1. Medical thingking: vomiting Chien-Ming Li MD, PhD

2. Aristotle’s 4 causes 1.Material: x is what y is (made) 2.Formal: the shape or form, x is what it is to be y 3.Efficient: x is what produces y 4.Final: x is what y is for

3. An exposure causes a disease? 1.Temporality 2.Analogy 3.Biological gradient 4.Coherence 5.Consistency 6.Experiment 7.Strength 8.Specificity 9.Plausibility

4. Koch’s postulates for an infectious disease 1.The microorganism must be found in abundance in all organisms suffering from the disease, but should not be found in healthy organisms. 2.The microorganism must be isolated from a diseased organism and grown in pure culture. 3.The cultured microorganism should cause disease when introduced into a healthy organism. 4.The microorganism must be re-isolated from the inoculated, diseased experimental host and identified as being identical to the original specific causative agent. https://en.wikipedia.org/wiki/Koch%27s_postulates

5. When you present with vomiting to a Dr. (s)he should find out what happens Onset: abrupt versus insidious Timing: 1.Before breakfast 2.During or after eating 3.< 4h after a meal 4.Continuous: depression 5.Irregular: depression Vomitus: 1.Undigested food 2.Partially digested food: GOO, gastroparesis 3.Bile: proximal small bowel obstruct 4.Feculent or odorous: fistula, bowel obstruct

6. When you present with vomiting to a Dr. (s)he should find out what happens Abdominal pain 1.RUQ: gall bladder, biliary tract 2.Epigastrium: stomach, pancreas 3.Severe pain: biliary, pancreatitis, bowl obstruction 4.Severe pain precedes vomiting: small bowel Associated symptoms 1.Weight loss: malignancy 2.Headache, stiff neck: brain 3.Diarrhea, myalgia, epidemiological clues: viruses 4.Early satiety, postprandial bloating: gastroparesis 5.Repetitive migraine headache, s/s of irritable bowel Sx

7. Only 2 diagnostic tests needed to diagnose vomiting Blood tests 1.CBC 2.Electrolytes 3.ESR: IF 4.Liver enzymes 5.Pancreatic enzymes 6.Pregnancy test 7.Toxins 8.TSH: hyperthyroidism Imaging studies 1.Endoscopy 2.Ultrasound 3.Computed tomography

8. Brain diseases cause vomiting 1.Closed head injury 2.Increased intracranial pressure 3.Cerebrovascular accident 4.(infarction/hemorrhage) 5.Hydrocephalus 6.Mass lesion 7.Meningitis/encephalitis/ abscess 8.Pseudotumor cerebri 9.Migraine 10.Seizure disorders2 11.Vestibular 12.Labyrinthitis 13.Ménière’s disease 14.Motion sickness

9. Bowel diseases cause vomiting Functional disorders 1.Gastroparesis Obstruction 1.Adhesions 2.Esophageal disorders 3.Intussusception 4.Malignancy 5.Pyloric stenosis 6.Strangulated hernia 7.Volvulus Organic disorders 1.Appendicitis 2.Cholecystitis/cholangiti s 3.Hepatitis 4.Inflammatory bowel disease 5.Mesenteric ischemia 6.Pancreatitis 7.Peptic ulcer disease 8.Peritonitis

10. Infectious diseases cause vomiting 1.Brain (Central Nervous System): meningitis, encephalitis; projectile 2.ENT (Ear, Nose, Throat): acute otitis media 3.GI (Gastrointestinal): 1)Food poisoning: toxins 2)Viruses: Adenovirus, Norovirus, Norwalk, Rotavirus, Dengue 4.GU (Genito-urinary): pyelonephritis

11. Chemicals poison patients causing vomiting Medications 1.Antiarrhythmics 2.Antibiotics 3.Anticonvulsants 4.Chemotherapeutics 5.Digoxin 6.Hormonal preparations 7.NSAIDs 8.Overdoses/withdrawal 9.Radiation therapy Toxins 1.Arsenic 2.Organophosphates/pesticide 3.Ricin 4.Ethanol overdose 5.Illicit substances 6.Opiates

12. Another diseases cause vomiting (metabolic and psychological disorders) Metabolic 1.Adrenal disorders 2.Diabetic ketoacidosis 3.Paraneoplastic syndromes 4.Parathyroid disorders 5.Pregnancy 6.Thyroid disorders 7.Uremia Psychological 1)Pain 2)Anxiety 3)Conversion 4)Depression 5)Bulimia nervosa 6)Anorexia nervosa