Causes of Viral gastroenteritis

• Inflammatory
  –Gastroesophageal reflux disease
  –Peptic ulcer disease
  –Pyelonephritis
  –Meningitis
  –Encephalitis
  –Eosinophilic enteropathy
• Central nervous system
  –Brain tumor
  –Trauma
  –Lead encephalopathy
  –Acute intracranial hemorrhage
  –Hydrocephalus
• Metabolic/endocrine
  –Congenital adrenal hyperplasia
  –Hypercalcemia
  –Wolman disease
  –Phenylketonuria

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Abdominal distention: Medical causes
(Handbook of Signs & Symptoms (Third Edition))

❑ Abdominal cancer.Generalized abdominal distention may occur when the cancer — most commonly ovarian, hepatic, or pancreatic — produces ascites (usually in a patient with a known tumor). It’s an indication of advanced disease. Shifting dullness and a fluid wave accompany distention. Associated signs and symptoms may include severe abdominal pain, an abdominal mass, anorexia, jaundice, GI hemorrhage (hematemesis or melena), dyspepsia, and weight loss that progresses to muscle weakness and atrophy.

❑ Abdominal trauma.When brisk internal bleeding accompanies trauma, abdominal distention may be acute and dramatic. Associated signs and symptoms of this life-threatening disorder include abdominal rigidity with guarding, decreased or absent bowel sounds, vomiting, tenderness, and abdominal bruising. Pain may occur over the trauma site, or over the scapula if abdominal bleeding irritates the phrenic nerve. Signs of hypovolemic shock (such as hypotension and rapid, thready pulse) appear with significant blood loss.

❑ Cirrhosis. In cirrhosis, ascites causes generalized distention and is confirmed by a fluid wave, shifting dullness, and a puddle sign. Umbilical eversion and caput medusae (dilated veins around the umbilicus) are common. The patient may report a feeling of fullness or weight gain. Associated findings include vague abdominal pain, fever, anorexia, nausea, vomiting, constipation or diarrhea, bleeding tendencies, severe pruritus, palmar erythema, spider angiomas, leg edema, and possibly splenomegaly. Hematemesis, encephalopathy, gynecomastia, or testicular atrophy may also be seen. Jaundice is usually a late sign. Hepatomegaly occurs initially, but the liver may not be palpable if the patient has advanced disease.

❑ Heart failure. Generalized abdominal distention due to ascites typically accompanies severe cardiovascular impairment and is confirmed by shifting dullness and a fluid wave. Signs and symptoms of heart failure are numerous and depend on the disease stage and degree of cardiovascular impairment. Hallmarks include peripheral edema, jugular vein distention, dyspnea, and tachycardia. Common associated signs and symptoms include hepatomegaly (which may cause right upper quadrant pain), nausea, vomiting, a productive cough, crackles, cool extremities, cyanotic nail beds, nocturia, exercise intolerance, nocturnal wheezing, diastolic hypertension, and cardiomegaly.

❑ Irritable bowel syndrome. Irritable bowel syndrome may produce intermittent, localized distention — the result of periodic intestinal spasms. Lower abdominal pain or cramping typically accompanies these spasms. The pain is usually relieved by defecation or by passage of intestinal gas and is aggravated by stress. Other possible signs and symptoms include diarrhea that may alternate with constipation or normal bowel function, nausea, dyspepsia, straining and urgency at defecation, a feeling of incomplete evacuation, and small, mucus-streaked stools.

❑ Large-bowel obstruction. Dramatic abdominal distention is characteristic in this life-threatening disorder; in fact, loops of the large bowel may become visible on the abdomen. Constipation precedes distention and may be the only symptom for days. Associated findings include tympany, high-pitched bowel sounds, and the sudden onset of colicky lower abdominal pain that becomes persistent. Fecal vomiting and diminished peristaltic waves and bowel sounds are late signs.

❑ Mesenteric artery occlusion (acute). In this life-threatening disorder, abdominal distention usually occurs several hours after the sudden onset of severe, colicky periumbilical pain accompanied by rapid (even forceful) bowel evacuation. The pain later becomes constant and diffuse. Related signs and symptoms include severe abdominal tenderness with guarding and rigidity, absent bowel sounds and, occasionally, a bruit in the right iliac fossa. The patient may also experience vomiting, anorexia, diarrhea, or constipation. Late signs include fever, tachycardia, tachypnea, hypotension, and cool, clammy skin. Abdominal distention or GI bleeding may be the only clue if pain is absent.

❑ Paralytic ileus. Paralytic ileus, which produces generalized distention with a tympanic percussion note, is accompanied by absent or hypoactive bowel sounds and, occasionally, mild abdominal pain and vomiting. The patient may be severely constipated or may pass flatus and small, liquid stools.

❑ Peritonitis. Peritonitis is a life-threatening disorder in which abdominal distention may be localized or generalized, depending on the extent of the inflammation. Fluid accumulates within the peritoneal cavity and then within the bowel lumen, causing a fluid wave and shifting dullness. Typically, distention is accompanied by sudden and severe abdominal pain that worsens with movement, rebound tenderness, and abdominal rigidity.

The skin over the patient’s abdomen may appear taut. Associated signs and symptoms usually include hypoactive or absent bowel sounds, fever, chills, hyperalgesia, nausea, and vomiting. Signs of shock, such as tachycardia and hypotension, appear with significant fluid loss into the abdomen.

❑ Small-bowel obstruction. Abdominal distention is characteristic in small-bowel obstruction, a life-threatening disorder, and is most pronounced during late obstruction, especially in the distal small bowel. Auscultation reveals hypoactive or hyperactive bowel sounds, whereas percussion produces a tympanic note. Accompanying signs and symptoms include colicky periumbilical pain, constipation, nausea, and vomiting; the higher the obstruction, the earlier and more severe the vomiting. Rebound tenderness reflects intestinal strangulation with ischemia. Associated signs and symptoms include drowsiness, malaise, and signs of dehydration. Signs of hypovolemic shock appear with progressive dehydration and plasma loss.

❑ Toxic megacolon (acute).Toxic megacolon is a life-threatening complication of infectious or ulcerative colitis.  It produces dramatic abdominal distention that usually develops gradually and is accompanied by a tympanic percussion note, diminished or absent bowel sounds, and mild rebound tenderness. The patient also presents with abdominal pain and tenderness, fever, tachycardia, and dehydration.

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Bowel sounds, hyperactive: Medical causes
(Handbook of Signs & Symptoms (Third Edition))

❑ Crohn's disease. Hyperactive bowel sounds usually arise insidiously. Associated signs and symptoms include diarrhea, cramping abdominal pain that may be relieved by defecation, anorexia, a low-grade fever, abdominal distention and tenderness and, in many cases, a fixed mass in the right lower quadrant. Perianal and vaginal lesions are common. Muscle wasting, weight loss, and signs of dehydration may occur as Crohn's disease progresses.

❑ Food hypersensitivity. Malabsorption — typically lactose intolerance — may cause hyperactive bowel sounds. Associated signs and symptoms include diarrhea and, possibly, nausea and vomiting, angioedema, and urticaria.

❑ Gastroenteritis. Hyperactive bowel sounds follow sudden nausea and vomiting and accompany “explosive” diarrhea. Abdominal cramping or pain is common, usually after a peristaltic wave. Fever may occur, depending on the causative organism.

❑ GI hemorrhage. Hyperactive bowel sounds provide the most immediate indication of persistent upper GI bleeding. Other findings include hematemesis, coffee-ground vomitus, abdominal distention, bloody diarrhea, rectal passage of bright red clots and jellylike material or melena, and pain during bleeding. Decreased urine output, tachycardia, and hypotension accompany blood loss.

❑ Mechanical intestinal obstruction. Hyperactive bowel sounds occur simultaneously with cramping abdominal pain every few minutes in patients with mechanical intestinal obstruction, a potentially life-threatening disorder; bowel sounds may later become hypoactive and then disappear. With small-bowel obstruction, nausea and vomiting occur earlier and with greater severity than in large-bowel obstruction. With complete bowel obstruction, hyperactive sounds are also accompanied by abdominal distention and constipation, although the part of the bowel distal to the obstruction may continue to empty for up to 3 days.

❑ Ulcerative colitis (acute). Hyperactive bowel sounds arise abruptly in patients with ulcerative colitis and are accompanied by bloody diarrhea, anorexia, abdominal pain, nausea and vomiting, fever, and tenesmus. Weight loss, arthralgias, and arthritis may occur.

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Vomiting: Medical causes
(Handbook of Signs & Symptoms (Third Edition))

Adrenal insufficiency

Common GI findings with the disorder include vomiting, nausea, anorexia, and diarrhea. Other findings include weakness; fatigue; weight loss; bronze skin; orthostatic hypotension; and weak, irregular pulse.

Anthrax (GI)

Initial signs and symptoms after eating contaminated meat from an infected animal include vomiting, loss of appetite, nausea, and fever. Signs and symptoms may progress to abdominal pain, severe bloody diarrhea, and hematemesis.

Appendicitis

Vomiting and nausea may follow or accompany abdominal pain. Pain typically begins as vague epigastric or periumbilical discomfort and rapidly progresses to severe, stabbing pain in the right lower quadrant. The patient generally has a positive McBurney’s sign — severe pain and tenderness on palpation about 2" (5 cm) from the right anterior superior spine of the ilium, on a line between that spine and the umbilicus. Associated findings usually include abdominal rigidity and tenderness, anorexia, constipation or diarrhea, cutaneous hyperalgesia, fever, tachycardia, and malaise.

Cholecystitis (acute)

With cholecystitis, nausea and mild vomiting commonly follow severe right-upper-quadrant pain that may radiate to the back or shoulders. Associated findings include abdominal tenderness and, possibly, rigidity and distention, fever, and diaphoresis.

