Diagnosis of Morning sickness
Morning sickness Diagnosis: Book Excerpts
Diagnostic Tests for Morning sickness: Online Medical Books
16 MEDICAL BOOKS ONLINE!
Review excerpts from medical books online, free, without registration,
for more information about diagnostis of Morning sickness.
NAUSEA AND VOMITING:
Ask the Following Questions:
(Algorithmic Diagnosis of Symptoms and Signs)
- Is there a history of alcohol or drug ingestion? Alcohol and many drugs such as digitalis, aspirin, nonsteroidal anti-inflammatory agents, antihypertensives, and antibiotics may cause gastric irritation or gastritis.
- Is there fever? Fever may point to a localized abdominal condition such as acute cholecystitis or acute appendicitis, as well as a systemic condition such as tuberculosis, brucellosis, yellow fever, and other febrile illnesses.
- Is there abdominal pain? Abdominal pain suggests the possibility of acute cholecystitis, acute appendicitis, pyelonephritis, pancreatitis, renal calculus, and peritonitis.
- Is there an abdominal mass? The presence of an abdominal mass suggests pyloric or intestinal obstruction, a pancreatic neoplasm, acute cholecystitis, Crohn's disease, perinephric abscess, diverticulitis, and other abscesses and neoplasms.
- Is there vertigo? The clinician should remember that inner ear diseases such as Ménière's disease and labyrinthitis may be associated with vomiting, and sometimes the patient does not mention vertigo.
- Is there headache? Migraine, concussion, cerebral tumors or other space-occupying lesions, meningitis, and subarachnoid hemorrhage are associated with headaches, nausea, and vomiting.
DIAGNOSTIC WORKUP
The basic workup includes a CBC, sedimentation rate, urinalysis, urine drug screen, chemistry panel and electrolytes, serum amylase, arterial blood gases, stools for occult blood, chest x-ray, EKG, and flat plate of the abdomen. Acute onset of nausea and vomiting with ataxia requires an immediate CT scan of the brain to rule out a cerebellar hemorrhage. A pregnancy test should be routine in women of child-bearing age. If there is fever, febrile agglutinins and a heterophile antibody titer should be done. If there is an abdominal mass, a gallbladder ultrasound and intravenous pyelogram may need to be done. Isotope scanning with iminodiacetic acid derivatives is extremely useful to detect acute cholecystitis. If there is chronic vomiting and abdominal pain, the diagnosis can often be made with an upper GI series, small bowel series, or barium enema.
When there is persistent vomiting with abdominal pain, an exploratory laparotomy may need to be considered. The presence of an abdominal mass or suspected pancreatic or biliary disease merits consideration of a CT scan. However, before ordering expensive diagnostic tests, a general surgeon or gastroenterologist ought to be consulted. Laparoscopy, gastroscopy, esophagoscopy, duodenoscopy, and colonoscopy all need to be considered in the workup. Gastroparesis and intestinal pseudo-obstruction can be ruled out by radioisotope studies and manometry of the stomach and small intestine. Angiography is useful to diagnose mesenteric artery ischemia.
» READ BOOK EXCERPT ONLINE »
Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
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
Workup and Diagnosis
- Complete history and physical examination is the most useful
diagnostic aid
–Neurologic examination looking for clues to CNS lesions
–Ear examination to evaluate for middle ear disease
–Ophthalmologic examination to evaluate for nystagmus in
labyrinthitis or benign positional vertigo
–Abdominal examination including stool guaiac to evaluate for GI pathology
-
Labs may include CBC, electrolytes, liver function tests, amylase, lipase, urinalysis, calcium, magnesium, salicylate level, hepatitis serologies, toxicology screen, and CSF analysis (for meningitis or bleeding)
-
ECG and cardiac enzymes may be indicated to evaluate for cardiac ischemia
-
Abdominal CT scan with oral and IV contrast if history and physical examination suggest abdominal pathology
-
Plain KUB X-rays may be indicated to evaluate for bowel obstruction or perforation
-
Abdomen/pelvic ultrasound is especially helpful in cases of lower abdominal pain in female patients or in suspected gallbladder disease
-
Endoscopy is indicated for suspected peptic ulcer disease
-
Head CT with and without contrast if CNS lesion is suspected
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
NAUSEA AND VOMITING:
Approach to the Diagnosis
(Differential Diagnosis in Primary Care)
The association of other symptoms and signs is essential in pinpointing the diagnosis of vomiting. For example, vomiting with tinnitus and vertigo suggests Ménière disease, whereas vomiting with hematemesis suggests gastritis, esophageal varices, and gastric ulcers. The laboratory workup should include a flat plate of the abdomen, upper GI series, esophagram, cholecystogram, gastric analysis, serum electrolytes, and amylase and lipase levels. Stools for occult blood, ova, and parasites are usually indicated. Gastroscopy and esophagoscopy are often indicated in the acute case, but an exploratory laparotomy should not be delayed if the patient’s condition is deteriorating and pancreatitis has been excluded.
