motion sickness
Benign paroxysmal positional vertigo
Cerebrovascular (embolic/ischemic/hemorrhagic) events
Hypercalcemia
Hypothyroidism
Gastric outlet obstruction
Small bowel obstruction
Colonic obstruction
Choledocholithiasis
Cholecystitis
Post-GI surgery
Severe constipation
Irritable bowel syndrome
Cyclic vomiting syndrome
Gastric dysrhythmias
Gastroparesis
Bacterial peritonitis
Anorexia nervosa
Bulimia nervosa
Pregnancy
Drug-induced
Nephrolithiasis
Uremia
Idiopathic functional dyspepsia or postprandial distress syndrome

Full details

Uncommon

Acute coronary syndrome
Postural orthostatic tachycardia syndrome (POTS)
Meniere disease
Acoustic neuroma
Traumatic brain injury
Meningitis
Brain abscess
Complex partial seizures
CNS tumors
Primary adrenal insufficiency (acute or chronic)
Hyperthyroidism
Hypopituitarism
Heat stroke
Acute pancreatitis
Bariatric surgery sequelae
Primary pseudo-obstruction
Secondary pseudo-obstruction
Abdominal abscess
Carcinomatous peritonitis
Stomach cancer
Ovarian cancer
Renal cancer
Small cell lung cancer
Pancreatic cancer
Chronic mesenteric ischemia
Cannabinoid hyperemesis
Chronic nausea and vomiting after antibiotics or anesthetics

Full details

Contributors

Authors VIEW ALL 

Kenneth L. Koch, MD

Professor

Section Head Gastroenterology

Wake Forest University

Health Sciences Center

Winston-Salem

Disclosures

KLK is a consultant for GlaxoSmithKline and a shareholder in 3 CPM Company. He is an author of a number of references cited in this monograph.

Peer reviewers VIEW ALL 

James Neuberger, BM, BCh

Consultant Physician

Liver Unit

Queen Elizabeth Hospital

Birmingham

Disclosures

JN declares that he has no competing interests.

Daniel Leffler, MD, MS

Instructor in Medicine

Harvard Medical School

Director of Clinical Research

The Celiac Center

Beth Israel Deaconess Medical Center

Boston

Disclosures

DL declares that he has no competing interests.

Ned Snyder, MD, FACP

Professor of Medicine

Chief of Clinical Gastroenterology and Hepatology

University of Texas Medical Branch

Galveston

Disclosures

NS declares that he has no competing interests.

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Evaluation of nausea and vomiting, adults

Summary

Differentials

Common

Uncommon

Contributors

Authors VIEW ALL 

Kenneth L. Koch, MD

Disclosures

Peer reviewers VIEW ALL 

James Neuberger, BM, BCh

Disclosures

Daniel Leffler, MD, MS

Disclosures

Ned Snyder, MD, FACP

Disclosures

Calculators

Procedural videos

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