Cholelithiasis

Nausea and vomiting accompany severe unlocalized right-upper-quadrant or epigastric pain after ingestion of fatty foods. Other findings include abdominal tenderness and guarding, flatulence, belching, epigastric burning, pyrosis, tachycardia, and restlessness.

Cholera

Signs and symptoms include vomiting and abrupt watery diarrhea. Severe water and electrolyte loss leads to thirst, weakness, muscle cramps, decreased skin turgor, oliguria, tachycardia, and hypotension. Without treatment, death can occur within hours.

Cirrhosis

Insidious early signs and symptoms of cirrhosis typically include nausea and vomiting, anorexia, aching abdominal pain, and constipation or diarrhea. Later findings include jaundice, hepatomegaly, and abdominal distention.

Electrolyte imbalances

Such disturbances as hyponatremia, hypernatremia, hypokalemia, and hypercalcemia frequently cause nausea and vomiting. Other effects include arrhythmias, tremors, seizures, anorexia, malaise, and weakness.

Escherichia coli (E. coli)

O157:H7. The signs and symptoms of this infection include vomiting, watery or bloody diarrhea, nausea, fever, and abdominal cramps. In children younger than age 5 and the elderly, hemolytic uremic syndrome may develop in which the red blood cells are destroyed, and this may ultimately lead to acute renal failure.

Food poisoning

Vomiting is a common finding of food poisoning, caused by preformed toxins produced by bacteria typically found in foods, such as Bacillus cereus, Clostridium, and Staphylococcus. Diarrhea and fever also usually occur.

Gastric cancer

This rare cancer may produce mild nausea, vomiting (possibly of mucus or blood), anorexia, upper abdominal discomfort, and chronic dyspepsia. Fatigue, weight loss, melena, and altered bowel habits are also common.

Gastritis

Nausea and vomiting of mucus or blood are common with gastritis, especially after ingestion of alcohol, aspirin, spicy foods, or caffeine. Epigastric pain, belching, and fever may occur.

Gastroenteritis

Gastroenteritis causes nausea, vomiting (often of undigested food), diarrhea, and abdominal cramping. Fever, malaise, hyperactive bowel sounds, and abdominal pain and tenderness may also occur.

Heart failure

Nausea and vomiting may occur, especially with right-sided heart failure. Associated findings include tachycardia, ventricular gallop, fatigue, dyspnea, crackles, peripheral edema, and jugular vein distention.

Hepatitis

Vomiting commonly follows nausea as an early sign of viral hepatitis. Other early findings include fatigue, myalgia, arthralgia, headache, photophobia, anorexia, pharyngitis, cough, and fever.

Hyperemesis gravidarum

Unremitting nausea and vomiting that last beyond the first trimester characterize this disorder of pregnancy. Vomitus contains undigested food, mucus, and small amounts of bile early in the disorder; later, it has a coffee-ground appearance. Associated findings include weight loss, headache, and delirium. Thyroid dysfunction may be associated with this condition.

Increased intracranial pressure

Projectile vomiting that isn’t preceded by nausea is a sign of increased intracranial pressure. The patient may exhibit a decreased LOC and Cushing’s triad (bradycardia, hypertension, and respiratory pattern changes). He may also have headache, widened pulse pressure, impaired motor movement, visual disturbances, pupillary changes, and papilledema.

Intestinal obstruction

Nausea and vomiting (bilious or fecal) are common with intestinal obstruction, especially of the upper small intestine. Abdominal pain is usually episodic and colicky but can become severe and steady. Constipation occurs early in large intestinal obstruction and late in small intestinal obstruction. Obstipation, however, may signal complete obstruction. In partial obstruction, bowel sounds are typically high pitched and hyperactive; in complete obstruction, bowel sounds are typically hypoactive or absent. Abdominal distention and tenderness also occur, possibly with visible peristaltic waves and a palpable abdominal mass.

Labyrinthitis

Nausea and vomiting commonly occur with this acute inner ear inflammation. Other findings include severe vertigo, progressive hearing loss, nystagmus, and possibly otorrhea.

Listeriosis

After the ingestion of food contaminated with the bacterium Listeria monocytogenes, vomiting, fever, myalgias, abdominal pain, nausea, and diarrhea occur. If the infection spreads to the nervous system, meningitis may develop. Signs and symptoms may include fever, headache, nuchal rigidity, and change in LOC. The food-borne illness primarily affects pregnant women, neonates, and those with weakened immune systems.

Gender Cue:Infections that occur during pregnancy may lead to premature delivery, infection of the neonate, or stillbirth.

Mesenteric venous thrombosis

Insidious or acute onset of nausea, vomiting, and abdominal pain occurs here, with diarrhea or constipation, abdominal distention, hematemesis, and melena.

Migraine headache

Nausea and vomiting are prodromal signs and symptoms, with fatigue, photophobia, light flashes, increased noise sensitivity, and possibly partial vision loss and paresthesia.

Motion sickness

Nausea and vomiting may be accompanied by headache, vertigo, dizziness, fatigue, diaphoresis, and dyspnea.

Pancreatitis (acute)

Vomiting, usually preceded by nausea, is an early sign of pancreatitis. Associated findings include steady, severe epigastric or left-upper-quadrant pain that may radiate to the back, abdominal tenderness and rigidity, hypoactive bowel sounds, anorexia, vomiting, and fever. Tachycardia, restlessness, hypotension, skin mottling, and cold, sweaty extremities may occur in severe cases.

Peritonitis

Nausea and vomiting usually accompany acute abdominal pain in the area of inflammation. Other findings include high fever with chills; tachycardia; hypoactive or absent bowel sounds; abdominal distention, rigidity, and tenderness; weakness; pale, cold skin; diaphoresis; hypotension; signs of dehydration; and shallow respirations.

Preeclampsia

Nausea and vomiting are common with preeclampsia, a disorder of pregnancy. Rapid weight gain, epigastric pain, generalized edema, elevated blood pressure, oliguria, severe frontal headache, and blurred or double vision also occur.

Q fever

Signs and symptoms of Q fever, a rickettsial infection, include vomiting, fever, chills, severe headache, malaise, chest pain, nausea, and diarrhea. Fever may last up to 2 weeks. In severe cases, the patient may develop hepatitis or pneumonia.

Renal and urologic disorders

Cystitis, pyelonephritis, calculi, and other disorders of this system can cause vomiting. Accompanying findings reflect the specific disorder. Persistent nausea and vomiting are typical findings in patients with acute or worsening chronic renal failure.

Rhabdomyolysis

Signs and symptoms of this disorder include vomiting, muscle weakness or pain, fever, nausea, 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 kidney’s attempt to filter the myoglobin from the bloodstream.

Typhus

Typhus is a rickettsial disease transmitted to humans by fleas, mites, or body louse. Initial symptoms include headache, myalgia, arthralgia, and malaise, followed by an abrupt onset of vomiting, nausea, chills, and fever. A maculopapular rash may be present in some cases.

Other causes

Drugs

Drugs that commonly cause vomiting include antineoplastics, opiates, ferrous sulfate, levodopa, oral potassium, chloride replacements, estrogens, sulfasalazine, antibiotics, quinidine, anesthetics, and overdoses of cardiac glycosides and theophylline. Syrup of ipecac is a mixture of ipecac fluid extract, glycerin, and syrup. It’s used to treat overdoses by inducing vomiting.

Radiation and surgery

Radiation therapy may cause nausea and vomiting if it disrupts the gastric mucosa. Postoperative nausea and vomiting are common, especially after abdominal surgery.

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Gastroenteritis: Causes and incidence
(Professional Guide to Diseases (Eighth Edition))

Gastroenteritis has many possible causes, including:

❑ bacteria (responsible for acute food poisoning), such as Staphylococcus aureus, Salmonella, Shigella, Clostridium botulinum, C. perfringens, and Escherichia coli

❑ amebae, especially Entamoeba histolytica

❑ parasites, such as Ascaris, Enterobius, and Trichinella spiralis

❑ viruses (may be responsible for traveler’s diarrhea) such as adenoviruses, echoviruses, or coxsackieviruses

❑ ingestion of toxins, including plants or toadstools

❑ drug reactions; for example, to antibiotics

❑ enzyme deficiencies

❑ food allergens.

The bowel reacts to any of these enterotoxins with hypermotility, producing severe diarrhea and secondary depletion of intracellular fluid. Chronic gastroenteritis is usually the result of another GI disorder such as ulcerative colitis.

Diarrhea accounts for as many as 3% of pediatric office visits and 10% of hospitalizations for patients younger than age 5. Each year, gastroenteritis affects every adult and accounts for 8 million physician visits and 250,000 hospitalizations. Traveler’s diarrhea affects 20% to 25% of people traveling from industrialized countries to developing countries.

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Abdominal distention: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Abdominal cancer

Generalized abdominal distention may occur when the cancer—most commonly ovarian, hepatic, or pancreatic cancer—produces ascites (usually in a patient with a known tumor). It’s an indication of advanced disease. Shifting dullness and a fluid wave accompany distention. Associated signs and symptoms may include severe abdominal pain, an abdominal mass, anorexia, jaundice, GI hemorrhage (hematemesis or melena), dyspepsia, and weight loss that progresses to muscle weakness and atrophy.

Abdominal trauma

When brisk internal bleeding accompanies trauma, abdominal distention may be acute and dramatic. Associated signs and symptoms of this life-threatening disorder include abdominal rigidity with guarding, decreased or absent bowel sounds, vomiting, tenderness, and abdominal bruising. The patient may feel pain over the trauma site, or over the scapula if abdominal bleeding irritates the phrenic nerve. Signs of hypovolemic shock (such as hypotension and rapid, thready pulse) appear with significant blood loss.

Bladder distention

Various disorders cause bladder distention, which in turn causes lower abdominal distention. Slight dullness on percussion above the symphysis indicates mild bladder distention. A palpable, smooth, rounded, fluctuant suprapubic mass suggests severe distention; a fluctuant mass extending to the umbilicus indicates extremely severe distention. Urinary dribbling, frequency, or urgency may occur with urinary obstruction. Suprapubic discomfort is also common.

Cirrhosis

In cirrhosis, ascites causes generalized distention and is confirmed by a fluid wave, shifting dullness, and a puddle sign. Umbilical eversion and caput medusae (dilated veins around the umbilicus) are common. The patient may report a feeling of fullness or weight gain. Associated findings include vague abdominal pain, fever, anorexia, nausea, vomiting, constipation or diarrhea, bleeding tendencies, severe pruritus, palmar erythema, spider angiomas, leg edema, and possibly splenomegaly. Hematemesis, encephalopathy, gynecomastia, or testicular atrophy may also occur. Jaundice is usually a late sign. Hepatomegaly occurs initially, but the liver may not be palpable in advanced disease.

Gastric dilation (acute)

Left-upper-quadrant distention is characteristic in acute gastric dilation, but the presentation varies. The patient usually complains of epigastric fullness or pain and nausea with or without vomiting. Physical examination reveals tympany, gastric tenderness, and a succussion splash. Initially, peristalsis may be visible. Later, hypoactive or absent bowel sounds confirm ileus. The patient may be pale and diaphoretic and may exhibit tachycardia or bradycardia.

Heart failure

Generalized abdominal distention due to ascites typically accompanies severe cardiovascular impairment and is confirmed by shifting dullness and a fluid wave. Signs and symptoms of heart failure are numerous and depend on the disease stage and degree of cardiovascular impairment. Hallmarks include peripheral edema, jugular vein distention, dyspnea, and tachycardia. Common associated signs and symptoms include hepatomegaly (which may cause right-upper-quadrant pain), nausea, vomiting, productive cough, crackles, cool extremities, cyanotic nail beds, nocturia, exercise intolerance, nocturnal wheezing, diastolic hypertension, and cardiomegaly.

Irritable bowel syndrome (IBS)

IBS may produce intermittent, localized distention—the result of periodic intestinal spasms. Lower abdominal pain or cramping typically accompanies these spasms. The pain is usually relieved by defecation or by passage of intestinal gas and is aggravated by stress. Other possible signs and symptoms include diarrhea that may alternate with constipation or normal bowel function; nausea; dyspepsia; straining and urgency at defecation; feeling of incomplete evacuation; and small, mucus-streaked stools.

Large-bowel obstruction

Dramatic abdominal distention is characteristic in large-bowel obstruction, a life-threatening disorder; in fact, loops of the large bowel may become visible on the abdomen. Constipation precedes distention and may be the only symptom for days. Associated findings include tympany, high-pitched bowel sounds, and sudden onset of colicky lower abdominal pain that becomes persistent. Fecal vomiting and diminished peristaltic waves and bowel sounds are late signs.

Mesenteric artery occlusion (acute)

In mesenteric artery occlusion—a life-threatening disorder—abdominal distention usually occurs several hours after the sudden onset of severe, colicky periumbilical pain accompanied by rapid (even forceful) bowel evacuation. The pain later becomes constant and diffuse. Related signs and symptoms include severe abdominal tenderness with guarding and rigidity, absent bowel sounds and, occasionally, a bruit in the right iliac fossa. The patient may also experience vomiting, anorexia, diarrhea, or constipation. Late signs include fever, tachycardia, tachypnea, hypotension, and cool, clammy skin. Abdominal distention or GI bleeding may be the only clue if pain is absent.

Nephrotic syndrome

Nephrotic syndrome may produce massive edema, causing generalized abdominal distention with a fluid wave and shifting dullness. It may also produce elevated blood pressure, hematuria or oliguria, fatigue, anorexia, depression, pallor, periorbital edema, scrotal swelling, and skin striae.

Ovarian cysts

Typically, large ovarian cysts produce lower abdominal distention accompanied by umbilical eversion. Because they’re thin walled and fluid filled, these cysts produce a fluid wave and shifting dullness—signs that mimic ascites. Lower abdominal pain and a palpable mass may be present.

Paralytic ileus

Paralytic ileus, which produces generalized distention with a tympanic percussion note, is accompanied by absent or hypoactive bowel sounds and, occasionally, mild abdominal pain and vomiting. The patient may be severely constipated or may pass flatus and small, liquid stools.

Peritonitis

In peritonitis—a life-threatening disorder—abdominal distention may be localized or generalized, depending on the extent of peritonitis. Fluid accumulates first within the peritoneal cavity and then within the bowel lumen, causing a fluid wave and shifting dullness. Typically, distention is accompanied by rebound tenderness, abdominal rigidity, and sudden and severe abdominal pain that worsens with movement.

The skin over the patient’s abdomen may appear taut. Associated signs and symptoms usually include hypoactive or absent bowel sounds, fever, chills, hyperalgesia, nausea, and vomiting. Signs of shock, such as tachycardia and hypotension, appear with significant fluid loss into the abdomen.

Small-bowel obstruction

Abdominal distention, which is characteristic in small-bowel obstruction—a life-threatening disorder—is most pronounced during late obstruction, especially in the distal small bowel. Auscultation reveals hypoactive or hyperactive bowel sounds, whereas percussion produces a tympanic note. Accompanying signs and symptoms include colicky periumbilical pain, constipation, nausea, and vomiting; the higher the obstruction, the earlier and more severe the vomiting. Rebound tenderness reflects intestinal strangulation with ischemia. Associated signs and symptoms include drowsiness, malaise, and signs of dehydration. Signs of hypovolemic shock appear with progressive dehydration and plasma loss.

Toxic megacolon (acute)

Toxic megacolon is a life-threatening complication of infectious or ulcerative colitis that produces dramatic abdominal distention. The distention usually develops gradually and is accompanied by a tympanic percussion note, diminished or absent bowel sounds, and mild rebound tenderness. The patient also experiences abdominal pain and tenderness, fever, tachycardia, and dehydration.

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Bowel sounds, hyperactive: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Crohn’s disease

Hyperactive bowel sounds usually arise insidiously in Crohn’s disease. Associated signs and symptoms include diarrhea, cramping abdominal pain that may be relieved by defecation, anorexia, low-grade fever, abdominal distention and tenderness and, in many cases, a fixed mass in the right lower quadrant. Perianal and vaginal lesions are common. Muscle wasting, weight loss, and signs of dehydration may occur as Crohn’s disease progresses.

Food hypersensitivity

Malabsorption—typically lactose intolerance—may cause hyperactive bowel sounds. Associated signs and symptoms include diarrhea and, possibly, nausea and vomiting, angioedema, and urticaria.

Gastroenteritis

Hyperactive bowel sounds follow sudden nausea and vomiting and accompany “explosive” diarrhea. Abdominal cramping or pain is common, often after a peristaltic wave. Fever may occur, depending on the causative organism.

GI hemorrhage

Hyperactive bowel sounds provide the most immediate indication of persistent upper GI bleeding. Other findings include hematemesis, coffee-ground vomitus, abdominal distention, bloody diarrhea, rectal passage of bright red clots and jellylike material or melena, and pain during bleeding. Decreased urine output, tachycardia, and hypotension accompany blood loss.

Mechanical intestinal obstruction

Hyperactive bowel sounds occur simultaneously with cramping abdominal pain every few minutes in patients with mechanical intestinal obstruction—a potentially life-threatening disorder. Bowel sounds may later become hypoactive and then disappear. Nausea and vomiting occur earlier and with greater severity in small-bowel obstruction than in large-bowel obstruction. In complete bowel obstruction, hyperactive sounds are also accompanied by abdominal distention and constipation, although the part of the bowel distal to the obstruction may continue to empty for up to 3 days.

Ulcerative colitis (acute)

Hyperactive bowel sounds arise abruptly in patients with ulcerative colitis and are accompanied by bloody diarrhea, anorexia, abdominal pain, nausea and vomiting, fever, and tenesmus. Weight loss, arthralgia, and arthritis may occur.

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Vomiting: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Adrenal insufficiency

Common GI findings in the disorder include nausea and vomiting, anorexia, and diarrhea. Other findings include weakness, fatigue, weight loss, bronze skin, orthostatic hypotension, and a weak, irregular pulse.

Anthrax, GI

Initial signs and symptoms after ingestion of contaminated meat from an infected animal include nausea and vomiting, anorexia, and fever. Later, abdominal pain, severe bloody diarrhea, and hematemesis may occur.

Appendicitis

Nausea and vomiting may follow or accompany abdominal pain. Pain typically begins as vague epigastric or periumbilical discomfort and rapidly progresses to severe, stabbing pain in the right lower quadrant. The patient generally has a positive McBurney’s sign—severe pain and tenderness at a point two-thirds the distance from the umbilicus to the right anterior superior spine of the ilium. Associated findings usually include abdominal rigidity and tenderness, anorexia, constipation or diarrhea, cutaneous hyperalgesia, fever, tachycardia, and malaise.

Bulimia

Most common in women ages 18 to 29, bulimia is characterized by polyphagia that alternates with self-induced vomiting, fasting, or diarrhea. It’s commonly accompanied by anorexia. The patient typically weighs less than normal but has a morbid fear of obesity. Self-induced vomiting may be evidenced by calloused knuckles and changes in teeth (enamel loss).

Cholecystitis (acute)

With this disorder, nausea and mild vomiting commonly follow severe right-upper-quadrant pain that may radiate to the back or shoulders. Associated findings include abdominal tenderness and, possibly, rigidity and distention, fever, and diaphoresis.

