Nausea

Nausea
derivative work: Kostisl (talk) 3205_-_Milano,_Duomo_-_Giorgio_Bonola_-_Miracolo · Public domain · source
Name	Nausea
Field	Internal medicine
Symptoms	sensation of urge to vomit
Complications	vomiting, dehydration, electrolyte imbalance

Nausea is a subjective sensation of unease and discomfort in the upper stomach with an inclination to vomit. It is a common presenting complaint in World Health Organization, Centers for Disease Control and Prevention, and emergency department settings, and occurs in contexts ranging from Migraine attacks to postoperative care after procedures like Coronary artery bypass grafting and Cesarean section. Clinicians from institutions such as Mayo Clinic and Johns Hopkins Hospital frequently evaluate nausea in association with disorders like Myocardial infarction, Vertigo, and medication effects including agents studied by Food and Drug Administration.

Signs and symptoms

Patients typically report a queasy or sick feeling with associated pallor, diaphoresis, and hypersalivation noted in settings like Anesthesia recovery or Chemotherapy clinics. Examination may reveal tachycardia, hypotension, or signs of dehydration as seen in Hyponatremia or Gastroenteritis outbreaks investigated by Centers for Disease Control and Prevention. Nausea may precede emesis in conditions such as Appendicitis, Small bowel obstruction, or Peptic ulcer disease and often coexists with non-gastrointestinal manifestations found in Pregnancy-related hyperemesis gravidarum cases managed at tertiary centers like Massachusetts General Hospital.

Causes

Etiologies span gastrointestinal, neurologic, cardiovascular, metabolic, infectious, pharmacologic, and psychiatric domains. Gastrointestinal causes include Gastroenteritis, Gastroparesis, Cholecystitis, and postoperative ileus following procedures like Pancreaticoduodenectomy. Neurologic triggers include Migraine, Vestibular neuritis, Concussion from events such as the 2008 Beijing Olympics gymnastics injuries, and intracranial pathology like Subarachnoid hemorrhage. Cardiovascular causes include Myocardial infarction and arrhythmias described in American Heart Association guidelines. Metabolic and endocrine contributors include Diabetic ketoacidosis and Uremia as detailed in textbooks from Harvard Medical School. Infectious causes range from viral agents implicated in 2009 H1N1 pandemic reports to bacterial enteropathogens monitored by World Health Organization. Drug-induced nausea is common with agents such as opioids, antineoplastics used for Hodgkin lymphoma, and antibiotics cited by the National Institutes of Health.

Pathophysiology

Nausea arises from integration of signals in central nervous system structures including the chemoreceptor trigger zone in the area postrema and higher cortical centers implicated in studies from University College London and Stanford University. Vestibular inputs via the vestibulocochlear pathways, described in work from Karolinska Institute, interact with brainstem nuclei to produce emetic sensations during conditions like motion exposure by vessels such as Queen Mary 2 or aviation events studied by National Aeronautics and Space Administration. Visceral afferents from the gastrointestinal tract transmit via vagal and sympathetic fibers, pathways mapped in research from Johns Hopkins School of Medicine, while humoral mediators including serotonin, dopamine, histamine, and substance P act on receptors targeted by therapies developed at institutions like Roche and GlaxoSmithKline.

Diagnosis

Diagnosis is clinical, relying on history and focused examination supplemented by tests directed at suspected causes—electrolytes and renal function panels used in Mayo Clinic protocols, electrocardiography per American Heart Association recommendations, and imaging such as abdominal ultrasound employed at centers like Cleveland Clinic. In oncology settings, nausea assessment tools validated in trials at Memorial Sloan Kettering Cancer Center and Dana-Farber Cancer Institute guide management. Specialized testing may include vestibular function studies modeled on Barany Society standards or endoscopy following guidelines from the American Society for Gastrointestinal Endoscopy.

Prevention and management

Preventive strategies and treatments target underlying causes and symptomatic relief. Antiemetic agents include 5-HT3 antagonists developed with input from World Health Organization model lists, dopamine antagonists used in perioperative care per American Society of Anesthesiologists guidance, antihistamines for vestibular causes referenced in Cochrane reviews, and NK1 receptor antagonists implemented in chemotherapy protocols at National Cancer Institute centers. Nonpharmacologic measures include hydration strategies endorsed by Red Cross disaster relief protocols, dietary adjustments advocated by American College of Obstetricians and Gynecologists for pregnancy-related nausea, acupressure techniques studied in trials at University of Toronto, and motion-reduction measures recommended by International Civil Aviation Organization for air travel. Severe or refractory cases may require intravenous fluids as per Surviving Sepsis Campaign principles, enteral or parenteral nutrition protocols from European Society for Clinical Nutrition and Metabolism, or surgical intervention when caused by mechanical obstruction treated in departments like Mount Sinai Health System.

Epidemiology

Nausea is ubiquitous across populations and settings studied by organizations such as the World Health Organization and United Nations Children's Fund. It is a hallmark symptom in conditions with high global burden like Gastroenteritis and Migraine disorder and is a frequent adverse effect in cancer therapy cohorts tracked by the National Cancer Institute. Incidence varies by cause: post-operative nausea and vomiting rates reported in studies from Royal College of Surgeons and American Society of Anesthesiologists range widely, while pregnancy-related nausea affects a majority of women in cohorts surveyed by Centers for Disease Control and Prevention and National Institutes of Health. Demographic patterns reflect associations with age, comorbidity burden documented in Framingham Heart Study datasets, and exposure risks cataloged in public health reports by World Health Organization.

Category:Symptoms and signs