Causes of Morning sickness
List of causes of Morning sickness
Following is a list of causes or underlying conditions
(see also Misdiagnosis of underlying causes of Morning sickness)
that could possibly cause Morning sickness includes:
Longer list of causes of Pregnancy symptoms:
see full list of causes for Pregnancy symptoms
Morning sickness Causes: Book Excerpts
Morning sickness as a complication of other conditions:
Other conditions that might have
Morning sickness as a complication may,
potentially, be an underlying cause of Morning sickness.
Our database lists the following as having
Morning sickness as a complication of that condition:
Morning sickness as a symptom:
Conditions listing Morning sickness
as a symptom may also be potential underlying causes of Morning sickness.
Our database lists the following as having
Morning sickness as a symptom of that condition:
Medical news summaries relating to Morning sickness:
The following medical news items are relevant to causes of Morning sickness:
Related information on causes of Morning sickness:
As with all medical conditions,
there may be many causal factors.
Further relevant information on causes of Morning sickness may be found in:
Causes of Morning sickness: Online Medical Books
16 MEDICAL BOOKS ONLINE!
Review excerpts from medical books online, free, without registration,
for more information about the causes of Morning sickness.
Nausea & Vomiting:
Differential Diagnosis
(In a Page: Signs and Symptoms)
- Central nausea/vomiting
–Pregnancy (hyperemesis gravidarum)
–Uremia
–Hypercalcemia
–Drugs (e.g., chemotherapy agents)
–Carbon monoxide poisoning
- Gastrointestinal disease
–Infection (e.g., gastroenteritis, appendicitis, cholecystitis)
–Obstruction (e.g., pyloric stenosis, small bowel obstruction, large bowel obstruction, gastroparesis, Ogilvie's syndrome)
–Inflammation (e.g., pancreatitis, peptic ulcer disease)
–Food poisoning
-
Toxic ingestions
–Syrup of ipecac
–Alcohol
–Salicylates: Result in tachypnea, tinnitus,
-
and metabolic acidosis/respiratory alkalosis
–Iron: Causes profound gastritis
–Arsenic
-
Middle ear disease (e.g., Ménie're's disease, labyrinthitis, benign positional vertigo)
-
Post-tussive emesis (especially in children)
-
Motion sickness
- CNS disease
–Increased intracranial pressure due to brain tumor, CNS infection (e.g., meningitis, abscess), head trauma, hydrocephalus, subarachnoid hemorrhage, vestibular neuritis, or intracerebral hemorrhage
–Migraine headache
-
Acute myocardial infarction (especially inferior MI)
-
Ovarian torsion
-
Testicular torsion
-
Malingering: Relatively common, but should be a diagnosis of exclusion until more serious causes are excluded
-
Intussusception: Classically causes colicky abdominal pain, vomiting, and currant jelly stools
-
Pyelonephritis or other abdominal process
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Nausea:
Medical causes
(Handbook of Signs & Symptoms (Third Edition))
Adrenal insufficiency
Common GI findings in adrenal insufficiency include nausea, vomiting, anorexia, and diarrhea. Other findings include weakness; fatigue; weight loss; bronze skin; hypotension; a weak, irregular pulse; vitiligo; and depression.
Anthrax (GI)
Initial signs and symptoms include nausea, vomiting, loss of appetite, and a fever. Signs and symptoms may progress to abdominal pain, severe bloody diarrhea, and hematemesis.
Appendicitis
With acute appendicitis, a brief period of nausea may accompany the onset of abdominal pain. Pain typically begins as vague epigastric or periumbilical discomfort and rapidly progresses to severe stabbing pain localized in the right lower quadrant (McBurney’s sign). Associated findings usually include abdominal rigidity and tenderness, cutaneous hyperalgesia, a fever, constipation or diarrhea, tachycardia, anorexia, moderate malaise, and positive psoas (increased abdominal pain occurs when the examiner places his hand above the patient’s right knee and the patient flexes his right hip against resistance) and obturator signs (internal rotation of the right leg with the leg flexed to 90 degrees at the hip and knee with a resulting tightening of the internal obturator muscle that causes abdominal discomfort).
Cholecystitis (acute)
With acute cholecystitis, nausea commonly follows severe right upper quadrant pain that may radiate to the back or shoulders, usually following meals. Associated findings include mild vomiting, flatulence, abdominal tenderness and, possibly, rigidity and distention, a fever with chills, diaphoresis, and a positive Murphy’s sign.
Cholelithiasis
With cholelithiasis, nausea accompanies attacks of severe right upper quadrant or epigastric pain after eating fatty foods. Other associated findings include vomiting, abdominal tenderness and guarding, flatulence, belching, epigastric burning, tachycardia, and restlessness. Occlusion of the common bile duct may cause jaundice, clay-colored stools, a fever, and chills.
Cirrhosis
Insidious early signs and symptoms of cirrhosis typically include nausea and vomiting, anorexia, abdominal pain, and constipation or diarrhea. As the disease progresses, jaundice and hepatomegaly may occur with abdominal distention, spider angiomas, palmar erythema, severe pruritus, dry skin, fetor hepaticus, enlarged superficial abdominal veins, mental changes, and bilateral gynecomastia and testicular atrophy or menstrual irregularities.
Diverticulitis
Besides nausea, diverticulitis causes intermittent crampy abdominal pain, constipation or diarrhea, a low-grade fever, and commonly a palpable, tender, firm, fixed mass.
