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Nausea and Vomiting

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What are nausea and vomiting?

Nausea is when you feel sick to your stomach, as if you are going to throw up. Vomiting is when you throw up.

What causes nausea and vomiting?

Nausea and vomiting can be symptoms of many different conditions, including

When should I see a health care provider for nausea and vomiting

Nausea and vomiting are common. They are usually not serious. However, you should contact your health care provider immediately if you have

  • A reason to think that your vomiting is from poisoning
  • Vomited for longer than 24 hours
  • Blood in the vomit
  • Severe abdominal pain
  • Severe headache and stiff neck
  • Signs of dehydration, such as dry mouth, infrequent urination or dark urine

How is the cause of nausea and vomiting diagnosed?

Your health care provider will take your medical history, ask about your symptoms and do a physical exam. The provider will look for signs of dehydration. You may have some tests, including blood and urine tests. Women may also have a pregnancy test.

What are the treatments for nausea and vomiting?

Treatments for nausea and vomiting depend on the cause. You may get treatment for the underlying problem. There are some medicines that can treatment nausea and vomiting. For severe cases of vomiting, you may need extra fluids through an IV (intravenous).

There are things that you can do to feel better:

  • Get enough fluids, to avoid dehydration. If you are having trouble keeping liquids down, drink small amounts of clear liquids often.
  • Eat bland foods; stay away from spicy, fatty, or salty foods
  • Eat smaller meals more often
  • Avoid strong smells, since they can sometimes trigger nausea and vomiting
  • If you are pregnant and have morning sickness, eat crackers before you get out of bed in the morning

Symptoms

Nausea and vomiting are common signs and symptoms that can be caused by numerous conditions. Nausea and vomiting most often are due to viral gastroenteritis — often mistakenly called stomach flu — or the morning sickness of early pregnancy.

Many medications can cause nausea and vomiting, as can general anesthesia for surgery. Rarely, nausea and vomiting may indicate a serious or even life-threatening problem.

Call or Emergency Medical Assistance

Seek prompt medical attention if nausea and vomiting are accompanied by other warning signs, such as:

Seek Immediate Medical Attention

Ask someone to drive you to urgent care or an emergency room if:

  • Nausea and vomiting are accompanied by pain or a severe headache, especially if you haven't had this type of headache before
  • You have signs or symptoms of dehydration — excessive thirst, dry mouth, infrequent urination, dark-colored urine and weakness, or dizziness or lightheadedness upon standing
  • Your vomit contains blood, resembles coffee grounds or is green

Schedule a Doctor's Visit

Make an appointment with your doctor if:

  • Vomiting lasts more than two days for adults, 24 hours for children under age 2 or 12 hours for infants
  • You've had bouts of nausea and vomiting for longer than one month
  • You've experienced unexplained weight loss along with nausea and vomiting

Take self-care measures while you wait for your appointment with your doctor:

Take It Easy

Too much activity and not getting enough rest might make nausea worse.

Stay Hydrated

Take small sips of cold, clear, carbonated or sour drinks, such as ginger ale, lemonade and water. Mint tea also may help. Oral rehydration solutions, such as Pedialyte, can aid in preventing dehydration.

Avoid Strong Odors and Other Triggers

Food and cooking smells, perfume, smoke, stuffy rooms, heat, humidity, flickering lights, and driving are among the possible triggers of nausea and vomiting.

Eat Bland Foods

Start with easily digested foods such as gelatin, crackers and toast. When you can keep these down, try cereal, rice, fruit, and salty or high-protein, high-carbohydrate foods. Avoid fatty or spicy foods. Wait to eat solid foods until about six hours after the last time you vomited.

Use Over-the-Counter (OTC) Motion Sickness Medicines

If you're planning a trip, OTC motion sickness drugs, such as dimenhydrinate (Dramamine) or meclizine (Rugby Travel Sickness) may help calm your queasy stomach. For longer journeys, such as a cruise, ask your doctor about prescription motion sickness adhesive patches, such as scopolamine (Transderm Scop).

If your queasiness stems from pregnancy, try nibbling on some crackers before you get out of bed in the morning.

Diagnosis

Upper GI Endoscopy

What is upper gastrointestinal (GI) endoscopy?

Upper GI endoscopy is a procedure in which a doctor uses an endoscope—a flexible tube with a camera—to see the lining of your upper GI tract.

Does upper GI endoscopy have another name?

Healthcare professionals may also call the procedure endoscopy, upper endoscopy, EGD or esophagogastroduodenoscopy.

Why do doctors use upper GI endoscopy?

Doctors use upper GI endoscopy to help diagnose and treat symptoms and conditions that affect the esophagus, stomach, and upper intestine or duodenum.

Upper GI endoscopy can help find the cause of unexplained symptoms, such as

Upper GI endoscopy can be used to identify many different diseases:

Upper GI endoscopy can check for damage after a person eats or drinks harmful chemicals.

