Differential diagnosis of NAUSEA (feeling sick) I cut and paste a differential diagnosis, there are LOADS of things that could have you feeling this way, it could also just be stress and panic attacks, which a lot of people have at some point in their life. Modern living hey............................
The patient complains of nausea with or without vomiting, or vomiting without nausea.
Ascertain the following during the history:
Duration of symptoms
Ok we know its a week
Characteristics, timing, and precipitating factors
How did it come on, slow, fast, any time of day that it seem worse? Did you notice anything different before it started?
Fever
Hematemesis
This means vomiting blood.
Jaundice
Are you looking more yellow? CHeck the whites of your eyes, it is usually quite obvious
Abdominal pain
Lightheadedness, dizziness, vertigo, or orthostatic symptoms
Are you dizzy when you stand up, bend over, with heights?
Polyuria -
ARE you urinating a lot?
Polydipsia
Are you drinking a lot more than usual?
Headache
Changes in vision
Neck stiffness
Pruritus -
this means itchy for your information
Hepatitis history
Have you had a liver function test?
Pancreatitis history
Do you have a history of gallstones, been drinking quite a bit, had mumps, had any impact in the abdomen?
Toxoplasmosis encephalitis history
Have you been around cat poo lately?
Cytomegalovirus history
CMV will give you one of the 'new' versions of 'yuppie flu, ME can't remember right now what the full name is.
Cryptococcal (or other chronic meningitis) history
Central nervous system (central nervous system) lymphoma history
Renal failure history
Unprotected sex
In the last 6 months? Have you ever had a complete STD screen? HIV can lie dormant for some time, not meaning to freak you out, but it is one of the possibilities.
Medications, new and ongoing
Have you taken a course of steroids?
Nutritional supplements and nonprescription medications
Alcohol intake, substance use or abuse
Are you taking ANYTHING? Drinking or taking any recreational drugs?
A partial differential diagnosis includes the following conditions:
Medication effect or reaction
Drug-drug interactions
Foodborne illness
Pancreatitis
Meningitis
Adrenal insufficiency
Toxoplasmosis encephalitis
Uremia -
How high is your protein intake, I know my urea levels get quite high on a 50% protein diet. You may be sensitive to the breakdown product of protein, urea
Diabetic ketoacidosis
Have you been doing a low carb diet? Do you have a history of diabetes in your family?
Lactic acidosis due to nucleoside analogues
How hard have you been training? If you have been excessive lactic acid can make you feel sick. Are you taking zovirax?
CNS lymphoma
Hepatitis, infectious or drug related (see chapters Hepatitis B Infection and Hepatitis C Infection)
Appendicitis
Blood work you will need:
Complete blood count (CBC) with differential
Blood urea nitrogen (BUN), creatinine, electrolytes
Glucose
Amylase
May not be necessary...........
Liver function tests (LFTs) and hepatitis serologies for possible acute hepatitis
Cortisol
May not necessary
Thyroid function test
Don't stress or panic more, studying pathology is a bit scary, I used to think I had every disease I studied
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