A patient presents to the clinic complaining of nausea and vomiting. What do you need to ask to exploit her condition? What are the questions that help localize the differential diagnosis?
Today we will go through a clinical situation as follows:
A 24-year-old female patient presents to the emergency department with complaints of vomiting and regurgitation for the past 4 weeks.
Nausea (nausea) and vomiting (vomiting) are common symptoms throughout our lives. Although they are manifestations of self-limiting diseases (self-limited illnesses), nausea and vomiting can also be signs of a life-threatening illness (life-threatening disease).
Vomiting causes decreased work efficiency and increased health care costs, especially in pregnant women, cancer patients undergoing chemotherapy. (cancer chemotherapy)and patients who are recovering from surgery.
- Chronic nausea and vomiting (Chronic nausea and vomiting): symptoms persist for more than 1 month.
- Full, sick, full stomach (Early Satiety): feeling full after eating a small amount of food (less than usual).
- Vomit (Nausea)
- Feeling nauseous and vomiting after chemotherapy (Postchemotherapy nausea and vomiting – PCNV)
- Recurrent vomiting (Recurrent vomiting): more than 3 attacks (3 or more episodes).
The initial differential diagnosis of vomiting is often extensive, but we can narrow it down by clinical circumstances.
Infants and young children with acute vomiting have special circumstances, for example the possibility of poisoning by swallowing (toxic ingestion) more in children than in adults. Although the rate has decreased but Reye’s syndrome is still one of the situations of acute vomiting in young children infected with the virus.
Similarly, the differential diagnoses for recurrent vomiting in children should be extended to congenital abnormalities (congenital abnormalities).
- Irregular rotation of the intestines (malroration)
- pyloric stenosis (pyloric stenosis)
- Esophageal real estate (esophageal atresia).
Vomiting in children may simply be reflux caused by Physiological gastroesophageal reflux.
Ask for medical history
Approach the patient with nausea and vomiting by defining symptoms and nature: duration, severity, and associated factors.
Frequently used questions
- Tell me about your nausea and vomiting? – Tell me about you nausea and vomiting?
- Tell me about the first time this symptom occurred? – Tell me about the first time this happened?
- Do you have diarrhea? Does anyone else in your community also have vomiting and diarrhea? – Do you also have diarrhea? Do others in your community also have vomiting and diarrhea? => think of viral enteritis (viral gastroenteritis)food poisoning disease (food-borne illness).
- Do you have any signs of pregnancy, such as a late period, breast swelling, stinging or pain when pressed? – Do you have any symptoms of pregnancy, such as late menstrual period or breast swelling, tingling or tenderness?
- Are you pregnant? (first trimester) – Are you pregnant (first trimester)? => severe morning sickness (hyperemesis gravidarum). If in the 2nd or 3rd trimester, pay attention to AFLP or HELLP . syndrome.
- Are you undergoing chemotherapy for cancer? – Have you been receving chemotherapy for cancer?
- Do you have a history of kidney disease or kidney failure? – Do you have a history of kidney disease or failure?
- Do you have a feeling of fullness in your stomach? – Do you feel full after eating just a small amount of food (early satiety)?
- Do you eat canned food? Do you have difficulty swallowing? – Do you eat home canned or preserved food? Do you have trouble swallowing? => cause Botulism.
Above is some information we exploit with patients with symptoms of nausea and vomiting.
BS. Tran Nam Anh
Articles of Bs. Tran Nam Anh
Posts same category: