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Differential Diagnosis and Therapeutical Management of Vomiting Patients
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Introduction
The vomiting patient is among the regular daily clinical consultations. When an individual is compromised by acute gastroenteritis (infectious, toxic, parasitic disease, foreign body, etc.), it is usually easy to make a diagnosis and administrate successful treatment. However, when the symptoms persist for more time (weeks, months or years) the formulation of differential diagnoses and indication of complementary diagnostic methods may generate doubts, as may the implementation of effective treatment.
Vomiting may be triggered by stimuli reaching the vomit center (VC) either directly or indirectly. Patients with kidney or liver diseases or decompensated diabetic patients, present a high quantity of circulating toxins which stimulate emesis by acting on the VC or on the chemoreceptor trigger zone (CTZ). This stimulus may also originate in the central nervous system (tumor, hemorrhage or edema -related increased intracranial pressure), or from the peripheral or vagal route. The latter carries information from the digestive tract, as well as from the biliary ducts, urinary tract, internal genitals, mesentery, etc.
The vestibular apparatus can also induce vomiting in the presence of inflammation or infection of the middle or inner ear.
Differential diagnosis
The first step in diagnosing a vomiting patient consists in performing a proper anamnesis and clinical examination. Initial differentiation must be based on regurgitation and productive coughing.
Regurgitation is caused by a passive mechanism that produces the expulsion of food or saliva from the pharynx or the esophagus through the mouth. It should be noted that this does not always occur immediately post ingestion. Unlike vomiting, regurgitation does not include a prodromic period, with a display of ptyalism, unrest, etc., or evident abdominal contractions.
When a vomiting condition has been established, emphasis must be made on the type of vomiting (food-related or otherwise), frequency, time at which it appears, relation to food intake, etc., as well as considering other symptoms.
Significant anamnesis data to be considered includes vaccination status, de-worming treatment administered, excessive intake of food, dietary changes, administration of drugs (AINES, digitalis, antibiotic, etc.), roaming habits, etc.
When this initial stage has concluded without leading to a sure diagnosis, a series of complementary methods must be requested to arrive at a conclusive diagnosis. [...]
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