» READ BOOK EXCERPT ONLINE »
Source: Differential Diagnosis in Primary Care, 2007
Nausea:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
Begin by obtaining a complete medical history. Focus on GI, endocrine, and metabolic disorders; recent infections; and cancer and its treatment. Ask about drug use and alcohol consumption. If the patient is a female of childbearing age, ask if she is or could be pregnant. Have the patient describe the onset, duration, and intensity of the nausea as well as what causes or relieves it. Ask about related complaints, particularly vomiting (color, amount), abdominal pain, anorexia and weight loss, changes in bowel habits or stool character, excessive belching or flatus, and a sensation of bloating.
Inspect the skin for jaundice, bruises, and spider angiomas, and assess skin turgor. Next, inspect the abdomen for distention, auscultate for bowel sounds and bruits, palpate for rigidity and tenderness, and test for rebound tenderness. Palpate and percuss the liver for enlargement. Assess other body systems as appropriate.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Nausea:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
Begin by obtaining a complete medical history. Focus on GI, endocrine, and metabolic disorders; recent infections; and cancer and its treatment. Ask about drug use and alcohol consumption. If the patient is a female of childbearing age, ask if she is or could be pregnant. Have the patient describe the onset, duration, and intensity of the nausea, as well as what causes or relieves it. Ask about related complaints, particularly vomiting (color, amount), abdominal pain, anorexia and weight loss, changes in bowel habits or stool character, excessive belching or flatus, and a sensation of bloating.
Inspect the skin for jaundice, bruises, and spider angiomas, and assess skin turgor. Next, inspect the abdomen for distention, auscultate for bowel sounds and bruits, palpate for rigidity and tenderness, and test for rebound tenderness. Palpate and percuss the liver for enlargement. Assess other body systems as appropriate.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Nausea and Vomiting:
History.
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
As is usually the case in clinical practice, most diagnoses will be made by history and confirmed by physical examination and laboratory studies. Key points in the history include the following:
A. Are the symptoms acute, chronic, or recurrent?
B. If vomiting is the predominant feature, consider GI infection, reflux, gastritis, or ulcer.
C. Nausea as the predominant feature often results from systemic problems.
D. Is there a history of travel, drinking unsafe water, or eating unusual or uncooked food?
E. Is there a history of fevers or chills (Chapter 2.6.)?
F. Are general systemic symptoms or signs such as edema, discolored urine or jaundice, fatigue, weight loss or anorexia, headache, or blurred vision present?
G. Are psychiatric symptoms present?
H. Is the patient taking any medications?
I. Is diarrhea present?
J. Is there abdominal pain? The presence of abdominal pain raises some important and potentially serious possibilities:
1. Common problems presenting with abdominal pain and vomiting include cholecystitis, appendicitis, gastritis or ulcer, hepatitis, small bowel obstruction, inferior myocardial infarction or ischemia, renal colic, peritonitis, pancreatitis, food poisoning, and complications of pregnancy.
2. Uncommon problems presenting with abdominal pain and vomiting include diabetic ketoacidosis, drug withdrawal, uremia, and vasculitis or abdominal migraine.
3. Rare problems presenting with abdominal pain and vomiting include porphyria, lead intoxication, adrenal insufficiency, hyperlipidemia, abdominal epilepsy, glaucoma, hypercalcemia, and acute hemolysis.
Physical examination.
A directed physical examination is dictated by the findings on history, but the following are areas of key importance:
A. Vital signs. Focus on presence of fever, pulse, and blood pressure to assess hydration, and respiratory rate to look for acidosis-related hyperventilation.