Cholelithiasis

Nausea and vomiting accompany severe unlocalized right-upper-quadrant or epigastric pain after ingestion of fatty foods. Other findings include abdominal tenderness and guarding, flatulence, belching, epigastric burning, pyrosis, tachycardia, and restlessness.

Cholera

Signs and symptoms of cholera include vomiting and abrupt watery diarrhea. Severe water and electrolyte loss leads to thirst, weakness, muscle cramps, decreased skin turgor, oliguria, tachycardia, and hypotension. Without treatment, death can occur within hours.

Cirrhosis

Insidious early signs and symptoms of cirrhosis typically include nausea and vomiting, anorexia, aching abdominal pain, and constipation or diarrhea. Later findings include jaundice, hepatomegaly, and abdominal distention.

Escherichia coli O157:H7

The signs and symptoms of this infection include nausea and vomiting, watery or bloody diarrhea, fever, and abdominal cramps. Children younger than age 5 and elderly people may develop hemolytic uremic syndrome, which causes red blood cell destruction and may eventually lead to acute renal failure.

Ectopic pregnancy

Nausea, vomiting, vaginal bleeding, and lower abdominal pain occur in this potentially life-threatening disorder.

Electrolyte imbalances

Such disturbances as hyponatremia, hypernatremia, hypokalemia, and hypercalcemia commonly cause nausea and vomiting. Other effects include arrhythmias, tremors, seizures, anorexia, malaise, and weakness.

Food poisoning

Vomiting, diarrhea, and fever are common findings in food poisoning, which is caused by ingestion of preformed toxins produced by bacteria typically found in foods, such as Bacillus cereus, Clostridium, and Staphylococcus.

Gastric cancer

This rare type of cancer may produce mild nausea, vomiting (possibly of mucus or blood), anorexia, upper abdominal discomfort, and chronic dyspepsia. Fatigue, weight loss, melena, and altered bowel elimination habits are also common.

Gastritis

Nausea and vomiting of mucus or blood are common in gastritis, especially after ingestion of alcohol, aspirin, spicy foods, or caffeine. Epigastric pain, belching, and fever may also occur.

Gastroenteritis

This disorder causes nausea, vomiting (often of undigested food), diarrhea, and abdominal cramping. Fever, malaise, hyperactive bowel sounds, and abdominal pain and tenderness may also occur.

Heart failure

Nausea and vomiting may occur, especially in right-sided heart failure. Associated findings include tachycardia, ventricular gallop, fatigue, dyspnea, crackles, peripheral edema, and jugular vein distention.

Hepatitis

Vomiting commonly follows nausea as an early sign of viral hepatitis. Other early findings include fatigue, myalgia, arthralgia, headache, photophobia, anorexia, pharyngitis, cough, and fever.

Hyperemesis gravidarum

Unremitting nausea and vomiting that last beyond the first trimester characterize this disorder of pregnancy. Vomitus contains undigested food, mucus, and small amounts of bile early in the disorder; later, it has a coffee-ground appearance. Associated findings include weight loss, headache, delirium and, possibly, thyroid dysfunction.

Increased intracranial pressure

Projectile vomiting that isn’t preceded by nausea is a sign of increased intracranial pressure. The patient may exhibit a decreased level of consciousness (LOC) and Cushing’s triad (bradycardia, hypertension, and respiratory pattern changes). He may also have a headache, widened pulse pressure, impaired movement, visual disturbances, pupillary changes, and papilledema.

Infection

Acute localized or systemic infection may cause vomiting and nausea. Other common findings include fever, headache, malaise, and fatigue.

Intestinal obstruction

Nausea and vomiting (bilious or fecal) are common in this type of obstruction, especially of the upper small intestine. Abdominal pain is usually episodic and colicky but can become severe and steady. Constipation occurs early in large intestinal obstruction and late in small intestinal obstruction. Obstipation, however, may signal complete obstruction. In partial obstruction, bowel sounds are typically high pitched and hyperactive; in complete obstruction, hypoactive or absent. Abdominal distention and tenderness also occur, possibly with visible peristaltic waves and a palpable abdominal mass.

Labyrinthitis

Nausea and vomiting commonly occur in this acute inner ear inflammation. Other findings include severe vertigo, progressive hearing loss, nystagmus and, possibly, otorrhea.

Listeriosis

After ingesting food contaminated with the bacterium Listeria monocytogenes, the patient develops nausea, vomiting, abdominal pain, diarrhea, fever, and myalgia. If the infection spreads to the nervous system, he may develop meningitis. Signs and symptoms may include fever, headache, nuchal rigidity, and altered LOC. This food-borne illness primarily affects pregnant women, newborns, and those with weakened immune systems.

Gender Cue: Listeriosis that occurs during pregnancy may lead to premature delivery, infection of the neonate, or stillbirth.

Ménière’s disease

This disorder results in sudden, brief, recurrent attacks of nausea and vomiting, dizziness, vertigo, hearing loss, tinnitus, diaphoresis, and nystagmus.

Mesenteric artery ischemia

This life-threatening disorder may cause nausea and vomiting and 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 along with diarrhea or constipation, abdominal distention, hematemesis, and melena.

Metabolic acidosis

This imbalance may produce nausea, vomiting, anorexia, diarrhea, Kussmaul’s respirations, and decreased LOC.

Migraine headache

Prodromal signs and symptoms of migraine include nausea and vomiting, fatigue, photophobia, light flashes, increased noise sensitivity and, possibly, partial vision loss and paresthesia.

Motion sickness

Nausea and vomiting may be accompanied by headache, vertigo, dizziness, fatigue, diaphoresis, and dyspnea.

Myocardial infarction

Nausea and vomiting may occur, but the cardinal symptom is severe substernal chest pain, which may radiate to the left arm, jaw, or neck. Dyspnea, pallor, clammy skin, diaphoresis, and restlessness also occur.

Norovirus infection

Violent vomiting may occur frequently and without warning in this infection. Children infected with noroviruses tend to experience acute-onset vomiting more often than adults. Additional symptoms include nausea, diarrhea, and abdominal pain or cramping. There are no drugs or vaccines for noroviruses, but symptomatic therapy may be necessary to replace fluids and correct electrolyte disturbances resulting from frequent vomiting and diarrhea. Young children, elderly people, and those who are otherwise ill are at increased risk for dehydration.

Pancreatitis (acute)

Vomiting, usually preceded by nausea, is an early sign of pancreatitis. Associated findings include steady, severe epigastric or left-upper-quadrant pain that may radiate to the back; abdominal tenderness and rigidity; hypoactive bowel sounds; anorexia; vomiting; and fever. Severe pancreatitis may result in tachycardia, restlessness, hypotension, skin mottling, and cold, sweaty extremities.

Peptic ulcer

Nausea and vomiting may follow sharp, burning or gnawing epigastric pain, especially when the stomach is empty or after ingestion of alcohol, caffeine, or aspirin. Attacks are relieved by eating or taking antacids. Hematemesis or melena may also occur.

Peritonitis

Nausea and vomiting usually accompany acute abdominal pain in the area of inflammation. Other findings include high fever with chills; tachycardia; hypoactive or absent bowel sounds; abdominal distention, rigidity, and tenderness; weakness; pale, cold skin; diaphoresis; hypotension; signs of dehydration; and shallow respirations.

Preeclampsia

Nausea and vomiting are common in this disorder of pregnancy. Rapid weight gain, epigastric pain, generalized edema, elevated blood pressure, oliguria, a severe frontal headache, and blurred or double vision also occur.

Q fever

Signs and symptoms of this rickettsial infection include nausea and vomiting, fever, chills, severe headache, malaise, chest pain, and diarrhea. Fever may last up to 2 weeks. In severe cases, the patient may develop hepatitis or pneumonia.

Renal and urologic disorders

Cystitis, pyelonephritis, calculi, and other renal and urologic disorders can cause vomiting. Accompanying findings reflect the specific disorder. Persistent nausea and vomiting are typical findings in patients with acute or worsening chronic renal failure.

Rhabdomyolysis

Signs and symptoms of this disorder include nausea and vomiting, muscle weakness or pain, fever, malaise, and dark urine. Acute renal failure, the most commonly reported complication of rhabdomyolysis, results from renal structure obstruction and injury during the kidneys’attempt to filter the myoglobin from the bloodstream.

Thyrotoxicosis

Nausea and vomiting may accompany the classic findings of severe anxiety, heat intolerance, weight loss despite increased appetite, diaphoresis, diarrhea, tremors, tachycardia, and palpitations. Other findings include exophthalmos, ventricular or atrial gallop, and an enlarged thyroid gland.

Typhus

Typhus is a rickettsial disease transmitted to humans by fleas, mites, or body louse. Initial symptoms include headache, myalgia, arthralgia, and malaise, followed by an abrupt onset of nausea, vomiting, chills, and fever. A maculopapular rash may be present in some cases.

Ulcerative colitis

Nausea, vomiting, and anorexia may occur, but the most common sign is recurrent diarrhea with blood, pus, and mucus. Fever, chills, and weight loss are other common signs and symptoms.

Other causes

Drugs

Drugs that commonly cause vomiting include antineoplastics, opiates, ferrous sulfate, levodopa, oral potassium, chloride replacements, estrogens, sulfasalazine, antibiotics, quinidine, anesthetics, and overdoses of cardiac glycosides and theophylline. Syrup of ipecac, a mixture of ipecac fluid extract, glycerin, and syrup, is used to treat drug overdoses by inducing vomiting.

Radiation and surgery

Radiation therapy may cause nausea and vomiting if it disrupts the gastric mucosa. Postoperative nausea and vomiting are common, especially after abdominal surgery.

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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

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Gastroenteritis: Causes
(Handbook of Diseases)

Gastroenteritis has many possible causes, including the following:

❑ bacteria (responsible for acute food poisoning) — Staphylococcus aureus, Salmonella, Shigella, Clostridium botulinum, Escherichia coli, Clostridium perfringens

❑ amoebae — especially Entamoeba histolytica

❑ parasites — Ascaris, Enterobius, Trichinella spiralis

❑ viruses (may be responsible for traveler’s diarrhea) — adenovirus, echovirus, or coxsackievirus

❑ ingestion of toxins — plants or toadstools (mushrooms)

❑ drug reactions — antibiotics

❑ enzyme deficiencies

❑ food allergens.

The bowel reacts to any of these enterotoxins with hypermotility, producing severe diarrhea and secondary depletion of intracellular fluid.

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Bowel sounds, hyperactive: Medical causes
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)

See Hyperactive bowel sounds: Causes and associated findings.

Crohn’s disease

Food hypersensitivity

Gastroenteritis

GI hemorrhage

Mechanical intestinal obstruction

Ulcerative colitis (acute)

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Vomiting: Medical causes
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)

Adrenal insufficiency

Common GI findings with adrenal insufficiency include vomiting, nausea, anorexia, and diarrhea. Other findings include weakness, fatigue, weight loss, bronze skin, orthostatic hypotension, and a weak, irregular pulse.

Anthrax (GI)

Initial signs and symptoms after eating contaminated meat from an infected animal include vomiting, loss of appetite, nausea, and fever. Signs and symptoms may progress to abdominal pain, severe bloody diarrhea, and hematemesis.

Appendicitis

Bulimia

Cholecystitis (acute)

With acute cholecystitis, nausea and mild vomiting commonly follow severe right upper quadrant pain that may radiate to the back or shoulders. Associated findings include abdominal tenderness and, possibly, rigidity and distention, fever, and diaphoresis.

Cholelithiasis

Nausea and vomiting accompany severe unlocalized right upper quadrant or epigastric pain after eating fatty foods. Other findings include abdominal tenderness and guarding, flatulence, belching, epigastric burning, pyrosis, tachycardia, and restlessness.

Cholera

Signs and symptoms include vomiting and abrupt watery diarrhea. Severe water and electrolyte loss leads to thirst, weakness, muscle cramps, decreased skin turgor, oliguria, tachycardia, and hypotension. Without treatment, death can occur within hours.

Cirrhosis

Insidious early signs and symptoms of cirrhosis typically include nausea and vomiting, anorexia, aching abdominal pain, and constipation or diarrhea. Later findings include jaundice, hepatomegaly, and abdominal distention. O157:H7. The signs and symptoms of E. coli O157:H7 infection include vomiting, watery or bloody diarrhea, nausea, fever, and abdominal cramps. In children younger than age 5 and in elderly people, hemolytic uremic syndrome may develop in which the red blood cells are destroyed, and this may ultimately lead to acute renal failure.

Ectopic pregnancy

Vomiting, nausea, vaginal bleeding, and lower abdominal pain occur in ectopic pregnancy, a potentially life-threatening disorder.

Electrolyte imbalances

Such disturbances as hyponatremia, hypernatremia, hypokalemia, and hypercalcemia commonly cause nausea and vomiting. Other effects include arrhythmias, tremors, seizures, anorexia, malaise, and weakness.

Food poisoning

Gastric cancer

This rare cancer may produce mild nausea, vomiting (possibly of mucus or blood), anorexia, upper abdominal discomfort, and chronic dyspepsia. Fatigue, weight loss, melena, and altered bowel habits are also common.

Gastritis

Nausea and vomiting of mucus or blood are common with gastritis, especially after ingestion of alcohol, aspirin, spicy foods, or caffeine. Epigastric pain, belching, and fever may also occur.

Gastroenteritis

Gastroenteritis causes nausea, vomiting (commonly of undigested food), diarrhea, and abdominal cramping. Fever, malaise, hyperactive bowel sounds, and abdominal pain and tenderness may also occur.

Heart failure

Nausea and vomiting may occur, especially with right-sided heart failure. Associated findings include tachycardia, ventricular gallop, fatigue, dyspnea, crackles, peripheral edema, and jugular vein distention.

Hepatitis

Vomiting commonly follows nausea as an early sign of viral hepatitis. Other early findings include fatigue, myalgia, arthralgia, headache, photophobia, anorexia, pharyngitis, cough, and fever.

Hyperemesis gravidarum

Unremitting nausea and vomiting that last beyond the first trimester characterize hyperemesis gravidarum, a disorder of pregnancy. Vomitus contains undigested food, mucus, and small amounts of bile early in the disorder; later, it has a coffee-ground appearance. Associated findings include weight loss, headache, and delirium. Thyroid dysfunction may be associated with this condition.

Increased ICP

Projectile vomiting that isn’t preceded by nausea is a sign of increased ICP. The patient may exhibit a decreased level of consciousness (LOC) and Cushing’s triad (bradycardia, hypertension, and respiratory pattern changes. He may also have headache, widened pulse pressure, impaired motor movement, vision disturbances, pupillary changes, and papilledema.

Infection

Acute localized or systemic infection may cause vomiting and nausea. Other common findings include fever, headache, malaise, and fatigue.

Intestinal obstruction

Nausea and vomiting (bilious or fecal) are common with intestinal obstruction, especially of the upper small intestine. Abdominal pain is usually episodic and colicky but can become severe and steady. Constipation occurs early in large intestinal obstruction and late in small intestinal obstruction. Obstipation, however, may signal complete obstruction. In partial obstruction, bowel sounds are typically high pitched and hyperactive; in complete obstruction, hypoactive or absent. Abdominal distention and tenderness also occur, possibly with visible peristaltic waves and a palpable abdominal mass.

Labyrinthitis

Nausea and vomiting commonly occur with labyrinthitis, an acute inner ear inflammation. Other findings include severe vertigo, progressive hearing loss, nystagmus and, possibly, otorrhea.

Listeriosis

Ménière’s disease

Ménière’s disease causes sudden, brief, recurrent attacks of nausea and vomiting, dizziness, vertigo, hearing loss, tinnitus, diaphoresis, and nystagmus.

Mesenteric artery ischemia

A life-threatening disorder, mesenteric artery ischemia may cause nausea and vomiting and 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

An insidious or an acute onset of nausea, vomiting, and abdominal pain occur with mesenteric venous thrombosis and may be accompanied by diarrhea or constipation, abdominal distention, hematemesis, and melena.

Metabolic acidosis

Metabolic acidosis is an imbalance that may produce nausea, vomiting, anorexia, diarrhea, Kussmaul’s respirations, and a decreased LOC.

Migraine headache

Nausea and vomiting are prodromal signs and symptoms, with fatigue, photophobia, light flashes, increased noise sensitivity and, possibly, partial vision loss and paresthesia.

Motion sickness

Nausea and vomiting may be accompanied by headache, vertigo, dizziness, fatigue, diaphoresis, and dyspnea.

Myocardial infarction

Nausea and vomiting may occur, but the cardinal symptom is severe substernal chest pain, which may radiate to the left arm, jaw, or neck. Dyspnea, pallor, clammy skin, diaphoresis, and restlessness also occur.

Pancreatitis (acute)

Vomiting, usually preceded by nausea, is an early sign of pancreatitis. Associated findings include steady, severe epigastric or left upper quadrant pain that may radiate to the back, abdominal tenderness and rigidity, hypoactive bowel sounds, anorexia, vomiting, and fever. Tachycardia, restlessness, hypotension, skin mottling, and cold, sweaty extremities may occur in severe cases.

Peptic ulcer

Nausea and vomiting may follow sharp, burning or gnawing epigastric pain, especially when the stomach is empty or after the ingestion of alcohol, caffeine, or aspirin. Attacks are relieved by eating or taking antacids. Hematemesis or melena may also occur.

Peritonitis

Nausea and vomiting usually accompany acute abdominal pain in the area of inflammation. Other findings include abdominal distention, rigidity, and tenderness as well as high fever with chills, tachycardia, hypoactive or absent bowel sounds, weakness, and pale, cold skin. The patient may also experience diaphoresis, hypotension, signs of dehydration, and shallow respirations.

Preeclampsia

Nausea and vomiting are common with preeclampsia, a disorder of pregnancy. Rapid weight gain, epigastric pain, generalized edema, elevated blood pressure, oliguria, severe frontal headache, and blurred or double vision also occur.

Q fever

Signs and symptoms of Q fever, a rickettsial infection, include vomiting, fever, chills, severe headache, malaise, chest pain, nausea, and diarrhea. Fever may last up to 2 weeks. In severe cases, the patient may develop hepatitis or pneumonia.

Renal and urologic disorders

Cystitis, pyelonephritis, calculi, and other disorders of this system can cause vomiting. Accompanying findings reflect the specific disorder. Persistent nausea and vomiting are typical findings in patients with acute or worsening chronic renal failure.

Rhabdomyolysis

Signs and symptoms of rhabdomyolisis include vomiting, muscle weakness or pain, fever, nausea, malaise, and dark urine. Acute renal failure is the most commonly reported complication. It results from renal structure obstruction and injury during the kidney’s attempt to filter myoglobin from the bloodstream.

Thyrotoxicosis

Nausea and vomiting may accompany the classic findings of severe anxiety, heat intolerance, weight loss despite increased appetite, diaphoresis, diarrhea, tremors, tachycardia, and palpitations. Other findings include exophthalmos, ventricular or atrial gallop, and an enlarged thyroid gland.

Typhus

Typhus is a rickettsial disease transmitted to humans by fleas, mites, or body lice. Initial symptoms include headache, myalgia, arthralgia, and malaise, followed by an abrupt onset of vomiting, nausea, chills, and fever. A maculopapular rash may be present in some cases.

Ulcerative colitis

Vomiting, nausea, and anorexia may occur, but the most common sign is recurrent diarrhea with blood, pus, and mucus. Fever, chills, and weight loss are also common.

Other causes

Drugs

Drugs that commonly cause vomiting include antineoplastics, opiates, ferrous sulfate, levodopa, oral potassium, chloride replacements, estrogens, sulfasalazine, antibiotics, quinidine, anesthetics, and overdoses of cardiac glycosides and theophylline. Syrup of ipecac, a mixture of ipecac fluid extract, glycerin, and syrup, is used to treat overdoses by inducing vomiting.

Radiation and surgery

Radiation therapy may cause nausea and vomiting if it disrupts the gastric mucosa. Postoperative nausea and vomiting are common, especially after abdominal surgery.

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Abdominal distention: Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)

Abdominal cancer

Generalized abdominal distention may occur when the cancer — most commonly ovarian, hepatic, or pancreatic — produces ascites (usually in a patient with a known tumor). It’s an indication of advanced disease. Shifting dullness and a fluid wave accompany distention. Associated signs and symptoms may include severe abdominal pain, an abdominal mass, anorexia, jaundice, GI hemorrhage (hematemesis or melena), dyspepsia, and weight loss that progresses to muscle weakness and atrophy.

Abdominal trauma

When brisk internal bleeding accompanies trauma, abdominal distention may be acute and dramatic. Associated signs and symptoms of this life-threatening disorder include abdominal rigidity with guarding, decreased or absent bowel sounds, vomiting, tenderness, and abdominal bruising. Pain may occur over the trauma site or over the scapula if abdominal bleeding irritates the phrenic nerve. Signs of hypovolemic shock (such as hypotension and rapid, thready pulse) appear with significant blood loss.

Bladder distention

Various disorders cause bladder distention which, in turn, causes lower abdominal distention. Slight dullness on percussion above the symphysis pubis indicates mild bladder distention. A palpable, smooth, rounded, fluctuant suprapubic mass suggests severe bladder distention; a fluctuant mass extending to the umbilicus indicates extremely severe bladder distention. Urinary dribbling, frequency, or urgency may occur with urinary obstruction. Suprapubic discomfort is also common.

Cirrhosis

With cirrhosis, ascites causes generalized distention and is confirmed by a fluid wave and shifting dullness. Umbilical eversion and caput medusae (dilated veins around the umbilicus) are common. The patient may report a feeling of fullness or weight gain. Associated findings include vague abdominal pain, fever, anorexia, nausea, vomiting, constipation or diarrhea, bleeding tendencies, severe pruritus, palmar erythema, spider angiomas, leg edema and, possibly, splenomegaly. Hematemesis, encephalopathy, gynecomastia, or testicular atrophy may also be seen. Jaundice is usually a late sign. Hepatomegaly occurs initially; however, the liver may not be palpable if the patient has advanced disease.

Gastric dilation (acute)

Left-upper-quadrant distention is characteristic of acute gastric dilation, but the presentation varies. The patient usually complains of epigastric fullness or pain and nausea (with or without vomiting). Physical examination reveals tympany, gastric tenderness, and a succussion splash. Initially, visible peristalsis may occur. Later, hypoactive or absent bowel sounds confirm ileus. The patient may be pale and diaphoretic and may exhibit tachycardia or bradycardia.

Heart failure

Generalized abdominal distention due to ascites typically accompanies severe cardiovascular impairment and is confirmed by shifting dullness and a fluid wave. Signs and symptoms of heart failure are numerous and depend on the disease stage and degree of cardiovascular impairment. Hallmarks include peripheral edema, jugular vein distention, dyspnea, and tachycardia. Common associated signs and symptoms include hepatomegaly (which may cause right-upper-quadrant pain), nausea, vomiting, productive cough, crackles, cool extremities, cyanotic nail beds, nocturia, exercise intolerance, nocturnal wheezing, diastolic hypertension, and cardiomegaly.

Irritable bowel syndrome

Irritable bowel syndrome may produce intermittent, localized distention — the result of periodic intestinal spasms. Lower abdominal pain or cramping typically accompanies these spasms. The pain is usually relieved by defecation or by passage of intestinal gas and is aggravated by stress. Other possible signs and symptoms include diarrhea that may alternate with constipation or normal bowel function; nausea; dyspepsia; straining and urgency at defecation; feeling of incomplete evacuation; and small, mucus-streaked stools.

Large-bowel obstruction

Dramatic abdominal distention is characteristic of large-bowel obstruction, a life-threatening disorder; in fact, loops of the large bowel may become visible on the abdomen. Constipation precedes distention and may be the only symptom for days. Associated findings include tympany, high-pitched bowel sounds, and the sudden onset of colicky lower abdominal pain that becomes persistent. Fecal vomiting and diminished peristaltic waves and bowel sounds are late signs.

Mesenteric artery occlusion (acute)

In acute mesenteric artery occlusion, a life-threatening disorder, abdominal distention usually occurs several hours after the sudden onset of severe, colicky periumbilical pain accompanied by rapid (even forceful) bowel evacuation. The pain later becomes constant and diffuse. Related signs and symptoms include severe abdominal tenderness with guarding and rigidity, absent bowel sounds and, occasionally, a bruit in the right iliac fossa. The patient may also experience vomiting, anorexia, diarrhea, or constipation. Late signs include fever, tachycardia, tachypnea, hypotension, and cool, clammy skin. Abdominal distention or GI bleeding may be the only clue if pain is absent.

Nephrotic syndrome

Nephrotic syndrome may produce massive edema, causing generalized abdominal distention with a fluid wave and shifting dullness. It may also produce elevated blood pressure, hematuria or oliguria, fatigue, anorexia, depression, pallor, periorbital edema, scrotal swelling, and skin striae.

Ovarian cysts

Typically, large ovarian cysts produce lower abdominal distention accompanied by umbilical eversion. Because they’re thin walled and fluid filled, these cysts produce a fluid wave and shifting dullness — signs that mimic ascites. Lower abdominal pain and a palpable mass may be present.

Paralytic ileus

Paralytic ileus, which produces generalized distention with a tympanic percussion note, is accompanied by absent or hypoactive bowel sounds and, occasionally, extreme distress and vomiting. The patient may be severely constipated or may pass flatus and small, liquid stools.

Peritonitis

In peritonitis, a life-threatening disorder, abdominal distention may be localized or generalized, depending on the extent of peritonitis. Fluid accumulates first within the peritoneal cavity and then within the bowel lumen, causing a fluid wave and shifting dullness. Typically, distention is accompanied by sudden and severe abdominal pain that worsens with movement. Rebound tenderness and abdominal rigidity may be present.

Associated signs and symptoms usually include hypoactive or absent bowel sounds, fever, chills, hyperalgesia, nausea, and vomiting. Also, the skin over the patient’s abdomen may appear taut. Signs of shock, such as tachycardia and hypotension, appear with significant fluid loss into the abdomen.

Small-bowel obstruction

Abdominal distention, which is characteristic of small-bowel obstruction, is most pronounced during late obstruction, especially in the distal small bowel. Auscultation reveals hypoactive or hyperactive bowel sounds, whereas percussion produces a tympanic note. Accompanying signs and symptoms of this life-threatening disorder include colicky periumbilical pain, constipation, nausea, and vomiting; the higher the obstruction, the earlier and more severe the vomiting. Rebound tenderness reflects intestinal strangulation with ischemia. Associated signs and symptoms include drowsiness, malaise, and signs of dehydration. Signs of hypovolemic shock appear with progressive dehydration and plasma loss.

Toxic megacolon (acute)

Acute toxic megacolon is a life-threatening complication of infectious or ulcerative colitis. It produces dramatic abdominal distention that usually develops gradually and is accompanied by a tympanic percussion note, diminished or absent bowel sounds, and mild rebound tenderness. The patient also presents with abdominal pain and tenderness, fever, tachycardia, and dehydration.

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Bowel sounds, hyperactive: Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)

Crohn’s disease

Hyperactive bowel sounds usually arise insidiously in those with Crohn’s disease. Associated signs and symptoms include diarrhea, cramping abdominal pain that may be relieved by defecation, anorexia, low-grade fever, abdominal distention and tenderness and, in many cases, a fixed mass in the right lower quadrant. Muscle wasting, weight loss, and signs of dehydration may occur as Crohn’s disease progresses.

Gastroenteritis

With gastroenteritis, hyperactive bowel sounds follow sudden nausea and vomiting and accompany “explosive” diarrhea. Abdominal cramping or pain is common, typically after a peristaltic wave. Fever may occur, depending on the causative organism.

GI hemorrhage

Hyperactive bowel sounds provide the most immediate indication of persistent upper GI bleeding. Other findings include hematemesis, coffee-ground vomitus, abdominal distention, bloody diarrhea, rectal passage of bright red clots and jellylike material or melena, and pain during bleeding. Decreased urine output, tachycardia, and hypotension accompany blood loss.

Malabsorption

Malabsorption — typically lactose intolerance — may cause hyperactive bowel sounds. Associated signs and symptoms include diarrhea and, possibly, nausea and vomiting, angioedema, and urticaria.

Mechanical intestinal obstruction

Mechanical intestinal obstruction — a potentially life-threatening disorder — causes hyperactive bowel sounds to occur simultaneously with cramping abdominal pain every few minutes; bowel sounds may later become hypoactive and then disappear. With small-bowel obstruction, nausea and vomiting occur earlier and with greater severity than in large-bowel obstruction. With complete bowel obstruction, hyperactive sounds are also accompanied by abdominal distention and constipation, although the part of the bowel distal to the obstruction may continue to empty for up to 3 days.

Ulcerative colitis (acute)

Hyperactive bowel sounds arise abruptly in patients with acute ulcerative colitis. The hallmark of this disorder is recurrent bloody diarrhea (usually containing pus and mucus) accompanied by anorexia, abdominal pain, nausea and vomiting, fever, and tenesmus. Weight loss, arthralgia, and arthritis may occur.

