Approach

1. History
   • If vomited, ask about Emesis(vomiting) → colour, frequency, amount of vomit as well as any related nausea
2. ID the cause
3. ID and correct the consequences
   • Electrolyte depletion
   • !Hypovolemia ↓
4. Correct the cause if possible
   1. !Bowel Obstruction → decompression, surgery
   • e.g. !Hypercalcemia - ↑Ca (> 2.5) → IV fluid, BP
5. Symptomatic management

DDx

• Post-op
  • Brain Surgery
• Brain (non post-op)
  • Increased ICP
    • Brain Tumor
    • Trauma, Hemorrhage
  • !Meningitis
• ENT
  • Ménière’s Disease (Labyrinthitis)
  • Vestibular neuritis
  • Caused by Vertigo
• GI (non post-op)
  • Upper GI (esophagus, stomach, duodenum)
    • Gastritis, Gastroenteritis
    • Gastroparesis
    • Gastric outlet obstruction
  • Bowel
    • Gastroenteritis
    • !Bowel Obstruction
    • Acute infectious enterirtis
    • IBD
  • Other organ
    • Acute Hepatitis, !Acute Pancreatitis, !Acute Cholecystitis
  • Peritoneal irritation
    • Splenomegaly, Hepatomegaly
    • !Appendicitis
  • Constipation
  • Ascites
• Medication
  • Always all medication
  • Toxin (e.g. Alcohol (RF))
  • Opioid (Narcotics)
• Cancer
• Metabolic
• Psychiatric
• Other

Symptom Management

• Anti-emetic