B. Skin, eyes, mucous membranes. Look for dehydration and signs of jaundice.
C. Signs of systemic infection. Pay special attention to examining the lung and the costovertebral angle for tenderness.
D. A detailed abdominal examination should include inspection, auscultation, palpation, percussion, areas of tenderness, rebound, guarding, hepatomegaly, Murphy’s sign, stool for occult blood, and bimanual pelvic examination.
» READ BOOK EXCERPT ONLINE »
Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
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
Diagnostic Approach
Neurological vomiting may be projectile (forceful emesis without prior nausea), positional, or associated with other neurological signs. Central vomiting (chemoreceptor trigger zone stimulation, usually caused by toxins) is alleviated by antidopaminergic medications, which do not work well when treating nausea due to mechanical causes such as obstruction.
Early morning nausea suggests pregnancy or metabolic causes (e.g., uremia). Vomiting of a large amount of undigested food 4 to 6 hours after eating is consistent with gastric retention resulting from pyloric obstruction
or gastroparesis or to esophageal disorders such as achalasia or Zencker diverticulum. Feculent vomiting suggests intestinal obstruction or gastrocolic fistula.
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Nausea:
History
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Begin by obtaining a complete medical history. Focus on GI, endocrine, and metabolic disorders; recent infections; and cancer and its treatment. Ask about drug use and alcohol consumption. If the patient is a female of childbearing age, ask if she is or could be pregnant. Have the patient describe the onset, duration, and intensity of the nausea as well as what causes or relieves it. Ask about related complaints, particularly vomiting (color, amount), abdominal pain, anorexia and weight loss, changes in bowel habits or stool character, excessive belching or flatus, and a sensation of bloating.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Nausea:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
Begin by obtaining a complete medical history. Focus on GI, endocrine, and metabolic disorders; recent infections; and cancer and its treatment. Ask about drug use and alcohol consumption. If the patient is a female of childbearing age, ask if she is or could be pregnant. Have the patient describe the onset, duration, and intensity of the nausea as well as what causes or relieves it. Ask about related complaints, particularly vomiting (such as color and amount), abdominal pain, anorexia and weight loss, changes in bowel habits or stool character, excessive belching or flatus, and a sensation of bloating.
Inspect the skin for jaundice, bruises, and spider angiomas, and assess skin turgor. Next, inspect the abdomen for distention, auscultate for bowel sounds and bruits, palpate for rigidity and tenderness, and test for rebound tenderness. Palpate and percuss the liver for enlargement. Assess other body systems as appropriate.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
NAUSEA AND VOMITING:
Approach to the Diagnosis
(Differential Diagnosis in Primary Care)
The association of other symptoms and signs is essential in pinpointing
the diagnosis of vomiting. For example, vomiting with tinnitus and vertigo
suggests Ménière disease, whereas vomiting with hematemesis suggests
gastritis, esophageal varices, and gastric ulcers. The laboratory workup
should include a flat plate of the abdomen, upper GI series, esophagram,
cholecystogram, gastric analysis, serum electrolytes, and amylase and lipase
levels. Stools for occult blood, ova, and parasites are usually indicated.
Gastroscopy and esophagoscopy are often indicated in the acute case, but an
exploratory laparotomy should not be delayed if the patient’s condition is
deteriorating and pancreatitis has been excluded.
» READ BOOK EXCERPT ONLINE »
Source: Differential Diagnosis in Primary Care, 2007
Have you ever thought about your favorite dessert and started to salivate? You may not have known it, but you were practicing visualization. This...
Many people with viral hepatitis don't know they are infected. Listen as experts discuss who should be tested and review the causes, prevention...
Hepatitis C is called a silent epidemic because many people are unaware they carry this virus of the liver. But experts say hepatitis C is a public...
Hepatitis B is a viral infection of the liver often spread through sexual contact. But people are usually unaware they carry the virus. Find out if...
See full list of 14 related videos
» Next page: Signs of Morning sickness
Rate This Website
What do you think about the features of this website?
Take our user survey and have your say:
Website User Survey
Medical Tools & Articles:
Next articles:
Tools & Services:
Medical Articles:
Forums & Message Boards
- Ask or answer a question at the Boards:
