Abstract
Nausea is a subjective symptom, best described as a queasiness or sick sensation with the feeling of the imminent need to vomit. Epigastric discomfort, systemic symptoms (e.g., sweating and light-headedness), and emotional symptoms (e.g., fatigue and depression) have been associated with nausea.
Nausea is a nonspecific symptom and is associated with numerous disorders and therapies. The differential diagnosis for nausea, either alone or accompanied by vomiting, is extensive. In the acute setting, it is often easier to identify the etiology for nausea. The diagnosis is more challenging, however, for those presenting with chronic nausea as it is often a pathologic response to a variety of disorders ranging from organic disease to psychological conditions. Moreover, adverse medication reactions are among the most common causes of nausea.
Nausea is considered chronic when it persists for >1 month. Chronic idiopathic nausea (CIN) has been recently defined as bothersome nausea occurring at least several times per week that is not associated with vomiting or an obvious metabolic or gastrointestinal disorder. For consistency purposes in this chapter, we will use the term CIN to refer to chronic nausea without an identifiable cause. When nausea is associated with vomiting, other diagnoses such as gastroparesis or cyclic vomiting syndrome need to be considered. It is not clear whether patients with CIN represent a distinct syndrome, a heterogeneous collection of different unidentified etiologies, or part of a spectrum of gastric sensorimotor dysfunction.
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Key References
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Teaching Questions
Teaching Questions
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1.
In a patient presenting with chronic nausea, a gastrointestinal etiology should be the main focus of the evaluation.
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(A)
True
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(B)
False
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(A)
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2.
A 42-year-old female teacher presents with a 6-month history of nausea. Which one of the following is the most important component of her diagnostic evaluation?
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(A)
History
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(B)
Upper endoscopy
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(C)
Gastric emptying test
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(D)
Brain imaging
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(A)
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3.
You are evaluating a 70-year-old man that has a 3-month history of nausea. On further history, he describes balance problems since the onset of the nausea. He denies vomiting, abdominal pain, or unintentional weight loss. He has been on a stable dose of an antihypertensive medication for 5 years. His evaluation reveals benign positional vertigo. Which of the following would be the best initial option to treat his nausea?
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(A)
Ondansetron
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(B)
Aprepitant
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(C)
Meclizine
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(D)
Omeprazole
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(A)
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Vazquez-Roque, M.I., Bouras, E.P. (2015). Chronic Nausea. In: Lacy, B., Crowell, M., DiBaise, J. (eds) Functional and Motility Disorders of the Gastrointestinal Tract. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1498-2_7
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DOI: https://doi.org/10.1007/978-1-4939-1498-2_7
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