Symptoms in the Pharmacy :Gastrointestinal Tract Problems(9)
Nausea and vomiting
Nausea and vomiting are symptoms that have many possible causes.
From the pharmacist’s point of view, while there are treatments available
to prevent nausea and vomiting, there is no effective OTC treatment
once vomiting is established.
For that reason, this section will
deal briefly with some of the causes of these symptoms and then
continue in the next section to consider the prevention of motion
sickness, where the pharmacist can recommend effective treatments
to help prevent the problem.
What you need to know
Age
The very young and the elderly are most at risk from dehydration as a
result of vomiting. Vomiting of milk in infants less than 1 year old may
be due to infection or feeding problems or, rarely, an obstruction such
as pyloric stenosis. In the latter there is thickening of the muscular
wall around the outlet of the stomach, which causes a blockage. It
typically occurs in the first few weeks of life in a first-born male.
The vomiting is frequently projectile in that the vomit is forcibly
expelled a considerable distance. The condition can be cured by a
simple operation. The pharmacist must distinguish, by questioning,
between vomiting (the forced expulsion of gastric contents through
the mouth) and regurgitation (where food is effortlessly brought up
from the throat and stomach). Regurgitation sometimes occurs in
babies, where it is known as posseting and is a normal occurrence.
When regurgitation occurs in adults, it is associated with oesophageal
disease with difficulty in swallowing and requires referral .
Nausea is associated with vomiting but not regurgitation and this can
be employed as a distinguishing feature during questioning.
Pregnancy
Nausea and vomiting are very common in pregnancy, usually beginning
after the first missed period and occurring early in the morning.
Pregnancy should be considered as a possible cause of nausea and
vomiting in any woman of childbearing age who presents at the
pharmacy complaining of nausea and vomiting. Nausea and vomiting
are more common in the first pregnancy than in subsequent ones.
Duration
Generally, adults should be referred to the doctor if vomiting has been
present for longer than 2 days. Children under 2 years are referred
whatever the duration because of the risks from dehydration. Anyone
presenting with chronic vomiting should be referred to the doctor
since such symptoms may indicate the presence of a peptic ulcer or
gastric carcinoma.
Associated symptoms
An acute infection (gastroenteritis) is often responsible for vomiting
and, in these cases, diarrhoea may also be present. Careful
questioning about food intake during the previous 2 days may give a
clue as to the cause. In young children, the rotavirus is the most
common cause of gastroenteritis; this is highly infectious and so it is
not unusual for more than one child in the family to be affected. In
such situations there are usually associated cold symptoms.
The vomiting of blood may indicate serious disease and is an
indication for referral, since it may be caused by haemorrhage from
a peptic ulcer or gastric carcinoma. Sometimes the trauma of vomiting
can cause a small bleed, due to a tear in the gut lining. Vomit with a
faecal smell means that the GI tract may be obstructed and requires
urgent referral.
Nausea and vomiting may be associated with a migraine. Any history of dizziness or vertigo should be noted as it may point to inner ear disease, e.g. labyrinthitis or Meniere’s disease
as a cause of the nausea.
Alcohol intake
People who drink large quantities of alcohol may vomit, often in the
morning. This may be due to occasional binge drinking or to chronic
ingestion of alcohol. Alcoholic patients often feel nauseous and retch
in the mornings. The questioning of patients about their intake of
alcohol is a sensitive area and should be approached with tact. Asking
about smoking habits might be a good way of introducing other social
habits.
Medication
Prescribed and OTC medicines may make patients feel sick and it is
therefore important to determine which medicines the patient is currently
taking. Aspirin and NSAIDs are common causes. Some antibiotics
may cause nausea and vomiting, e.g. doxycyline. Oestrogens,
steroids and narcotic analgesics may also produce these symptoms.
Symptoms can sometimes be improved by taking the medication with
food, but if they continue, the patient should see the doctor. Digoxin
toxicity may show itself by producing nausea and vomiting, and such
symptoms in a patient who is taking digoxin, especially an elderly
person, should prompt immediate referral where questioning has not
produced an apparent cause for the symptoms. Vomiting, with loss of
fluids and possible electrolyte imbalances, may cause problems in
elderly people taking digoxin and diuretics.
Previous history
Any history that suggests chronic nausea and vomiting would indicate
referral.
Nausea and vomiting are symptoms that have many possible causes.