Escherichia coli O157:H7
Signs and symptoms include nausea, watery or bloody diarrhea, vomiting, a fever, and abdominal cramps. In children younger than age 5 and in the elderly, hemolytic uremic syndrome — in which red blood cells are destroyed — may develop. This may ultimately lead to acute renal failure.
Gastritis
Nausea is common with gastritis, especially after ingestion of alcohol, aspirin, spicy foods, or caffeine. Vomiting of mucus or blood, epigastric pain, belching, a fever, and malaise may also occur.
Gastroenteritis
Usually viral, gastroenteritis causes nausea, vomiting, diarrhea, and abdominal cramping. A fever, malaise, hyperactive bowel sounds, abdominal pain and tenderness, and possible dehydration and electrolyte imbalances may also develop.
Heart failure
Heart failure may produce nausea and vomiting, particularly with right-sided heart failure. Associated findings include tachycardia, a ventricular gallop, profound fatigue, dyspnea, crackles, peripheral edema, jugular vein distention, ascites, nocturia, and diastolic hypertension.
Hepatitis
Nausea is an insidious early symptom of viral hepatitis. Vomiting, fatigue, myalgia and arthralgia, a headache, anorexia, photophobia, pharyngitis, a cough, and a fever also occur early in the preicteric phase.
Hyperemesis gravidarum
Unremitting nausea and vomiting that persist beyond the first trimester are characteristic of hyperemesis gravidarum, a pregnancy disorder. Vomitus ranges from undigested food, mucus, and bile early in the disorder to a coffee-ground appearance in later stages. Associated findings include weight loss, signs of dehydration, a headache, and delirium.
Intestinal obstruction
Nausea commonly occurs, especially with high small-intestinal obstruction. Vomiting may be bilious or fecal; abdominal pain is usually episodic and colicky, but can become severe and steady with strangulation. Constipation occurs early in large-intestinal obstruction and later in small-intestinal obstruction; obstipation may signal complete obstruction. Bowel sounds are typically hyperactive in partial obstruction and hypoactive or absent in complete obstruction. Abdominal distention and tenderness occur, possibly with visible peristaltic waves and a palpable abdominal mass.
Labyrinthitis
Nausea and vomiting commonly occur with labyrinthitis, an acute inner ear inflammation. More significant findings include severe vertigo, progressive hearing loss, nystagmus, tinnitus and, possibly, otorrhea.
Listeriosis
Signs and symptoms include nausea, vomiting, diarrhea, a fever, myalgia, and abdominal pain. If listerosis spreads to the nervous system and causes meningitis, signs and symptoms include a fever, a headache, nuchal rigidity, and a change in the level of consciousness (LOC).
Gender Cue:Listeriosis infection during pregnancy may lead to premature delivery, infection of the neonate, or still birth.
Ménière’s disease
Ménière’s disease causes sudden, brief, recurrent attacks of nausea, vomiting, vertigo, tinnitus, diaphoresis, and nystagmus. It also causes hearing loss and ear fullness.
Mesenteric venous thrombosis
An insidious or acute onset of nausea, vomiting, and abdominal pain occurs, with diarrhea or constipation, abdominal distention, hematemesis, and melena.
Metabolic acidosis
Metabolic acidosis is an acid-base imbalance that may produce nausea and vomiting, anorexia, diarrhea, Kussmaul’s respirations, and a decreased LOC.
Migraine headache
Nausea and vomiting may occur in the prodromal stage, along with photophobia, light flashes, increased sensitivity to noise, light-headedness and, possibly, partial vision loss and paresthesia of the lips, face, and hands.
Motion sickness
With motion sickness, nausea and vomiting are brought on by motion or rhythmic movement. A headache, dizziness, fatigue, diaphoresis, hypersalivation, and dyspnea may also occur.
Myocardial infarction
Nausea and vomiting may occur, but the cardinal symptom is severe substernal chest pain that may radiate to the left arm, jaw, or neck. Dyspnea, pallor, clammy skin, diaphoresis, altered blood pressure, and arrhythmias also occur.
Pancreatitis (acute)
Nausea, usually followed by vomiting, is an early symptom of pancreatitis. Other common findings include steady, severe pain in the epigastrium or left upper quadrant that may radiate to the back; abdominal tenderness and rigidity; anorexia; diminished bowel sounds; and a fever. Tachycardia, restlessness, hypotension, skin mottling, and cold, sweaty extremities may occur in severe cases.
Peptic ulcer
With peptic ulcer, nausea and vomiting may follow attacks of sharp or gnawing, burning epigastric pain. Attacks typically occur when the stomach is empty or after the ingestion of alcohol, caffeine, or aspirin; they’re relieved by eating food or taking an antacid or antisecretory. Hematemesis or melena may also occur.
Peritonitis
Nausea and vomiting usually accompany acute abdominal pain localized to the area of inflammation. Other findings include a high fever with chills; tachycardia; hypoactive or absent bowel sounds; abdominal distention, rigidity, and tenderness (including rebound tenderness); a positive obturator sign and obturator weakness; pale, cold skin; diaphoresis; hypotension; shallow respirations; and hiccups.
Preeclampsia
Nausea and vomiting commonly occur with preeclampsia — a pregnancy disorder — along with rapid weight gain, epigastric pain, oliguria, a severe frontal headache, hyperreflexia, and blurred or double vision. The classic diagnostic triad of signs include hypertension, proteinuria, and edema.
