NAUSEA AND VOMITING
Nausea and vomiting are found in a wide variety of gastrointestinal (GI) disorders.
They are also found in conditions that are unrelated to GI disease, including pregnancy,
infectious diseases, central nervous system (CNS) disorders (e.g., meningitis),
cardiovascular problems (e.g., myocardial infarction), metabolic disorders (e.g., diabetes
mellitus), side effects of drugs (e.g., chemotherapy, opioids), and psychologic factors
Vomiting can occur when the GI tract becomes overly irritated, excited, or distended.
o It can be a protective mechanism to rid the body of spoiled or irritating foods and
o Pulmonary aspiration is a concern when vomiting occurs in the patient who is
elderly, is unconscious, or has other conditions that impair the gag reflex.
o The color of the emesis aids in identifying the presence and source of bleeding.
Drugs that control nausea and vomiting include anticholinergics (e.g., scopolamine),
antihistamines (e.g., promethazine [Phenergan]), phenothiazines (e.g., chlorpromazine
[Thorazine], prochlorperazine [Compazine]), and butyrophenones (e.g., droperidol
The patient with severe or prolonged vomiting is at risk for dehydration and acid-base
and electrolyte imbalances. The patient may require intravenous (IV) fluid therapy with
electrolyte and glucose replacement until able to tolerate oral intake.
Upper Gastrointestinal Bleeding
The mortality rate for upper GI bleeding remains at 6% to 10% despite advances in
intensive care, hemodynamic monitoring, and endoscopy.
The severity of bleeding depends on whether the origin is venous, capillary, or arterial.
Bleeding ulcers account for 50% of the cases of upper GI bleeding.
Drugs such as aspirin, nonsteroidal antiinflammatory agents, and corticosteroids are a
major cause of upper GI bleeding.
Although approximately 80% to 85% of patients who have massive hemorrhage
spontaneously stop bleeding, the cause must be identified and treatment initiated
The immediate physical examination includes a systemic evaluation of the patient’s
condition with emphasis on blood pressure, rate and character of pulse, peripheral
perfusion with capillary refill, and observation for the presence or absence of neck vein
distention. Vital signs are monitored every 15 to 30 minutes. The goal of endoscopic hemostasis is to coagulate or thrombose the bleeding artery.
Several techniques are used including thermal (heat) probe, multipolar and bipolar