From the pharmacist’s point of view, while there are treatments available
to prevent nausea and vomiting, there is no effective OTC treatment
once vomiting is established.
For that reason, this section will
deal briefly with some of the causes of these symptoms and then
continue in the next section to consider the prevention of motion
sickness, where the pharmacist can recommend effective treatments
to help prevent the problem.
What you need to know
- Age
- Infant, child, adult, elderly
- Pregnancy
- Duration
- Associated symptoms
- Has vomiting started?
- Abdominal pain
- Diarrhoea
- Constipation
- Fever
- Alcohol intake
- Medication
- Prescribed
- OTC
- Previous history
- Dizziness/vertigo
Age
The very young and the elderly are most at risk from dehydration as a
result of vomiting. Vomiting of milk in infants less than 1 year old may
be due to infection or feeding problems or, rarely, an obstruction such
as pyloric stenosis. In the latter there is thickening of the muscular
wall around the outlet of the stomach, which causes a blockage. It
typically occurs in the first few weeks of life in a first-born male.
The vomiting is frequently projectile in that the vomit is forcibly
expelled a considerable distance. The condition can be cured by a
simple operation. The pharmacist must distinguish, by questioning,
between vomiting (the forced expulsion of gastric contents through
the mouth) and regurgitation (where food is effortlessly brought up
from the throat and stomach). Regurgitation sometimes occurs in
babies, where it is known as posseting and is a normal occurrence.
When regurgitation occurs in adults, it is associated with oesophageal
disease with difficulty in swallowing and requires referral .
Nausea is associated with vomiting but not regurgitation and this can
be employed as a distinguishing feature during questioning.
Pregnancy
Nausea and vomiting are very common in pregnancy, usually beginning
after the first missed period and occurring early in the morning.
Pregnancy should be considered as a possible cause of nausea and
vomiting in any woman of childbearing age who presents at the
pharmacy complaining of nausea and vomiting. Nausea and vomiting
are more common in the first pregnancy than in subsequent ones.
Duration
Generally, adults should be referred to the doctor if vomiting has been
present for longer than 2 days. Children under 2 years are referred
whatever the duration because of the risks from dehydration. Anyone
presenting with chronic vomiting should be referred to the doctor
since such symptoms may indicate the presence of a peptic ulcer or
gastric carcinoma.
Associated symptoms
An acute infection (gastroenteritis) is often responsible for vomiting
and, in these cases, diarrhoea may also be present. Careful
questioning about food intake during the previous 2 days may give a
clue as to the cause. In young children, the rotavirus is the most
common cause of gastroenteritis; this is highly infectious and so it is
not unusual for more than one child in the family to be affected. In
such situations there are usually associated cold symptoms.
The vomiting of blood may indicate serious disease and is an
indication for referral, since it may be caused by haemorrhage from
a peptic ulcer or gastric carcinoma. Sometimes the trauma of vomiting
can cause a small bleed, due to a tear in the gut lining. Vomit with a
faecal smell means that the GI tract may be obstructed and requires
urgent referral.
Nausea and vomiting may be associated with a migraine. Any history of dizziness or vertigo should be noted as it may point to inner ear disease, e.g. labyrinthitis or Meniere’s disease
as a cause of the nausea.
Alcohol intake
People who drink large quantities of alcohol may vomit, often in the
morning. This may be due to occasional binge drinking or to chronic
ingestion of alcohol. Alcoholic patients often feel nauseous and retch
in the mornings. The questioning of patients about their intake of
alcohol is a sensitive area and should be approached with tact. Asking
about smoking habits might be a good way of introducing other social
habits.
Medication
Prescribed and OTC medicines may make patients feel sick and it is
therefore important to determine which medicines the patient is currently
taking. Aspirin and NSAIDs are common causes. Some antibiotics
may cause nausea and vomiting, e.g. doxycyline. Oestrogens,
steroids and narcotic analgesics may also produce these symptoms.
Symptoms can sometimes be improved by taking the medication with
food, but if they continue, the patient should see the doctor. Digoxin
toxicity may show itself by producing nausea and vomiting, and such
symptoms in a patient who is taking digoxin, especially an elderly
person, should prompt immediate referral where questioning has not
produced an apparent cause for the symptoms. Vomiting, with loss of
fluids and possible electrolyte imbalances, may cause problems in
elderly people taking digoxin and diuretics.
Previous history
Any history that suggests chronic nausea and vomiting would indicate
referral.
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