During upper GI endoscopy, a doctor obtains biopsies by passing an instrument through the endoscope to obtain a small piece of tissue for testing. Biopsies are needed to diagnose conditions such as

Doctors also use upper GI endoscopy to

  • treat conditions such as bleeding from ulcers, esophageal varices, or other conditions
  • dilate or open up strictures with a small balloon passed through the endoscope
  • remove objects, including food, that may be stuck in the upper GI tract
  • remove polyps or other growths
  • place feeding tubes or drainage tubes

Doctors are also starting to use upper GI endoscopy to perform weight loss procedures for some people with obesity.

How do I prepare for an upper GI endoscopy?

Talk with your doctor

You should talk with your doctor about your medical history, including medical conditions and symptoms you have, allergies, and all prescribed and over-the-counter medicines, vitamins, and supplements you take, including

You can take most medicines as usual, but you may need to adjust or stop some medicines for a short time before your upper GI endoscopy. Your doctor will tell you about any necessary changes to your medicines before the procedure.

Arrange for a ride home

For safety reasons, you can't drive for 24 hours after the procedure, as the sedatives used during the procedure need time to wear off. You will need to make plans for getting a ride home after the procedure.

Do not eat or drink before the procedure

To see your upper GI tract clearly, your doctor will most likely ask you not to eat or drink up to 8 hours before the procedure.

How do doctors perform an upper GI endoscopy?

A doctor performs an upper GI endoscopy in a hospital or an outpatient center. Before the procedure, you will likely get a sedative or a medicine to help you stay relaxed and comfortable during the procedure. The sedative will be given to you through an intravenous (IV) needle in your arm.

In some cases, the procedure can be done without getting a sedative. You may also be given a liquid medicine to gargle or a spray to numb your throat and help prevent you from gagging during the procedure. The health care staff will monitor your vital signs and keep you as comfortable as possible.

You'll be asked to lie on your side on an exam table. The doctor will carefully pass the endoscope down your esophagus and into your stomach and duodenum. A small camera mounted on the endoscope will send a video image to a monitor, allowing close examination of the lining of your upper GI tract. The endoscope pumps air into your stomach and duodenum, making them easier to see.

During the upper GI endoscopy, the doctor may

  • take small samples of tissue, cells, or fluid in your upper GI tract for testing.
  • stop any bleeding.
  • perform other procedures, such as opening up strictures.

The upper GI endoscopy most often takes between 15 and 30 minutes. The endoscope does not interfere with your breathing, and many people fall asleep during the procedure.

What should I expect after an upper GI endoscopy?

After an upper GI endoscopy, you can expect the following:

  • to stay at the hospital or outpatient center for 1 to 2 hours after the procedure so the sedative can wear off
  • to rest at home for the rest of the day
  • bloating or nausea for a short time after the procedure
  • a sore throat for 1 to 2 days
  • to go back to your normal diet once your swallowing returns to normal

After the procedure, you—or a friend or family member who is with you if you're still groggy—will receive instructions on how to care for yourself when you are home. You should follow all instructions.

Some results from an upper GI endoscopy are available right away. Your doctor will share these results with you or, if you choose, with your friend or family member. A pathologist will examine the samples of tissue, cells, or fluid that were taken to help make a diagnosis. Biopsy results take a few days or longer to come back. The pathologist will send a report to your health care professional to discuss with you.

What are the risks of an upper G.I. endoscopy?

Upper GI endoscopy is considered a safe procedure. The risks of complications from an upper GI endoscopy are low, but may include

  • bleeding from the site where the doctor took the tissue samples or removed a polyp
  • perforation in the lining of your upper GI tract
  • an abnormal reaction to the sedative, including breathing or heart problems

Bleeding caused by the procedure often is minor and stops without treatment. Serious complications such as perforation are uncommon. Your doctor may need to perform surgery to treat some complications. Your doctor can also treat an abnormal reaction to a sedative with medicines or IV fluids during or after the procedure.

Seek Care Right Away

If you have any of the following symptoms after an upper GI endoscopy, seek medical care right away:

  • chest pain
  • problems breathing
  • problems swallowing or throat pain that gets worse
  • vomiting—particularly if your vomit is bloody or looks like coffee grounds
  • pain in your abdomen that gets worse
  • bloody or black, tar-colored stool
  • fever

Antiemetic Medicines: OTC Relief for Nausea and Vomiting

Over-the-counter (OTC) medicines are medicines you can buy without a prescription from your doctor. Medicines for nausea are called antiemetics. They can help relieve nausea and vomiting. Several OTC medicines are used as antiemetics. These include:

  • Bismuth subsalicylate (2 brand names: Kaopectate, Pepto-Bismol). It may help treat some types of nausea and vomiting, such as from gastroenteritis (stomach flu). It's also used for upset stomach and as an antidiarrheal (medicine to treat diarrhea).
  • Antihistamines. Certain types may help prevent nausea and vomiting caused by motion sickness. These include dimenhydrinate (brand name: Dramamine) and meclizine hydrochloride (brand name: Dramamine Less Drowsy).

Path to Improved Health

How do antiemetic medicines work?

Bismuth subsalicylate works by protecting the stomach lining.

Antihistamines appear to dull the inner ear's ability to sense motion. They block messages to the part of the brain that controls nausea and vomiting. This is why they work best if you take them before you start feeling motion sickness.

