Investigating nausea and vomiting (summary)

Dr Jeremy Jones et al.

Nausea and vomiting are non-specific physical manifestations of disease. They may occur together, or in isolation and may be the result of obstructive pathology as a general manifestation of systemic disease. As such, radiological investigation must be driven by other factors including history and examination as well as other tests, including blood results.

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Summary

  • questions
    • is this a mechanical obstruction?
    • timing of symptom onset
    • are the hernial orifes normal?
    • has the patient had abdominal surgery previously?
    • is the patient well enough for investigation?
  • investigations
    • abdominal x-ray
      • commonly used, but of limited value
      • only helpful if the bowel is dilated and gas-filled
    • CT abdomen
      • contrast-enhanced examination
      • quantifies bowel dilatation
      • identifies transition point
      • helps determine cause
      • assessment of complications (perforation and ischaemia)
    • US abdomen
      • not that useful in cases of mechanical obstruction
      • can visualise fluid-filled loops
      • transition point and cause will be difficult to identify
      • the exception: children and intussusception
    • upper GI contrast study
      • only really ever used in a paediatric context
  • making the request
    • know the question that the team is asking
    • what is the differential and the most likely diagnosis?
    • what is the surgical history?
  • common pathology

Medical student radiology curriculum
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rID: 47907
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Cases and Figures

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    Small bowel obstruction
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    Small bowel obstruction attributed to adhesions
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