Makindo Medical Notes

Clinical History

1. Onset and Duration: Ask when the nausea began and whether it is acute, chronic, or intermittent.
2. Pattern and Timing:
   • Is it related to meals or specific foods?
   • Does it occur at certain times of the day (e.g., morning sickness)?
3. Associated Symptoms:
   • Vomiting
   • Abdominal pain or discomfort
   • Diarrhoea or constipation
   • Dizziness or headache
   • Fever or chills
4. Dietary History: Recent changes in diet or consumption of potentially spoiled foods.
5. Medical History:
   • History of gastrointestinal disorders (e.g., GERD, gastritis, peptic ulcer)
   • Neurological conditions (e.g., migraines, vestibular disorders)
   • Metabolic conditions (e.g., diabetes, thyroid disease)
   • Pregnancy history in reproductive-age women
6. Medication History: Medications known to cause nausea, such as:
   • Antibiotics
   • NSAIDs
   • Chemotherapy agents
7. Lifestyle Factors:
   • Alcohol or drug use
   • Travel history or potential exposure to infectious agents

2. Physical Examination

1. General Inspection: Look for signs of dehydration, pallor, jaundice, or distress.
2. Vital Signs: Check for fever, tachycardia, hypotension, or hypertension.
3. Abdominal Examination:
   • Palpate for tenderness, masses, or organomegaly.
   • Auscultate for bowel sounds (hyperactive in cases of obstruction or infection).
4. Neurological Examination: If indicated by history, assess for nystagmus, cranial nerve function, or signs of increased intracranial pressure.
5. ENT Examination: Look for signs of ear or vestibular pathology if dizziness or vertigo is reported.

3. Investigations

1. Blood Tests:
   • Complete Blood Count (CBC): To assess for infection or anaemia.
   • Electrolytes: Assess for dehydration or electrolyte imbalance.
   • Liver Function Tests (LFTs): Rule out hepatobiliary causes.
   • Renal Function Tests: Evaluate for uremia in chronic kidney disease.
   • Amylase/Lipase: If pancreatitis is suspected.
2. Pregnancy Test: Essential for women of childbearing age to rule out pregnancy-related nausea.
3. Imaging:
   • Abdominal ultrasound or CT scan for suspected intra-abdominal pathology.
   • Head CT or MRI if neurological causes are suspected.
4. Stool Tests: If infectious or inflammatory bowel disease is suspected.

4. Possible Causes of Nausea

• Gastrointestinal Causes:
  • Gastroesophageal reflux disease (GERD)
  • Gastritis or peptic ulcer disease
  • Gastroenteritis
  • Intestinal obstruction
  • Hepatitis or biliary disease
  • Pancreatitis
• Neurological Causes:
  • Migraine
  • Vestibular disorders (e.g., labyrinthitis, Meniere's disease)
  • Increased intracranial pressure (e.g., due to tumours or head injury)
• Metabolic and Endocrine Causes:
  • Diabetic ketoacidosis
  • Thyroid dysfunction (hyperthyroidism or hypothyroidism)
  • Renal failure (uraemia)
  • Electrolyte imbalances
• Pregnancy-Related Causes: Nausea and vomiting in early pregnancy (morning sickness or hyperemesis gravidarum).
• Medication-Induced Causes: Drugs like NSAIDs, antibiotics, and chemotherapy.
• Psychogenic Causes: Anxiety, stress, or depression may contribute to nausea.

5. Management

1. Identify and Treat the Underlying Cause:
   • Medications for specific GI disorders (e.g., PPIs for GERD, antiemetics for symptomatic relief)
   • Address dehydration with fluid and electrolyte replacement if needed.
   • Discontinue or adjust medications causing nausea if possible.
2. Lifestyle Modifications:
   • Advise a bland diet, avoiding triggers (e.g., fatty or spicy foods).
   • Encourage small, frequent meals.
   • Avoid alcohol and excessive caffeine intake.
3. Medications: Anti-nausea medications (e.g., ondansetron, metoclopramide) may be used for symptom relief.
4. Follow-Up: Regular review for chronic cases or if symptoms persist despite treatment.

Summary