Q Fever
Signs and symptoms include nausea, vomiting, diarrhea, a fever, chills, a severe headache, malaise, and chest pain. The fever may last up to 2 weeks, and in severe cases, the patient may develop hepatitis or pneumonia.
Rhabdomyolysis
Signs and symptoms include nausea, vomiting, muscle weakness or pain, a fever, malaise, and dark urine. Acute renal failure is the most commonly reported complication of the disorder. It results from renal structure obstruction and injury during the kidneys’attempt to filter myoglobin from the bloodstream.
Typhus
An abrupt onset of nausea, vomiting, a fever, and chills follows the initial symptoms of a headache, myalgia, arthralgia, and malaise.
Other causes
Drugs
Common nausea-producing drugs include antineoplastics, opiates, ferrous sulfate, levodopa, oral potassium chloride replacements, estrogens, sulfasalazine, antibiotics, quinidine, anesthetics, cardiac glycosides, theophylline (overdose), and nonsteroidal anti-inflammatory drugs.
Herb Alert
Herbal remedies, such as ginkgo biloba and St. John’s wort, can produce adverse reactions, including nausea.
Radiation and surgery
Radiation therapy can cause nausea and vomiting. Postoperative nausea and vomiting are common, especially after abdominal surgery.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Nausea:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Adrenal insufficiency
Common GI findings in this endocrine disorder include nausea, vomiting, anorexia, and diarrhea. Other findings include weakness; fatigue; weight loss; bronze skin; hypotension; a weak, irregular pulse; vitiligo; and depression.
Anthrax (GI)
Initial signs and symptoms include nausea, vomiting, loss of appetite, and fever. Signs and symptoms may progress to abdominal pain, severe bloody diarrhea, and hematemesis.
Appendicitis
With acute appendicitis, a brief period of nausea may accompany onset of abdominal pain. Pain typically begins as vague epigastric or periumbilical discomfort and rapidly progresses to severe stabbing pain localized in the right lower quadrant (McBurney’s sign). Associated findings usually include abdominal rigidity and tenderness, cutaneous hyperalgesia, fever, constipation or diarrhea, tachycardia, anorexia, moderate malaise, and positive psoas (increased abdominal pain occurs when the examiner places his hand above the patient’s right knee and the patient flexes his right hip against resistance) and obturator signs (internal rotation of the right leg with the leg flexed to 90 degrees at the hip and knee with a resulting tightening of the internal obturator muscle that causes abdominal discomfort).
Cholecystitis (acute)
With this disease, nausea often follows severe right-upper-quadrant pain that may radiate to the back or shoulders, often following meals. Associated findings include mild vomiting, flatulence, abdominal tenderness and, possibly, rigidity and distention, fever with chills, diaphoresis, and a positive Murphy’s sign.
Cholelithiasis
With this disease, nausea accompanies attacks of severe right-upper-quadrant or epigastric pain after ingestion of fatty foods. Other associated findings include vomiting, abdominal tenderness and guarding, flatulence, belching, epigastric burning, tachycardia, and restlessness. Occlusion of the common bile duct may cause jaundice, clay-colored stools, fever, and chills.
Cirrhosis
Insidious early signs and symptoms of cirrhosis typically include nausea and vomiting, anorexia, abdominal pain, and constipation or diarrhea. As the disease progresses, jaundice and hepatomegaly may occur with abdominal distention, spider angiomas, palmar erythema, severe pruritus, dry skin, fetor hepaticus, enlarged superficial abdominal veins, mental changes, and bilateral gynecomastia and testicular atrophy or menstrual irregularities.
Diverticulitis
Besides nausea, diverticulitis causes intermittent crampy abdominal pain, constipation or diarrhea, low-grade fever, and often a palpable, tender, firm, fixed mass.
Ectopic pregnancy
Nausea, vomiting, vaginal bleeding, and lower abdominal pain occur in this potentially life-threatening disorder. Suspect ectopic pregnancy in a female of childbearing age with a 1- to 2-month history of amenorrhea.
Electrolyte imbalances
Such disturbances as hyponatremia or hypernatremia, hypokalemia, and hypercalcemia commonly cause nausea and vomiting. Other effects include cardiac arrhythmias, tremors or seizures, anorexia, malaise, and weakness.
Escherichia coli O157:H7
Signs and symptoms include nausea, watery or bloody diarrhea, vomiting, fever, and abdominal cramps. In children younger than age 5 and in the elderly, hemolytic uremic syndrome may develop in which red blood cells are destroyed, which may ultimately lead to acute renal failure.
Gastric cancer
This rare cancer may produce vague GI symptoms—mild nausea, anorexia, upper abdominal discomfort, and chronic dyspepsia. Fatigue, weight loss, weakness, hematemesis, melena, and altered bowel habits are also common.
Gastritis
Nausea is common with this disorder, especially after ingestion of alcohol, aspirin, spicy foods, or caffeine. Vomiting of mucus or blood, epigastric pain, belching, fever, and malaise may also occur.
Gastroenteritis
Usually viral, this disorder causes nausea, vomiting, diarrhea, and abdominal cramping. Fever, malaise, hyperactive bowel sounds, abdominal pain and tenderness, and possible dehydration and electrolyte imbalances may also develop.
Heart failure
This disorder may produce nausea and vomiting, particularly with right-sided heart failure. Associated findings include tachycardia, ventricular gallop, profound fatigue, dyspnea, crackles, peripheral edema, jugular vein distention, ascites, nocturia, and diastolic hypertension.