How do I safely take OTC antiemetic medicines?

Before you take an OTC antiemetic medicine, read the directions on the drug facts label. This will tell you how much medicine to take and how often to take it. If you have any questions, call your family doctor or pharmacist. Keep a record of which OTC medicines you are using and when you take them. If you need to go to the doctor, take this list with you.

Follow these tips to make sure you are taking the right amount of medicine:

  • Take only the amount recommended on the medicine's label. Don't assume that more medicine will work better or quicker. Taking more than the recommended amount can be dangerous.
  • If you are taking a prescription medicine, ask your doctor if it's okay to also take an OTC antiemetic medicine.
  • Don't use more than 1 kind of OTC antiemetic medicine at a time unless your doctor says it's okay. They may have similar active ingredients. These could add up to be too much medicine.

How can I safely store OTC antiemetic medicines?

Store all medicines up and away, out of reach and sight of young children. Keep medicines in a cool, dry place. This will help prevent them from becoming less effective. Do not store medicines in bathrooms or bathroom cabinets. They are often hot and humid.

Things to Consider

Healthy adults usually don't experience side effects from antiemetic medicines. Side effects can be a concern for older adults or people who have health problems.

The most common side effects of bismuth subsalicylate are:

These are short-term side effects.

Antihistamines may make you feel sleepy. This can affect your ability to drive or operate machines. It may be hard for you to think clearly. Alcohol can increase the drowsiness caused by antihistamines. Antihistamines may also cause your mouth and eyes to feel dry.

Who shouldn't take OTC antiemetic medicines?

Some people are allergic to aspirin or other salicylate medicines. They should not take bismuth subsalicylate. Don't give bismuth subsalicylate to children 12 years of age or younger. Don't give it to children or teenagers who may have the flu or chickenpox. This increases their risk for Reye syndrome. This is a serious illness that can lead to death.

Before taking an antihistamine, talk to your doctor if you have any of the following problems:

Can OTC antiemetic medicines cause problems with any other medicines I take?

Bismuth subsalicylate may affect how well some medicines work. It also may cause side effects if combined with other medicines. Ask your doctor before taking bismuth subsalicylate if you also take:

Ask your doctor before taking bismuth subsalicylate if you take pain relievers or cold medicines. These medicines may contain aspirin, which is a salicylate. You may get too much salicylate if you take more than 1 of these medicines at a time.

Talk to your doctor before taking an antihistamine if you take sleeping pills, sedatives, or muscle relaxants. Many OTC cold and allergy medicines contain antihistamines. If you use more than 1 of these medicines, you may get more antihistamine than you intend. Some prescription medicines have side effects similar to the side effects of antihistamines. These could include dry mouth and drowsiness. Talk with your doctor before taking these medicines at the same time.

Questions to ask your doctor

  • What kind of antiemetic medicine is best for me?
  • How does the medicine help my nausea?
  • How often can I take it?
  • Is there a limit on how many days I can take it?
  • What kinds of side effects should I look for?

BRAT Diet: Recovering From an Upset Stomach

An upset stomach or diarrhea can leave you feeling miserable. If left untreated, it can lead to exhaustion and dehydration, too, so it's important to make sure your body stays nourished — but it can be hard to determine what to eat after throwing up or having diarrhea. A special diet known as the BRAT diet (Bananas, Rice, Applesauce, and Toast) is an effective way to treat both.

Path to Improved Health

The BRAT diet is a bland food diet recommended for adults and children. The benefits of using the BRAT diet to treat upset stomach and diarrhea include:

  • The foods used in the diet make your stools firmer. That's because the foods are considered "binding" foods — low-fiber, bland, starchy foods.
  • The foods help replace nutrients your body needs and has lost due to vomiting and diarrhea. Bananas, for example, are high in the vitamin potassium.

Bland foods don't irritate your stomach. After you have diarrhea or vomiting, follow the BRAT diet to help your body ease back into normal eating. This diet also may help ease the nausea and vomiting some women experience during pregnancy.

You can add other bland foods to the BRAT diet. For example, you can try saltine crackers, plain potatoes, or clear soup broths. Don't start eating dairy products, sugary, or fatty foods right away. These foods may trigger nausea or lead to more diarrhea.

Things to Consider

  • At first, stick to sips of clear liquids. Solid foods like those in the BRAT diet are not recommended for adults and children who are actively vomiting. Wait until you can eat solid foods without vomiting. If you have been vomiting or have diarrhea, try drinking a beverage with electrolytes (a mix of important nutrients to keep our bodies hydrated).
  • Follow your doctor's instructions on the types of foods to eat when dealing with an upset stomach or diarrhea.
  • As you feel better, return to a normal, healthy diet. The BRAT diet does not provide all the elements of a healthy diet. You should be able to start eating a more regular diet, including fruits and vegetables, within about 24 to 48 hours after vomiting or having diarrhea.

Questions for your doctor

  • What if the foods in the BRAT diet make me nauseous?
  • Can you become constipated by staying on the BRAT diet for too long?
  • Is rice better than potatoes?

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