From the Guidelines
The diagnostic workup for persistent recurrent vomiting in a 55-year-old female should begin with a thorough history and physical examination, followed by basic laboratory tests and targeted imaging studies to evaluate for underlying gastrointestinal, hepatobiliary, pancreatic, or neurological causes. The initial evaluation should include a complete blood count, comprehensive metabolic panel, amylase, lipase, and thyroid function tests to assess for potential metabolic or infectious causes 1. Given the age of the patient, it is essential to consider a broad range of potential causes, including but not limited to gastric outlet obstruction, peptic ulcer disease, malignancy, hepatobiliary disease, pancreatic disorders, bowel obstruction, and gastroparesis. Upper endoscopy is recommended as a first-line procedure to evaluate the upper gastrointestinal tract for structural abnormalities, while abdominal imaging with ultrasound or CT scan can help assess for hepatobiliary disease, pancreatic disorders, or bowel obstruction. If initial tests are unrevealing, additional specialized tests such as a gastric emptying study, esophageal pH monitoring, small bowel follow-through, or CT enterography may be necessary to evaluate for conditions like gastroparesis or small bowel pathology. It is also crucial to review the patient's medication list, as many drugs can cause vomiting, including NSAIDs, antibiotics, and chemotherapeutic agents. Laboratory evaluation should include pregnancy testing and assessment for metabolic disorders, and if psychological factors are suspected, psychiatric evaluation may be appropriate after organic causes have been excluded. Key considerations in the diagnostic workup include:
- Thorough history and physical examination
- Basic laboratory tests (complete blood count, comprehensive metabolic panel, amylase, lipase, thyroid function tests)
- Targeted imaging studies (upper endoscopy, abdominal ultrasound or CT scan)
- Specialized tests as needed (gastric emptying study, esophageal pH monitoring, small bowel follow-through, CT enterography)
- Medication review and laboratory evaluation for metabolic disorders and pregnancy testing.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Diagnostic Considerations
- The patient's symptoms of persistent recurrent vomiting may be related to various conditions, including gastrointestinal disorders or other systemic diseases.
- A thorough diagnostic workup is necessary to determine the underlying cause of the symptoms.
Gastrointestinal Disorders
- Irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) are potential causes of gastrointestinal symptoms, including nausea and vomiting 2.
- According to a study published in Neurogastroenterology and motility, IBS patients reported greater severity of nausea/vomiting symptoms compared to IBD patients and the general population 2.
Other Systemic Diseases
- Cerebral amyloid angiopathy (CAA) is a rare condition that can present with a range of symptoms, including vision changes, language disturbances, and headache 3.
- Although CAA is not typically associated with gastrointestinal symptoms, it is essential to consider other systemic diseases that may cause vomiting, such as neurological or metabolic disorders.
Diagnostic Evaluation
- A comprehensive diagnostic evaluation, including laboratory tests, imaging studies, and endoscopic procedures, may be necessary to determine the underlying cause of the patient's symptoms.
- The choice of diagnostic tests will depend on the patient's medical history, physical examination, and presenting symptoms.