Hepatitis
Nausea is an insidious early symptom of viral hepatitis. Vomiting, fatigue, myalgia and arthralgia, headache, anorexia, photophobia, pharyngitis, cough, and fever also occur early in the preicteric phase.
Hyperemesis gravidarum
Unremitting nausea and vomiting that persist beyond the first trimester are characteristic of this pregnancy disorder. Vomitus ranges from undigested food, mucus, and bile early in the disorder to a coffee-ground appearance in later stages. Associated findings include weight loss, signs of dehydration, headache, and delirium.
Infection
Acute localized or systemic infection typically produces nausea. Other common findings include fever, headache, fatigue, and malaise.
Inflammatory bowel disease
The most common symptom is recurrent diarrhea with blood, pus, and mucus. Nausea, vomiting, abdominal pain, and anorexia may also occur.
Intestinal obstruction
Nausea commonly occurs, especially with high small-intestinal obstruction. Vomiting may be bilious or fecal; abdominal pain is usually episodic and colicky but can become severe and steady with strangulation. Constipation occurs early in large-intestinal obstruction and later in small-intestinal obstruction; obstipation may signal complete obstruction. Bowel sounds are typically hyperactive in partial obstruction, and hypoactive or absent in complete obstruction. Abdominal distention and tenderness occur, possibly with visible peristaltic waves and a palpable abdominal mass.
Irritable bowel syndrome
Nausea, dyspepsia, and abdominal distention may occur with this syndrome especially during periods of increased stress. Other findings include lower abdominal pain and abdominal tenderness, which is generally relieved by moving the bowels; diurnal diarrhea alternating with constipation or normal bowel function; and small stools with visible mucus and a feeling of incomplete evacuation.
Labyrinthitis
Nausea and vomiting commonly occur with this acute inner ear inflammation. More significant findings include severe vertigo, progressive hearing loss, nystagmus, tinnitus and, possibly, otorrhea.
Lactose intolerance
Depending on the individual, signs and symptoms may include nausea, diarrhea, cramps, bloating, and gas, and they occur after eating dairy products.
Listeriosis
Signs and symptoms include nausea, vomiting, diarrhea, fever, myalgias, and abdominal pain. If the infection spreads to the nervous system and causes meningitis, signs and symptoms include fever, headache, nuchal rigidity, and change in level of consciousness.
Ménière’s disease
This disease causes sudden, brief, recurrent attacks of nausea, vomiting, vertigo, tinnitus, diaphoresis, and nystagmus. It also causes hearing loss and ear fullness.
Mesenteric artery ischemia
With this condition, nausea and vomiting may accompany severe cramping abdominal pain, especially after meals. Other findings include diarrhea or constipation, abdominal tenderness and bloating, anorexia, weight loss, and abdominal bruits.
Mesenteric venous thrombosis
Insidious or acute onset of nausea, vomiting, and abdominal pain occurs, with diarrhea or constipation, abdominal distention, hematemesis, and melena.
Metabolic acidosis
This acid-base imbalance may produce nausea and vomiting, anorexia, diarrhea, Kussmaul’s respirations, and decreased level of consciousness.
Migraine headache
Nausea and vomiting may occur in the prodromal stage, along with photophobia, light flashes, increased sensitivity to noise, light-headedness and, possibly, partial vision loss and paresthesia of the lips, face, and hands.
Motion sickness
With this disorder, nausea and vomiting are brought on by motion or rhythmic movement. Headache, dizziness, fatigue, diaphoresis, hypersalivation, and dyspnea may also occur.
Myocardial infarction
Nausea and vomiting may occur, but the cardinal symptom is severe substernal chest pain that may radiate to the left arm, jaw, or neck. Dyspnea, pallor, clammy skin, diaphoresis, altered blood pressure, and arrhythmias also occur.
Norovirus infection
Acute gastroenteritis from noroviruses commonly causes infected individuals to experience nausea. Frequent accompanying symptoms include vomiting, diarrhea, and abdominal pain or cramping. Less commonly, individuals may develop low-grade fever, headache, chills, muscle aches, and generalized tiredness. These viruses are carried in the stool or vomit of infected individuals, and are often spread through contaminated food or water. Duration of illness is brief, with healthy individuals recovering in 24 to 60 hours.
Pancreatitis (acute)
Nausea, usually followed by vomiting, is an early symptom of pancreatitis. Other common findings include steady, severe pain in the epigastrium or left upper quadrant that may radiate to the back; abdominal tenderness and rigidity; anorexia; diminished bowel sounds; and fever. Tachycardia, restlessness, hypotension, skin mottling, and cold, sweaty extremities may occur in severe cases.
Peptic ulcer
With this disorder, nausea and vomiting may follow attacks of sharp or gnawing, burning epigastric pain. Attacks typically occur when the stomach is empty, or after ingestion of alcohol, caffeine, or aspirin; they’re relieved by eating food or taking an antacid or an antisecretory. Hematemesis or melena may also occur.
Peritonitis
Nausea and vomiting usually accompany acute abdominal pain localized to the area of inflammation. Other findings include high fever with chills; tachycardia; hypoactive or absent bowel sounds; abdominal distention, rigidity, and tenderness (including rebound tenderness); positive obturator sign and obturator weakness; pale, cold skin; diaphoresis; hypotension; shallow respirations; and hiccups.
Preeclampsia
Nausea and vomiting commonly occur with this disorder of pregnancy, along with rapid weight gain, epigastric pain, oliguria, severe frontal headache, hyperreflexia, and blurred or double vision. The classic diagnostic triad of signs include hypertension, proteinuria, and edema.
