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Nausea - Causes, symptoms and treatment. MF.

  • Nausea - Causes, symptoms and treatment. MF.

    Nausea is a kind of unpleasant sensation in the epigastric region, chest, mouth, which often precedes vomiting and is often accompanied by general weakness, sweating, increased salivation, cold extremities, blushing of the skin, lowering of blood pressure.

    Causes of nausea

    Possible causes not related to any disease:

    1. Overeating and / or regular consumption of foods with very high fat content;
    2. Side effects of drugs and the penetration of toxic substances into the body;
    3. Psychogenic reactions: fear and anxiety, hysterics;
    4. Kinetosis( seasickness), accompanied by a feeling of nausea and "motion sickness";
    5. Pregnancy( morning sickness normally goes to the end of the first trimester);
    6. Effects of smoke, toxic fumes and various harmful substances;
    7. Sunstroke, hyperthermia.

    Diseases accompanied by nausea

    Diseases in which nausea is observed are very diverse and can be associated with digestive, nervous, reproductive, cardiovascular and endocrine systems.

    The most common nausea develops due to the pathology of the gastrointestinal tract, among them:

    1. acute surgical diseases: peritonitis, appendicitis, acute pancreatitis, acute intestinal obstruction, gastrointestinal bleeding, acute cholecystitis;
    2. chronic diseases: gastroesophageal reflux disease( GERD) and hernia of the esophageal opening of the diaphragm, gastritis, peptic ulcer and duodenal ulcer, enterocolitis, duodenitis, cholelithiasis, inflammatory bowel disease( Crohn's disease, ulcerative colitis), irritable bowel syndrome, chronicpancreatitis;
    3. Defects in the development of the digestive tract: constriction of the pylorus( stenosis), infection of the site of the gastrointestinal tract( atresia), defects in the development of the pancreas;
    4. infections of the gastrointestinal tract: viral gastroenteritis, food toxic infections, helminthiases;
    5. foreign bodies of the stomach, esophagus, intestines;
    6. Functional disorders accompanied by impaired motor function of the stomach and intestines;
    7. liver disease( hepatitis, cirrhosis of the liver);
    8. Food intolerance or food allergies.

    In addition to disruption of the gastrointestinal tract, nausea can be caused by diseases of other organs and systems:

    1. Central nervous system diseases: tumors and brain traumas, brain infections( encephalitis, meningitis), increased intracranial pressure.
    2. Diseases of the cardiovascular system: hypertension, heart failure, myocardial infarction.
    3. Diseases of the inner ear: Ménière's disease, labyrinthitis.
    4. Diseases of the endocrine system: in diabetes mellitus - ketoacidosis;thyrotoxicosis, insufficiency of adrenal function, phenylketonuria.
    5. Kidney disease( urolithiasis, kidney failure);

    Nausea accompanied by cancer treatment( chemotherapy and radiation therapy), imbalance of blood electrolytes, migraine.

    Nausea can be a manifestation of such urgent conditions as poisoning, diabetic ketoacidosis, intestinal obstruction, cerebral hemorrhage, acute cardiovascular cephalalgia, renal insufficiency, hepatic insufficiency, sepsis.

    Most often, nausea does not appear on its own, but in combination with other symptoms: abdominal pain, belching, diarrhea, increased gas production, dyspepsia, vomiting, muscle pain, dizziness, severe fatigue, fever and chills, headache, jaundice and sclera.

    Particular attention should be paid to the combination of nausea with the following symptoms: a black chair or the presence of blood in the stool, the presence of blood in the vomit, severe abdominal pain, shortness of breath, fainting, unconsciousness, high body temperature( > 38.5 ° C), rapid pulse, frequent shallow breathing, severe headache, stiff neck. The appearance of these symptoms indicates the development of a life-threatening condition, upon detection of which you need to immediately consult a doctor. Also, you should definitely see a doctor if you have nausea after suffering a head injury.

    Patient examination with nausea.

    Nausea is a nonspecific symptom of many diseases, therefore, the diagnostic value is only in conjunction with other signs of the disease( for example, signs of irritation of the peritoneum with acute appendicitis).

    To determine the direction of the survey, it is necessary to conduct an active questioning of the patient. So, if nausea is accompanied by other dyspeptic manifestations( belching, a feeling of heaviness in the epigastric region, etc.) and the relationship between the onset of nausea and food intake is revealed, one should assume diseases of the digestive organs( gastritis, cholecystitis, pancreatitis, stomach tumor, etc.).and carry out a gastrointestinal examination;when nausea is combined with a headache, sensitivity disorders or movements, a neurological examination is needed, etc.

    Clarify which medications the patient was taking. For drugs that often cause nausea and vomiting, include: analgesics, cardiovascular drugs, hormones, antibiotics, drugs that primarily affect the central nervous system, and antitumor agents. The use or withdrawal of drugs can also be a cause of nausea or vomiting. If the withdrawal of the medication is accompanied by the disappearance of nausea, it can be considered that this disorder is associated with taking the medication, but it is required to make sure that there is no symptomatology for a considerable time after the drug was discontinued.

    When an objective examination reveals an "acute abdomen" and other life-threatening conditions. If the cause of nausea is not established, then conduct a laboratory examination:

    1. a general blood test( possible anemia, leukocytosis, accelerated ESR with peptic ulcer of stomach, duodenal ulcer, ulcerative colitis, etc.);
    2. electrolytes, urea, creatinine( are being studied for the diagnosis of kidney function and evaluation of water-electrolyte disorders);
    3. biochemical indicators of liver function: ALT( alanine aminotransferase), AST( aspartate aminotransferase), gamma-glutamyltranspeptidase, total protein level in blood, blood albumins, bilirubin);
    4. blood glucose( normal values ​​of 3,3-5,5 mmol / l, increase in glucose indicates the probability of diabetes);
    5. biochemical indicators of pancreatic function: enzyme alpha-amylase, enzyme lipase;
    6. antibodies to Helicobacter pylori( for the detection of gastric ulcer associated with Helicobacter pylori infection);
    7. In the analysis of feces in the diagnosis of diseases of the digestive system, evaluate the amount, consistency and shape, color, odor, impurities, the presence of mucus, pH;at the chemical level determine the content of blood, bilirubin, stercobilin, protein;
    8. The study of intestinal microflora is carried out in the diagnosis of intestinal dysbiosis.

    The plan for further examination depends on the patient's age and clinical manifestations. It should be especially thorough if nausea and vomiting occur for a long time.

    In women of childbearing age, pregnancy tests should be performed.

    Sometimes you need a general urine test, toxicology study, crops, as well as examination of the function of the endocrine glands( level of TSH and thyroid hormones, fasting cortisol level in the morning).

    To exclude diseases of the gastrointestinal tract, diseases of the liver and biliary tract, perform a survey radiography of the abdominal cavity, study of the stomach and intestines with barium, ultrasound of the abdominal cavity organs, CT and endoscopic examinations.

    FEGDS( fibrogastroduodenoscopy) is primarily designed to exclude obstruction, gastric or duodenal ulcers or other organic pathology.

    Colonoscopy is necessary to detect non-specific ulcerative colitis, Crohn's disease, chronic non-ulcerative colitis, with suspicion of a tumor process.

    pH - metry is used to study the secretory function of the stomach with suspicion of gastritis, stomach ulcer.

    Rectomanoscopy is used for diseases of the rectum.

    If you suspect a neurological disorder( migraine, increased intracranial pressure, internal ear pathology) that can cause permanent or periodic nausea, you should perform a clinical neurologic examination, exclude increased intracranial pressure by examining the fundus or performing magnetic resonance imaging of the brain.

    Sometimes, the diagnosis requires esophageal manometry, diurnal esophageal pH-metry, a study of motor and evacuation functions of the stomach, and sometimes electrogastrography and examination of the motility of the small intestine.

    If you suspect a psychiatric illness that causes persistent or recurrent nausea, anxiety disorders, depression, eating disorders, prescribe a psychiatrist consultation.

    Treatment of nausea

    Because nausea is a symptom, the method of treatment depends on the cause or underlying disease. When suspected of a disease, it is important not to engage in self-medication, since nausea can be associated with urgent conditions or the initial manifestation of severe pathology that require immediate medical attention and the initiation of specific treatment under medical supervision.

    If the cause is not related to the disease, it is necessary to eliminate as quickly as possible the effect of the harmful factor( sun, smoke, excess food).

    For seasickness, it is possible to use scapalamine in the form of a skin patch 5-6 hours before the start of travel.

    When pregnancy is recommended rest and relaxation, it is possible to use meclosin orally 25 mg twice a day or in candles of 50 mg.

    To eliminate nausea in such cases, the use of folk remedies is possible:

    • For nausea and vomiting in pregnant women, it is recommended, there is often and little by little. In the morning, drink only water with lemon or a little sweetened juice, there are biscuits.
    • Green tea is a proven remedy for nausea.
    • Grate the root of ginger on the grater, add to the dishes.
    • Before meals, drink 0.25-0.5 tablespoons fresh potato juice.
    • Pour a tablespoon of peppermint leaf with a glass of boiling water. Let it brew for two hours. Tincture take a tablespoon three times a day.
    • In 200 ml of water, boil a teaspoon of dill seeds. Take with poisoning, stomach disorders.
    • Pour a glass of boiling water 4 teaspoons of dry crushed herbs of lemon balm. Insist for several hours. To eat before meals four times a day for ½ cup.
    • Pour 400 ml of cold water two teaspoons of a three-leaved watch, insist for eight hours. Use during the day. Used for nausea to stimulate digestion.

    Possible complications of

    In some cases, in the absence of treatment, nausea can lead to complications such as dehydration( a violation of the water-electrolyte balance of the body) and a deficiency of nutrients in the body. As a rule, this is due to the inability to retain water or food in the body, as well as lack of appetite.

    Which doctor should I use when I feel nauseous?

    Depending on the accompanying symptoms, it may be necessary to consult a therapist, a gastroenterologist, a neurologist, a psychiatrist, a toxicologist, an endocrinologist, an allergist.

    Physician therapist Kletkina Yu. V.