Gastroparesis

Today we discussed the case of an elderly woman with history of diabetes and afib who presented with subacute onset nausea/emesis and epigastric abdominal pain, with gastric emptying study showing marked delayed gastric emptying with >90% of food retained at 4 hours.

We discussed a framework for nausea/emesis as well as how to approach and treat gastroparesis.

Nausea/Emesis can be broken into Acute and Chronic etiologies.

Common etiologies for ACUTE nausea/emesis:

Infections- acute gastroenteritis

Postop Nausea/Emesis- 1/3 of surgical pts have nausea/emesis or both after general anesthesia

Vestibular Neuritis- Rapid onset severe vertigo w/ nausea/emesis, gait instability

Chemo- Common; Anticipatory antiemetic indicated when highly emetogenic chemo regimen given

Common etiologies for CHRONIC nausea/emesis:

Gastroparesis – delayed gastric emptying w/o mechanical obstruction – idiopathic, diabetic

GERD

Gastric Outlet obstruction- pyloric stenosis from malignancy or PUD

Chronic idiopathic

Functional nausea/vomiting disorder

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