Q Fever
Signs and symptoms include nausea, vomiting, diarrhea, fever, chills, severe headache, malaise, and chest pain. Fever may last up to 2 weeks, and in severe cases, the patient may develop hepatitis or pneumonia.
Renal and urologic disorders
Cystitis, pyelonephritis, calculi, uremia, and other disorders of the renal system can cause nausea. Related findings reflect the specific disorder.
Rhabdomyolysis
Signs and symptoms include nausea, vomiting, muscle weakness or pain, fever, malaise, and dark urine. Acute renal failure is the most commonly reported complication of the disorder. It results from renal structure obstruction and injury during the kidneys’attempt to filter the myoglobin from the bloodstream.
Thyrotoxicosis
With this disorder, nausea and vomiting may accompany the classic findings of severe anxiety, heat intolerance, weight loss despite increased appetite, diaphoresis, diarrhea, tremor, tachycardia, and palpitations. Other signs include exophthalmos, ventricular or atrial gallop, and an enlarged thyroid gland.
Typhus
An abrupt onset of nausea, vomiting, fever, and chills follows the initial symptoms of headache, myalgia, arthralgia, and malaise.
Other causes
Drugs
Common nausea-producing drugs include antineoplastics, opiates, ferrous sulfate, levodopa, oral potassium chloride replacements, estrogens, sulfasalazine, antibiotics, quinidine, anesthetics, cardiac glycosides, theophylline (overdose), and nonsteroidal anti-inflammatories.
Herb alert Herbal remedies, such as ginkgo biloba and St. John’s wort, can produce adverse reactions, including nausea.
Radiation and surgery
Radiation therapy can cause nausea and vomiting. Postoperative nausea and vomiting are common, especially after abdominal surgery.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Nausea/Vomiting:
Differential Overview
(Field Guide to Bedside Diagnosis)
Presenting Symptom
❑ Gastroesophageal reflux
❑ Pregnancy
❑ Psychogenic
❑ Bulimia
❑ Rumination
❑ Diabetic ketoacidosis
❑ Hepatitis
❑ Inferior myocardial infarction
❑ Uremia
❑ Adrenal insufficiency
With Abdominal Pain
❑ Viral gastroenteritis
❑ Food poisoning
❑ Peptic ulcer disease
❑ Renal colic
❑ Pancreatitis
❑ Pyelonephritis
❑ Appendicitis
❑ Cholecystitis
❑ Small bowel obstruction
❑ Peritonitis
With Neurologic Signs
❑ Migraine headache
❑ Vestibular disturbance
❑ Autonomic dysfunction
❑ Increased intracranial pressure
❑ Hypercalcemia
❑ Cerebellar hemorrhage
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Nausea:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Adrenal insufficiency
Common GI findings in adrenal insufficiency include nausea, vomiting, anorexia, and diarrhea. Other findings include weakness, fatigue, weight loss, bronze skin, hypotension, vitiligo, depression, and a weak, irregular pulse.
Anthrax (GI)
Initial signs and symptoms of GI anthrax include nausea, vomiting, loss of appetite, and fever. Signs and symptoms may progress to abdominal pain, severe bloody diarrhea, and hematemesis.
Appendicitis
With acute appendicitis, a brief period of nausea may accompany onset of abdominal pain. Pain typically begins as vague epigastric or periumbilical discomfort and rapidly progresses to severe stabbing pain localized in the right lower quadrant (McBurney’s sign). Associated findings usually include abdominal rigidity and tenderness, cutaneous hyperalgesia, fever, constipation or diarrhea, tachycardia, anorexia, moderate malaise, and positive psoas (increased abdominal pain occurs when the examiner places his hand above the patient’s right knee and the patient flexes his right hip against resistance) and obturator signs (internal rotation of the right leg with the leg flexed to 90 degrees at the hip and knee with a resulting tightening of the internal obturator muscle that causes abdominal discomfort).
Cholecystitis (acute)
With acute cholecystitis, nausea typically follows severe right-upper-quadrant pain that may radiate to the back or shoulders, commonly following meals. Associated findings include mild vomiting, flatulence, abdominal tenderness and, possibly, rigidity and distention, fever with chills, diaphoresis, and a positive Murphy’s sign.
Cholelithiasis
With cholelithiasis, nausea accompanies attacks of severe right-upper-quadrant or epigastric pain after ingestion of fatty foods. Other associated findings include vomiting, abdominal tenderness and guarding, flatulence, belching, epigastric burning, tachycardia, and restlessness. Occlusion of the common bile duct may cause jaundice, clay-colored stools, fever, and chills.
Cirrhosis
Insidious early signs and symptoms of cirrhosis typically include nausea and vomiting, anorexia, abdominal pain, and constipation or diarrhea. As the disease progresses, jaundice and hepatomegaly may occur with abdominal distention, spider angiomas, palmar erythema, severe pruritus, dry skin, fetor hepaticus, enlarged superficial abdominal veins, mental changes, and bilateral gynecomastia and testicular atrophy or menstrual irregularities.
Diverticulitis
Besides nausea, diverticulitis causes intermittent crampy abdominal pain, constipation or diarrhea, low-grade fever and, in many cases, a palpable, tender, firm, fixed mass. Signs and symptoms may also include anorexia, bloody stools, and flatulence.
