Investigating nausea and vomiting (summary)

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This is a basic article for medical students and other non-radiologists

Nausea and vomiting (often abbreviated in medical notes to N&V) are non-specific physical manifestations of disease. They may occur together, or in isolation and may be the result of obstructive pathology or as a general manifestation of systemic disease. As such, radiological investigation must be driven by other factors including history and examination as well as other tests, including blood results.

Reference article

This is a summary article; we do not have a more in-depth reference article.

Summary

  • questions
    • is this a mechanical obstruction?
    • timing of symptom onset
    • are the hernial orifices normal?
    • has the patient had abdominal surgery previously?
    • is the patient well enough for investigation?
  • investigations
    • abdominal x-ray
      • commonly used, but of limited value
      • only helpful if the bowel is dilated and gas-filled
    • CT abdomen
      • contrast-enhanced examination
      • quantifies bowel dilatation
      • identifies transition point
      • helps determine cause
      • assessment of complications (perforation and ischemia)
    • US abdomen
      • not that useful in cases of mechanical obstruction
      • can visualize fluid-filled loops
      • transition point and cause will be difficult to identify
      • the exception: children and intussusception
    • upper GI contrast study
      • only really ever used in a pediatric context
  • making the request
    • know the question that the team is asking
    • what is the differential and the most likely diagnosis?
    • what is the surgical history?
  • common pathology
Medical student radiology curriculum