LYCOS RETRIEVER 
Vomiting: Patients
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For chronic nausea and vomiting, the diagnostic algorithm is based on history and physical exam findings that point to the organ system involved: the gastrointestinal tract, the nervous system or the endocrine system. Psychogenic causes are an important additional category to consider in chronic nausea and vomiting. A subset of patients will have no cause identified despite extensive diagnostic testing. This group of patients may benefit from referral to specialized centers. Certain presentations prompt referral to a gastroenterologist (Table 12).
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Postoperative nausea and vomiting (PONV) is among the most disagreeable experiences associated with surgery, causing dehydration and retching, which can lead to poor wound healing, among other adverse effects. While postoperative management of patients undergoing abdominoplasty has traditionally involved withholding food until patients demonstrate evidence of bowel activity, this practice requires patients to remain in the hospital for the administration of intravenous fluids to prevent dehydration. However, no literature exists to support this practice.
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Certain environmental exposures can lead to nausea and vomiting. Heat exhaustion occurs in an unacclimatized person who exercises on a hot day. It results from loss of salt and water, with the patient complaining of headache, nausea, vomiting, dizziness, weakness, irritability, cramps or diaphoresis. Therapy consists of rest in a cool environment, and volume repletion with salt-containing solutions. If vomiting is present, IV normal saline may be necessary.
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Verify that the patient is conscious enough to control their vomiting. You should [N]ever attempt to induce vomiting in someone who cannot sit upright or in someone who is in an altered level of consciousness. They could choke on the vomit.
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Postoperative nausea and vomiting are common consequences of anesthetic and surgical procedures, and frequently occur following the procedures. Patients undergoing abdominal, gynecological, ear/nose/throat, or optical procedures are at highest risk for PONV. Additional factors that can increase the risk for PONV include female gender, non-smoking status, prior history of PONV or motion sickness, length of surgery and the use of volatile anesthetics and opioids.
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The data demonstrate that abnormal gastrointestinal motility occurs during an asymptomatic state in patients with cyclic episodes of nausea and vomiting. Because all patients with this syndrome had abnormal gastrointestinal motility but normal results of other gastrointestinal studies, idiopathic cyclic nausea and vomiting may be related to altered gastrointestinal motility.
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