Electrolyte imbalances
Electrolyte imbalances such as hyponatremia or hypernatremia, hypokalemia, and hypercalcemia commonly cause nausea and vomiting. Other effects include cardiac arrhythmias, tremors or seizures, anorexia, malaise, and weakness.
Escherichia coli 0157:H7
Signs and symptoms of E. coli 0157:H7 include nausea, watery or bloody diarrhea, vomiting, fever, and abdominal cramps. In children under age 5 and in elderly people, hemolytic uremic syndrome may develop, which may ultimately lead to acute renal failure.
Gastritis
Nausea is common with gastritis, especially after ingestion of alcohol, aspirin, spicy foods, or caffeine. Vomiting of mucus or blood, epigastric pain, belching, fever, and malaise may also occur.
Gastroenteritis
Usually viral, gastroenteritis causes nausea, vomiting, diarrhea, and abdominal cramping. Fever, malaise, hyperactive bowel sounds, abdominal pain and tenderness, and possible dehydration and electrolyte imbalances may also develop.
Heart failure
Heart failure may produce nausea and vomiting, particularly with right-sided heart failure. Associated findings include tachycardia, ventricular gallop, profound fatigue, dyspnea, crackles, peripheral edema, jugular vein distention, ascites, nocturia, and diastolic hypertension.
Hepatitis
Nausea is an insidious early symptom of viral hepatitis. Vomiting, fatigue, myalgia and arthralgia, headache, anorexia, photophobia, pharyngitis, cough, and fever also occur early in the preicteric phase.
Hyperemesis gravidarum
In hyperemesis gravidarum, unremitting nausea and vomiting that persist beyond the first trimester of pregnancy are characteristic. Vomitus ranges from undigested food, mucus, and bile in the early stages of the disorder to a coffee-ground appearance in later stages. Associated findings include weight loss, signs of dehydration, headache, and delirium.
Inflammatory bowel disease
The most common symptom of inflammatory bowel disease is recurrent diarrhea with blood, pus, and mucus. Nausea, vomiting, abdominal pain, and anorexia may also occur. The patient may report abdominal cramps and spasms after meals.
Intestinal obstruction
Nausea commonly occurs, especially with high small-intestinal obstruction. Vomiting may be bilious or fecal; abdominal pain is usually episodic and colicky but can become severe and steady with strangulation. Constipation occurs early in large-intestinal obstruction and later in small-intestinal obstruction; obstipation may signal complete obstruction. Bowel sounds are typically hyperactive in partial obstruction and hypoactive or absent in complete obstruction. Abdominal distention and tenderness occur, possibly with visible peristaltic waves and a palpable abdominal mass.
Irritable bowel syndrome
Nausea, dyspepsia, and abdominal distention may occur with irritable bowel syndrome, especially during periods of increased stress. Other findings include lower abdominal pain and abdominal tenderness, which is generally relieved by moving the bowels; diurnal diarrhea alternating with constipation or normal bowel function; and small stools with visible mucus and a feeling of incomplete evacuation.
Labyrinthitis
Nausea and vomiting commonly occur with labyrinthitis (acute inner ear inflammation). More significant findings in this disorder include severe vertigo, progressive hearing loss, nystagmus, tinnitus and, possibly, otorrhea.
Lactose intolerance
Depending on the individual, signs and symptoms of lactose intolerance may include nausea, diarrhea, cramps, bloating, and gas that occurs after eating dairy products. Borborygmi may be heard on auscultation.
Ménière’s disease
Ménière’s disease causes sudden, brief, recurrent attacks of nausea, vomiting, vertigo, tinnitus, diaphoresis, and nystagmus. It also causes hearing loss and ear fullness.
Metabolic acidosis
Metabolic acidosis is an acid-base imbalance that may produce nausea and vomiting, anorexia, diarrhea, Kussmaul’s respirations, and decreased level of consciousness. The patient may also exhibit central nervous system depression, drowsiness, lethargy, and stupor.
Migraine headache
Nausea and vomiting may occur in the prodromal stage, along with photophobia, light flashes, increased sensitivity to noise, light-headedness and, possibly, partial vision loss and paresthesia of the lips, face, and hands.
Motion sickness
With motion sickness, nausea and vomiting are brought on by motion or rhythmic movement. Headache, dizziness, fatigue, diaphoresis, hypersalivation, and dyspnea may also occur.
Myocardial infarction
Nausea and vomiting may occur, but the cardinal symptom of myocardial infarction is severe substernal chest pain that may radiate to the left arm, jaw, or neck. Dyspnea, pallor, clammy skin, diaphoresis, altered blood pressure, and arrhythmias also occur.
Pancreatitis (acute)
Nausea, usually followed by vomiting, is an early symptom of pancreatitis. Other common findings include steady, severe pain in the epigastrium or left upper quadrant that may radiate to the back; abdominal tenderness and rigidity; anorexia; diminished bowel sounds; and fever. Tachycardia, restlessness, hypotension, skin mottling, and cold, sweaty extremities may occur in severe cases.
Peptic ulcer
With a peptic ulcer, nausea and vomiting may follow attacks of sharp or gnawing, burning epigastric pain. Attacks typically occur when the stomach is empty or after ingesting alcohol, caffeine, or aspirin; they’re relieved by eating food or taking an antacid or an antisecretory. Hematemesis or melena may also occur.
Peritonitis
Nausea and vomiting usually accompany acute abdominal pain localized to the area of inflammation. Other findings in peritonitis include high fever with chills; tachycardia; hypoactive or absent bowel sounds; abdominal distention, rigidity, and tenderness (including rebound tenderness); positive obturator sign and obturator weakness; pale, cold skin; diaphoresis; hypotension; shallow respirations; and hiccups.
Preeclampsia
Nausea and vomiting commonly occur with this disorder of pregnancy, along with rapid weight gain, epigastric pain, oliguria, severe frontal headache, hyperreflexia, and blurred or double vision. The classic diagnostic triad of signs includes hypertension, proteinuria, and edema.
Renal and urologic disorders
Cystitis, pyelonephritis, calculi, uremia, and other disorders of the renal system can cause nausea. Related findings reflect the specific disorder.
Rhabdomyolysis
Signs and symptoms of rhabdomyolysis include nausea, vomiting, fever, malaise, and dark urine. The patient may also report tenderness, swelling, and muscle weakness that’s caused by muscle trauma and pressure.
Thyrotoxicosis
With thyrotoxicosis, nausea and vomiting may accompany the classic findings of severe anxiety, heat intolerance, weight loss despite increased appetite, diaphoresis, diarrhea, tremor, tachycardia, and palpitations. Other signs include exophthalmos, ventricular or atrial gallop, and an enlarged thyroid gland.
Other causes
Drugs
Common nausea-producing drugs include antineoplastics, opiates, ferrous sulfate, levodopa, oral potassium chloride replacements, estrogens, sulfasalazine, antibiotics, quinidine, anesthetics, cardiac glycosides, theophylline (upon overdose), and nonsteroidal anti-inflammatories.
Radiation and surgery
Radiation therapy can cause nausea and vomiting. Postoperative nausea and vomiting are common, especially after abdominal surgery.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Nausea:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Adrenal insufficiency.Common GI findings in adrenal insufficiency include nausea, vomiting, anorexia, and diarrhea. Other findings include weakness; fatigue; weight loss; bronze-colored skin; hypotension; a weak, irregular pulse; vitiligo; and depression.
Anthrax (GI).Initial signs and symptoms of GI anthrax include nausea, vomiting, loss of appetite, and fever. Signs and symptoms may progress to abdominal pain, severe bloody diarrhea, and hematemesis.
Appendicitis.With acute appendicitis, a brief period of nausea may accompany the onset of abdominal pain. Pain typically begins as vague epigastric or periumbilical discomfort and rapidly progresses to severe stabbing pain localized in the right lower quadrant (McBurney's sign). Associated findings usually include abdominal rigidity and tenderness, cutaneous hyperalgesia, fever, constipation or diarrhea, tachycardia, anorexia, moderate malaise, and positive psoas (increased abdominal pain occurs when the examiner places his hand above the patient's right knee and the patient flexes his right hip against resistance) and obturator signs (internal rotation of the right leg with the leg flexed to 90 degrees at the hip and knee with a resulting tightening of the internal obturator muscle that causes abdominal discomfort).
Cholecystitis (acute).With acute cholecystitis, nausea commonly follows severe right upper quadrant pain that may radiate to the back or shoulders, usually following meals. Associated findings include mild vomiting, flatulence, abdominal tenderness and, possibly, rigidity and distention, fever with chills, diaphoresis, and a positive Murphy's sign.
Cholelithiasis.With cholelithiasis, nausea accompanies attacks of severe right upper quadrant or epigastric pain after eating fatty foods. Other associated findings include vomiting, abdominal tenderness and guarding, flatulence, belching, epigastric burning, tachycardia, and restlessness. Occlusion of the common bile duct may cause jaundice, clay-colored stools, fever, and chills.
Cirrhosis.Insidious early signs and symptoms of cirrhosis typically include nausea and vomiting, anorexia, abdominal pain, and constipation or diarrhea. As the disease progresses, jaundice and hepatomegaly may occur with abdominal distention, spider angiomas, palmar erythema, severe pruritus, dry skin, fetor hepaticus, enlarged superficial abdominal veins, mental changes, and bilateral gynecomastia and testicular atrophy or menstrual irregularities.
Diverticulitis.Besides nausea, diverticulitis causes intermittent crampy abdominal pain, constipation or diarrhea, a low-grade fever, and commonly a palpable, tender, firm, fixed mass.
Escherichia coli O157:H7. Signs and symptoms of E. coli infection include nausea, watery or bloody diarrhea, vomiting, fever, and abdominal cramps. In children younger than age 5 and in the elderly, hemolytic uremic syndrome—in which red blood cells are destroyed—may develop. This may ultimately lead to acute renal failure.
Gastritis.Nausea is common with gastritis, especially after ingestion of alcohol, aspirin, spicy foods, or caffeine. Vomiting of mucus or blood, epigastric pain, belching, fever, and malaise may also occur.
Gastroenteritis.Usually viral, gastroenteritis causes nausea, vomiting, diarrhea, and abdominal cramping. Fever, malaise, hyperactive bowel sounds, abdominal pain and tenderness, and possible dehydration and electrolyte imbalances may also develop.
Heart failure.Heart failure may produce nausea and vomiting, particularly with right-sided heart failure. Associated findings include tachycardia, a ventricular gallop, profound fatigue, dyspnea, crackles, peripheral edema, jugular vein distention, ascites, nocturia, and diastolic hypertension.
Hepatitis.Nausea is an insidious early symptom of viral hepatitis. Vomiting, fatigue, myalgia and arthralgia, headache, anorexia, photophobia, pharyngitis, cough, and fever also occur early in the preicteric phase.
Hyperemesis gravidarum.Unremitting nausea and vomiting that persist beyond the first trimester are characteristic of hyperemesis gravidarum. Vomitus ranges from undigested food, mucus, and bile early in the disorder to a coffee-ground appearance in later stages. Associated findings include weight loss, signs of dehydration, headache, and delirium.
Intestinal obstruction.Nausea commonly occurs, especially with high small-intestinal obstruction. Vomiting may be bilious or fecal; abdominal pain is usually episodic and colicky, but can become severe and steady with strangulation. Constipation occurs early in large-intestinal obstruction and later in small-intestinal obstruction; obstipation may signal complete obstruction. Bowel sounds are typically hyperactive in partial obstruction and hypoactive or absent in complete obstruction. Abdominal distention and tenderness occur, possibly with visible peristaltic waves and a palpable abdominal mass.
Labyrinthitis.Nausea and vomiting commonly occur with labyrinthitis. More significant findings include severe vertigo, progressive hearing loss, nystagmus, tinnitus and, possibly, otorrhea.
Listeriosis.Signs and symptoms of listeriosis include nausea, vomiting, diarrhea, fever, myalgia, and abdominal pain. If listerosis spreads to the nervous system and causes meningitis, signs and symptoms include fever, headache, nuchal rigidity, and a change in the level of consciousness (LOC).
Ménière's disease.Ménière's disease causes sudden, brief, recurrent attacks of nausea, vomiting, vertigo, tinnitus, diaphoresis, and nystagmus. It also causes hearing loss and ear fullness.
Mesenteric venous thrombosis.An insidious or acute onset of nausea, vomiting, and abdominal pain occurs with mesenteric venous thrombosis, along with diarrhea or constipation, abdominal distention, hematemesis, and melena.
Metabolic acidosis.Metabolic acidosis may produce nausea and vomiting, anorexia, diarrhea, Kussmaul's respirations, and decreased LOC.
Migraine headache.Nausea and vomiting may occur in the prodromal stage of a migraine headache, along with photophobia, light flashes, increased sensitivity to noise, light-headedness and, possibly, partial vision loss and paresthesia of the lips, face, and hands.
Motion sickness.With motion sickness, nausea and vomiting are brought on by motion or rhythmic movement. Headache, dizziness, fatigue, diaphoresis, hypersalivation, and dyspnea may also occur.
Myocardial infarction (MI).Nausea and vomiting may occur with an MI, but the cardinal symptom is severe substernal chest pain that may radiate to the left arm, jaw, or neck. Dyspnea, pallor, clammy skin, diaphoresis, altered blood pressure, and arrhythmias also occur.
Norovirus infection.Acute gastroenteritis from noroviruses commonly causes infected individuals to experience nausea. Common accompanying symptoms include vomiting, diarrhea, and abdominal pain or cramping. Less commonly, individuals may develop low-grade fever, headache, chills, muscle aches, and generalized tiredness.
Pancreatitis (acute).Nausea, usually followed by vomiting, is an early symptom of pancreatitis. Other common findings include steady, severe pain in the epigastrium or left upper quadrant that may radiate to the back; abdominal tenderness and rigidity; anorexia; diminished bowel sounds; and fever. Tachycardia, restlessness, hypotension, skin mottling, and cold, sweaty extremities may occur in severe cases.
Peptic ulcer.With peptic ulcer, nausea and vomiting may follow attacks of sharp or gnawing, burning epigastric pain. Attacks typically occur when the stomach is empty or after the ingestion of alcohol, caffeine, or aspirin; they're relieved by eating food or taking an antacid or antisecretory. Hematemesis or melena may also occur.
Peritonitis.With peritonitis, nausea and vomiting usually accompany acute abdominal pain localized to the area of inflammation. Other findings include a high fever with chills; tachycardia; hypoactive or absent bowel sounds; abdominal distention, rigidity, and tenderness (including rebound tenderness); positive obturator sign and obturator weakness; pale, cold skin; diaphoresis; hypotension; shallow respirations; and hiccups.
Preeclampsia.Nausea and vomiting commonly occur with preeclampsia along with rapid weight gain, epigastric pain, oliguria, a severe frontal headache, hyperreflexia, and blurred or double vision. The classic diagnostic triad of signs include hypertension, proteinuria, and edema.
Q fever.Signs and symptoms of Q fever include nausea, vomiting, diarrhea, fever, chills, severe headache, malaise, and chest pain. In severe cases, the patient may develop hepatitis or pneumonia.
Rhabdomyolysis.Signs and symptoms of rhabdomyolysis include nausea, vomiting, muscle weakness or pain, fever, malaise, and dark urine. Acute renal failure is the most commonly reported complication of the disorder. It results from renal structure obstruction and injury during the kidneys'attempt to filter myoglobin from the bloodstream.
Typhus.With typhus, an abrupt onset of nausea, vomiting, fever, and chills follows the initial symptoms of headache, myalgia, arthralgia, and malaise.
Other causes
Drugs.Common nausea-producing drugs include antineoplastics, opiates, ferrous sulfate, levodopa, oral potassium chloride replacements, estrogens, sulfasalazine, antibiotics, quinidine, anesthetics, cardiac glycosides, theophylline (overdose), and nonsteroidal anti-inflammatory drugs.
Radiation and surgery.Radiation therapy can cause nausea and vomiting. Postoperative nausea and vomiting are common, especially after abdominal surgery.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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