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Vomiting: Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)

Adrenal insufficiency

Common GI findings associated with adrenal insufficiency include vomiting, nausea, anorexia, and diarrhea. Other findings include weakness; fatigue; weight loss; bronze skin; orthostatic hypotension; and weak, irregular pulse.

Anthrax (GI)

With anthrax, initial signs and symptoms after eating contaminated meat from an infected animal include vomiting, loss of appetite, nausea, and fever. Signs and symptoms may progress to abdominal pain, severe bloody diarrhea, and hematemesis.

Appendicitis

With appendicitis, vomiting and nausea may follow or accompany abdominal pain. Pain typically begins as vague epigastric or periumbilical discomfort and rapidly progresses to severe, stabbing pain in the right lower quadrant. The patient generally has a positive McBurney’s sign — severe pain and tenderness on palpation about 2"(5 cm) from the right anterior superior spine of the ilium, on a line between that spine and the umbilicus. Associated findings usually include abdominal rigidity and tenderness, anorexia, constipation or diarrhea, cutaneous hyperalgesia, fever, tachycardia, and malaise.

Bulimia

Most common in women ages 18 to 29, bulimia is characterized by polyphagia that alternates with self-induced vomiting, fasting, or diarrhea. It’s commonly accompanied by anorexia. The patient typically weighs less than normal but has a morbid fear of obesity. Self-induced vomiting may be evidenced by calloused knuckles.

Cholecystitis (acute)

With acute cholecystitis, nausea and mild vomiting commonly follow severe right-upper-quadrant pain that may radiate to the back or shoulders. Associated findings include abdominal tenderness and, possibly, rigidity and distention, fever, and diaphoresis.

Cholelithiasis

Nausea and vomiting accompany severe unlocalized right-upper-quadrant or epigastric pain after ingestion of fatty foods. Other findings in cholelithiasis include abdominal tenderness and guarding, flatulence, belching, epigastric burning, pyrosis, tachycardia, and restlessness.

Cirrhosis

Insidious early signs and symptoms of cirrhosis typically include nausea and vomiting, anorexia, aching abdominal pain, and constipation or diarrhea. Later findings include jaundice, hepatomegaly, and abdominal distention.

Escherichia coli 0157:H7

The signs and symptoms of E. coli include vomiting, watery or bloody diarrhea, nausea, fever, and abdominal cramps. In children younger than age 5 and elderly patients, hemolytic uremic syndrome may develop in which the red blood cells are destroyed, and this may ultimately lead to acute renal failure.

Ectopic pregnancy

Vomiting, nausea, vaginal bleeding, and lower abdominal pain occur in ectopic pregnancy, a potentially life-threatening disorder. The patient with an ectopic pregnancy may have a tender adrenal mass and a 1- to -2-month history of amenorrhea.

Electrolyte imbalances

Electrolyte imbalances such as hyponatremia, hypernatremia, hypokalemia, and hypercalcemia frequently cause nausea and vomiting. Other effects include arrhythmias, tremors, seizures, anorexia, malaise, and weakness.

Food poisoning

Vomiting is a common finding in food poisoning. Diarrhea, severe, cramping abdominal pain, prostration, and fever also usually occur.

Gastritis

Nausea and vomiting of mucus or blood are common with gastritis, especially after ingestion of alcohol, aspirin, spicy foods, or caffeine. Epigastric pain, belching, and fever may occur.

Gastroenteritis

Gastroenteritis causes nausea, vomiting (often of undigested food), diarrhea, and abdominal cramping. Fever, malaise, hyperactive bowel sounds, and abdominal pain and tenderness may also occur.

Heart failure

Nausea and vomiting may occur, especially with right-sided heart failure. Associated findings include tachycardia, ventricular gallop, fatigue, dyspnea, crackles, peripheral edema, and jugular vein distention.

Hepatitis

Vomiting commonly follows nausea as an early sign of viral hepatitis. Other early findings include fatigue, myalgia, arthralgia, headache, photophobia, anorexia, pharyngitis, cough, and fever.

Hyperemesis gravidarum

Unremitting nausea and vomiting that last beyond the first trimester characterize hyperemesis gravidarum, a disorder of pregnancy. Vomitus contains undigested food, mucus, and small amounts of bile early in the disorder; later, it has a coffee-ground appearance. Associated findings include weight loss, headache, and delirium.

Increased intracranial pressure

Projectile vomiting that isn’t preceded by nausea is a sign of increased ICP. The patient may exhibit a decreased level of consciousness (LOC) and Cushing’s triad (bradycardia, hypertension, and respiratory pattern changes). He may also have headache, widened pulse pressure, impaired motor movement, vision disturbances, pupillary changes, and papilledema.

Intestinal obstruction

Nausea and vomiting (bilious or fecal) are common with intestinal obstruction, especially of the upper small intestine. Abdominal pain is usually episodic and colicky but can become severe and steady. Constipation occurs early in large intestinal obstruction and late in small intestinal obstruction. Obstipation, however, may signal complete obstruction. In partial obstruction bowel sounds are typically high pitched and hyperactive; in complete obstruction, hypoactive or absent. Abdominal distention and tenderness also occur, possibly with visible peristaltic waves and a palpable abdominal mass.

Labyrinthitis

Nausea and vomiting commonly occur with labyrinthitis, an acute inner ear inflammation. Other findings in labyrinthitis include severe vertigo, progressive hearing loss, nystagmus, and possibly otorrhea.

Ménière’s disease

Ménière’s disease causes sudden, brief, recurrent attacks of nausea and vomiting, dizziness, vertigo, hearing loss, tinnitus, diaphoresis, and nystagmus. Hearing loss may be progressive and tinnitus may persist between attacks.

Mesenteric artery ischemia

Mesenteric artery ischemia is a life-threatening disorder that may cause nausea and vomiting and 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

With mesenteric venous thrombosis, insidious or acute onset of nausea, vomiting, and abdominal pain occurs along with diarrhea or constipation, abdominal distention, hematemesis, and melena.

Metabolic acidosis

Metabolic acidosis may produce nausea, vomiting, anorexia, diarrhea, Kussmaul’s respirations, and decreased LOC.

Migraine headache

Nausea and vomiting are prodromal signs and symptoms of a migraine headache. Fatigue, photophobia, light flashes, increased noise sensitivity, and possibly partial vision loss and paresthesia also occur.

Motion sickness

Rhythmic or erratic motion causes nausea and vomiting that may be accompanied by headache, vertigo, dizziness, fatigue, diaphoresis, and dyspnea.

Myocardial infarction

Nausea and vomiting may occur, but the cardinal symptom of myocardial infarction is severe substernal chest pain, which may radiate to the left arm, jaw, or neck. Dyspnea, pallor, clammy skin, diaphoresis, and restlessness also occur.

Pancreatitis (acute)

Vomiting, usually preceded by nausea, is an early sign of pancreatitis. Associated findings include steady, severe epigastric or left-upper-quadrant pain that may radiate to the back, abdominal tenderness and rigidity, hypoactive bowel sounds, anorexia, vomiting, and fever. Tachycardia, restlessness, hypotension, skin mottling, and cold, sweaty extremities may occur in severe cases.

Peptic ulcer

Nausea and vomiting may follow sharp, burning or gnawing epigastric pain, especially when the stomach is empty or after ingestion of alcohol, caffeine, or aspirin. Attacks are relieved by eating or taking antacids. Hematemesis or melena may also occur.

Peritonitis

With peritonitis, nausea and vomiting usually accompany acute abdominal pain in the area of inflammation. Other findings include high fever with chills; tachycardia; hypoactive or absent bowel sounds; abdominal distention, rigidity, and tenderness; weakness; pale, cold skin; diaphoresis; hypotension; signs of dehydration; and shallow respirations.

Preeclampsia

Nausea and vomiting are common with preeclampsia, a disorder of pregnancy. Rapid weight gain, epigastric pain, generalized edema, elevated blood pressure, oliguria, severe frontal headache, and blurred or double vision also occur.

Renal and urologic disorders

Cystitis, pyelonephritis, calculi, and other renal and urologic disorders can cause vomiting. Accompanying findings reflect the specific disorder. Persistent nausea and vomiting are typical findings in patients with acute or worsening chronic renal failure.

Thyrotoxicosis

With thyrotoxicosis, nausea and vomiting may accompany the classic findings of severe anxiety, heat intolerance, weight loss despite increased appetite, diaphoresis, diarrhea, tremors, tachycardia, and palpitations. Other findings include exophthalmos, ventricular or atrial gallop, and an enlarged thyroid gland.

Ulcerative colitis

Vomiting, nausea, and anorexia may occur, but the most common sign of ulcerative colitis is recurrent diarrhea with blood, pus, and mucus. Fever, chills, and weight loss are other common signs and symptoms.

Other causes

Drugs

Drugs that commonly cause vomiting include antineoplastics, opiates, ferrous sulfate, levodopa, oral potassium, chloride replacements, estrogens, sulfasalazine, antibiotics, quinidine, anesthetics, and overdoses of cardiac glycosides and theophylline. Syrup of ipecac is used to treat overdoses by inducing vomiting.

Radiation and surgery

Radiation therapy may cause nausea and vomiting if it disrupts the gastric mucosa. Postoperative nausea and vomiting are common, especially after abdominal surgery.

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Regurgitation and Vomiting: Principal Causes of Regurgitation
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)

1. Normalvariations
2. Gastroesophageal reflux
3. Esophageal disorders
   1. Congenitalanomalies
      1. Esophagealatresia with or without tracheoesophageal fistula
      2. Esophageal stenosis
      3. Esophageal web
      4. Duplication
   2. Foreign body
   3. Stricture
4. Hiatal hernia
5. Rumination

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Abdominal distention: Medical causes
(Nursing: Interpreting Signs and Symptoms)

Abdominal cancer.Generalized abdominal distention may occur when the cancer—most commonly ovarian, hepatic, or pancreatic—produces ascites (usually in a patient with a known tumor). It's an indication of advanced disease. Shifting dullness and a fluid wave accompany distention. Associated signs and symptoms may include severe abdominal pain, an abdominal mass, anorexia, jaundice, GI hemorrhage (hematemesis or melena), dyspepsia, and weight loss that progresses to muscle weakness and atrophy.

Abdominal trauma.When brisk internal bleeding accompanies trauma, abdominal distention may be acute and dramatic. Associated signs and symptoms of this life-threatening disorder include abdominal rigidity with guarding, decreased or absent bowel sounds, vomiting, tenderness, and abdominal bruising. Pain may occur over the trauma site, or over the scapula if abdominal bleeding irritates the phrenic nerve. Signs of hypovolemic shock (such as hypotension and rapid, thready pulse) appear with significant blood loss.

Cirrhosis.In cirrhosis, ascites causes generalized distention and is confirmed by a fluid wave, shifting dullness, and a puddle sign. Umbilical eversion and caput medusae (dilated veins around the umbilicus) are common. The pa-tient may report a feeling of fullness or weight gain. Associated findings include vague abdominal pain, fever, anorexia, nausea, vomiting, constipation or diarrhea, bleeding tendencies, severe pruritus, palmar erythema, spider angiomas, leg edema, and possibly splenomegaly. Hematemesis, encephalopathy, gynecomastia, or testicular atrophy may also be seen. Jaundice is usually a late sign. Hepatomegaly occurs initially, but the liver may not be palpable if the patient has advanced disease.

Heart failure.Generalized abdominal distention due to ascites typically accompanies severe cardiovascular impairment and is confirmed by shifting dullness and a fluid wave. Signs and symptoms of heart failure are numerous and depend on the disease stage and degree of cardiovascular impairment. Hallmarks include peripheral edema, jugular vein distention, dyspnea, and tachycardia. Common associated signs and symptoms include hepatomegaly (which may cause right upper quadrant pain), nausea, vomiting, a productive cough, crackles, cool extremities, cyanotic nail beds, nocturia, exercise intolerance, nocturnal wheezing, diastolic hypertension, weight gain, and cardiomegaly.

Irritable bowel syndrome.Irritable bowel syndrome may produce intermittent, localized distention—the result of periodic intestinal spasms. Lower abdominal pain or cramping typically accompanies these spasms. The pain is usually relieved by defecation or by passage of intestinal gas and is aggravated by stress. Other possible signs and symptoms include diarrhea that may alternate with constipation or normal bowel function, nausea, dyspepsia, straining and urgency at defecation, a feeling of incomplete evacuation, and small, mucus-streaked stools.

Large-bowel obstruction.Dramatic abdominal distention is characteristic in this life-threatening disorder; in fact, loops of the large bowel may become visible on the abdomen. Constipation precedes distention and may be the only symptom for days. Associated findings include tympany, high-pitched bowel sounds, and the sudden onset of colicky lower abdominal pain that becomes persistent. Nausea, fecal vomiting, and diminished peristaltic waves and bowel sounds are late signs.

Mesenteric artery occlusion (acute). In this life-threatening disorder, abdominal distention usually occurs several hours after the sudden onset of severe, colicky periumbilical pain accompanied by rapid (even forceful) bowel evacuation. The pain later becomes constant and diffuse. Related signs and symptoms include severe abdominal tenderness with guarding and rigidity, absent bowel sounds and, occasionally, a bruit in the right iliac fossa. The patient may also experience vomiting, anorexia, diarrhea, or constipation. Late signs include fever, tachycardia, tachypnea, hypotension, and cool, clammy skin. Abdominal distention or GI bleeding may be the only clue if pain is absent.

Paralytic ileus.Paralytic ileus, which produces generalized distention with a tympanic percussion note, is accompanied by absent or hypoactive bowel sounds and, occasionally, mild abdominal pain and vomiting. The patient may be severely constipated or may pass flatus and small, liquid stools.

Peritonitis.Peritonitis is a life-threatening disorder in which abdominal distention may be localized or generalized, depending on the extent of the inflammation. Fluid accumulates within the peritoneal cavity and then within the bowel lumen, causing a fluid wave and shifting dullness. Typically, distention is accompanied by sudden and severe abdominal pain that worsens with movement, rebound tenderness, and abdominal rigidity.

The skin over the patient's abdomen may appear taut. Associated signs and symptoms usually include hypoactive or absent bowel sounds, fever, chills, hyperalgesia, nausea, and vomiting. Signs of shock, such as tachycardia and hypotension, appear with significant fluid loss into the abdomen.

Small-bowel obstruction.Abdominal distention is characteristic in small-bowel obstruction, a life-threatening disorder, and is most pronounced during late obstruction, especially in the distal small bowel. Auscultation reveals hypoactive or hyperactive bowel sounds, whereas percussion produces a tympanic note. Accompanying signs and symptoms include colicky periumbilical pain, constipation, nausea, and vomiting; the higher the obstruction, the earlier and more severe the vomiting. Rebound tenderness reflects intestinal strangulation with ischemia. Associated signs and symptoms include drowsiness, malaise, and signs of dehydration. Signs of hypovolemic shock appear with progressive dehydration and plasma loss.

Toxic megacolon (acute).Toxic megacolon is a life-threatening complication of infectious or ulcerative colitis. It produces dramatic abdominal distention that usually develops gradually and is accompanied by a tympanic percussion note, diminished or absent bowel sounds, and mild rebound tenderness. The patient also presents with abdominal pain and tenderness, fever, tachycardia, and dehydration.

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Bowel sounds, hyperactive: Medical causes
(Nursing: Interpreting Signs and Symptoms)

Crohn's disease.Hyperactive bowel sounds usually arise insidiously. Associated signs and symptoms include diarrhea, cramping abdominal pain that may be relieved by defecation, anorexia, a low-grade fever, abdominal distention and tenderness and, in many cases, a fixed mass in the right lower quadrant. Perianal and vaginal lesions are common. Muscle wasting, weight loss, and signs of dehydration may occur as Crohn's disease progresses.

Food hypersensitivity.Malabsorption—typically lactose intolerance—may cause hyperactive bowel sounds. Associated signs and symptoms include diarrhea and, possibly, nausea and vomiting, angioedema, and urticaria.

Gastroenteritis.Hyperactive bowel sounds follow sudden nausea and vomiting and accompany “explosive” diarrhea. Abdominal cramping or pain is common, usually after a peristaltic wave. Fever may occur, depending on the causative organism.

GI hemorrhage.Hyperactive bowel sounds provide the most immediate indication of persistent upper GI bleeding. Other findings include hematemesis, coffee-ground vomitus, abdominal distention, bloody diarrhea, rectal passage of bright red clots and jellylike material or melena, and pain during bleeding. Decreased urine output, tachycardia, and hypotension accompany significant blood loss.

Mechanical intestinal obstruction.Hyperactive bowel sounds occur simultaneously with cramping abdominal pain every few minutes in patients with mechanical intestinal obstruction, a potentially life-threatening disorder; bowel sounds may later become hypoactive and then disappear. With small-bowel obstruction, nausea and vomiting occur earlier and with greater severity than in large-bowel obstruction. With complete bowel obstruction, hyperactive sounds are also accompanied by abdominal distention and constipation, although the part of the bowel distal to the obstruction may continue to empty for up to 3 days.

Ulcerative colitis (acute).Hyperactive bowel sounds arise abruptly in patients with acute ulcerative colitis and are accompanied by bloody diarrhea, anorexia, abdominal pain, nausea and vomiting, fever, and tenesmus. Weight loss, arthralgias, and arthritis may occur.

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Vomiting: Medical causes
(Nursing: Interpreting Signs and Symptoms)

Adrenal insufficiency.Common GI findings with adrenal insufficiency include vomiting, nausea, anorexia, and diarrhea. Other findings include weakness; fatigue; weight loss; bronze skin; orthostatic hypotension; and weak, irregular pulse.

Anthrax (GI).Initial signs and symptoms after eating contaminated meat from an animal infected with anthrax include vomiting, loss of appetite, nausea, and fever. Signs and symptoms may progress to abdominal pain, severe bloody diarrhea, and hematemesis.

Appendicitis.Vomiting and nausea may follow or accompany abdominal pain from appendicitis. Pain typically begins as vague epigastric or periumbilical discomfort and rapidly progresses to severe, stabbing pain in the right lower quadrant. The patient generally has a positive McBurney's sign—severe pain and tenderness on palpation about 29 (5 cm) from the right anterior superior spine of the ilium, on a line between that spine and the umbilicus. Associated findings usually include abdominal rigidity and tenderness, anorexia, constipation or diarrhea, cutaneous hyperalgesia, fever, tachycardia, and malaise.

Cholecystitis (acute).With cholecystitis, nausea and mild vomiting commonly follow severe right-upper-quadrant pain that may radiate to the back or shoulders. Associated findings include abdominal tenderness and, possibly, rigidity and distention, fever, and diaphoresis.

Cholelithiasis.With cholelithiasis, nauseaand vomiting accompany severe, unlocalized right-upper-quadrant or epigastric pain after ingestion of fatty foods. Other findings include abdominal tenderness and guarding, flatulence, belching, epigastric burning, pyrosis, tachycardia, and restlessness.

Cholera.Signs and symptoms of cholera include vomiting and abrupt watery diarrhea. Severe water and electrolyte loss leads to thirst, weakness, muscle cramps, decreased skin turgor, oliguria, tachycardia, and hypotension. Without treatment, death can occ