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| {{EH}} | | '''For patient information, click [[Nausea and vomiting (patient information)|here]]''' |
| | {{Nausea and Vomiting}} |
| | {{CMG}}; {{AE}} [[User:Tayebah Chaudhry|Tayebah Chaudhry]][mailto:dr.thch@yahoo.com]; '''Associate Editor-In-Chief:''' {{MUT}} |
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| ==Overview==
| | '''''Synonyms and Keywords:''''' Emesis |
| '''Nausea''' ([[Latin]]: ''Nausea'', [[Greek language|Greek]]: ''{{Polytonic|Ναυτεία}}'', "[[sea-sickness]]") is the sensation of unease and discomfort in the [[stomach]] with an urge to [[vomit]]. | |
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| Nausea is not a sickness, but rather a symptom of several conditions, many of which are not related to the stomach. Nausea is often indicative of an underlying condition elsewhere in the body. Travel sickness, which is due to confusion between perceived movement and actual movement, is an example. The sense of equilibrium lies in the ear and works together with eyesight. When these two don't "agree" to what extent the body is actually moving the symptom is presented as nausea even though the stomach itself has nothing to do with the situation. Nausea is also an [[Adverse effect (medicine)|adverse effect]] of many drugs. Nausea may also be an effect of a large intake of sugary foods. | | ==[[Nausea and vomiting overview|Overview]]== |
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| In medicine, nausea can be a problem during some [[chemotherapy]] regimens and following [[general anaesthesia]]. Nausea is also a common symptom of [[pregnancy]]. Mild nausea experienced during pregnancy can be normal, and should not be considered an immediate cause for alarm.
| | ==[[Nausea and vomiting historical perspective|Historical Perspective]]== |
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| * '''Vomiting ''' (also '''throwing up''' or '''emesis''') is the forceful expulsion of the contents of one's [[stomach]] through the [[mouth]] and sometimes the [[nose]]. '''Vomiting''' may result from many causes, ranging from [[gastritis]] or [[poison]]ing to [[brain tumor]]s, or elevated [[intracranial pressure]] (ICP). The feeling that one is about to vomit is called [[nausea]]. It usually precedes, but does not always lead to vomiting. [[Antiemetic]]s are sometimes necessary to suppress nausea and vomiting, and in severe cases where [[dehydration]] develops, [[intravenous]] fluid may need to be administered to replace fluid volume.
| | ==[[Nausea and vomiting classification|Classification]]== |
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| The medical branch investigating vomiting, emetics and antiemetics is called '''emetology'''.
| | ==[[Nausea and vomiting pathophysiology|Pathophysiology]]== |
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| ==Causes of Nausea== | | ==[[Nausea and vomiting causes|Causes]]== |
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| *[[Addison disease]]
| | ==[[Nausea and vomiting differential diagnosis|Differentiating Nausea and Vomiting from other Conditions]]== |
| *[[Alcoholism]]
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| *[[Appendicitis]]
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| *[[Brain tumor]]
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| *[[Bulimia]]
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| *[[Cancer]]
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| *[[Chronic fatigue syndrome]]
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| *[[Crohn's disease]]
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| *[[Depression (mood)|Depression]]
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| *[[Diabetes]]
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| *[[Flu]]
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| *[[Food poisoning]]
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| *[[Gastroenteritis]]
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| *[[Gastroesophageal reflux disease]]
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| *[[Gastroparesis]]
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| *[[Heart attack]]
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| *[[Hydrocephalus]]
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| *[[Kidney failure]]
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| *[[Medication]]s
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| *[[Migraine]]
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| *[[Morning sickness]]
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| *[[Nervousness]]
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| *[[Norovirus]]
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| *[[Pancreatitis]]
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| *[[Peptic ulcer]]
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| *[[Sleep deprivation]]
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| *[[Tobacco smoking]] and [[Passive smoking|second-hand smoke]]
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| *[[Vertigo (medical)|Vertigo]]
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| *Vestibular [[balance disorder]]
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| *Viral [[hepatitis]]
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| ==Mechanism of Vomiting== | | ==[[Nausea and vomiting epidemiology and demographics|Epidemiology and Demographics]]== |
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| === Vomiting center === | | ==[[Nausea and vomiting risk factors|Risk Factors]]== |
| Vomiting is coordinated in the vomiting center in the lateral medullary [[reticular formation]] in the [[pons]]. Receptors on the floor of the [[fourth ventricle]] of the brain represent a [[chemoreceptor trigger zone]], stimulation of which can lead to vomiting. The chemoreceptor zone lies outside the [[blood-brain barrier]], and can therefore be stimulated by blood-borne drugs that can [[Vomiting#Emetics|stimulate vomiting]], or [[Vomiting#Antiemetics|inhibit it]].
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| There are various sources of input to the vomiting center:
| | ==[[Nausea and vomiting natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
| *The chemoreceptor trigger zone at the base of the fourth ventricle has numerous [[Dopamine receptor D2|dopamine D<sub>2</sub> receptors]], [[5-HT receptor|serotonin 5-HT<sub>3</sub> receptors]], [[opioid receptor]]s, [[Acetylcholine receptor]]s, and receptors for [[substance P]]. Stimulation of different receptors are involved in different pathways leading to emesis, in the final common pathway substance P appears to be involved.<ref>Hornby PJ. Central neurocircuitry associated with emesis. Am J Med 2001;111:106S-12S. PMID 11749934.</ref>
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| *The vestibular system which sends information to the brain via [[cranial nerve VIII]] (vestibulocochlear nerve). It plays a major role in [[motion sickness]] and is rich in [[Muscarinic acetylcholine receptor|muscarinic receptors]] and [[histamine receptor|histamine H<sub>1</sub> receptors]].
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| *[[Vagus nerve|Cranial nerve X]] (vagus nerve), which is activated when the pharynx is irritated, leading to a gag reflex.
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| *Vagal and [[enteric nervous system]] inputs that transmit information regarding the state of the [[gastrointestinal system]]. Irritation of the GI mucosa by chemotherapy, radiation, distention or acute infectious [[gastroenteritis]] activates the 5-HT<sub>3</sub> receptors of these inputs.
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| *The CNS mediates vomiting arising from psychiatric disorders and stress.
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| === Vomiting Act === | | ==Diagnosis== |
| The vomiting act encompasses three types of outputs initiated by the medulla: Motor, [[parasympathetic nervous system]] (PNS) and [[sympathetic nervous system]] (SNS). Collectively, they are as follows:
| | [[Nausea and vomiting history and symptoms|History and Symptoms]] | [[Nausea and vomiting physical examination|Physical Examination]] | [[Nausea and vomiting laboratory findings|Laboratory Findings]] | [[Nausea and vomiting electrocardiogram|Electrocardiogram]] | [[Nausea and vomiting x ray|X Ray]] | [[Nausea and vomiting CT|CT]] | [[Nausea and vomiting MRI|MRI]] | [[Nausea and vomiting echocardiography or ultrasound|Echocardiography or Ultrasound]] | [[Nausea and vomiting other imaging findings|Other Imaging Findings]] | [[Nausea and vomiting other diagnostic studies|Other Diagnostic Studies]] |
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| *Increased [[saliva]]tion to protect the [[tooth enamel|enamel]] of [[teeth]] from stomach acids (excessive vomiting leads to [[dental caries|caries]]). This is part of the PNS output.
| | ==Treatment== |
| *[[Retroperistalsis]], starting from the middle of the [[small intestine]], sweeping up the contents of the digestive tract into the stomach, through the relaxed pyloric sphincter.
| | [[Nausea and vomiting medical therapy|Medical Therapy]] | [[Nausea and vomiting surgery|Surgery]] | [[Nausea and vomiting primary prevention|Primary Prevention]] | [[Nausea and vomiting secondary prevention|Secondary Prevention]] | [[Nausea and vomiting cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Nausea and vomiting future or investigational therapies|Future or Investigational Therapies]] |
| *A lowering of intrathoracic pressure (by inspiration against a closed [[glottis]]), coupled with an increase in abdominal pressure as the [[abdomen|abdominal muscles]] contract, propels stomach contents into the [[esophagus]] without involvement of retroperistalsis. The [[cardia|lower esophageal sphincter]] relaxes. This is part of the motor output, and it is also important to note that the stomach itself does not contract in the process of vomiting.
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| *Vomiting is ordinarily preceded by [[retching]].
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| *Vomiting also initiates a SNS response causing both sweating and increased heart rate.
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| The [[neurotransmitter]]s that regulate vomiting are poorly understood, but inhibitors of [[dopamine]], [[histamine]] and [[serotonin]] are all used to suppress vomiting, suggesting that these play a role in the initiation or maintenance of a vomiting cycle. [[Vasopressin]] and neurokinin may also participate.
| | ==Case Studies== |
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| ==Content==
| | [[Nausea and vomiting case study one|Case #1]] |
| Since the stomach secretes acid, vomit contains a high concentration of [[hydronium|hydronium ion]]s and is thus strongly acidic. Recent food intake will be reflected in the gastric vomit.
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| The content of the '''vomitus''' (vomit) may be of medical interest. Fresh [[blood]] in the vomit is termed [[hematemesis]] ("blood vomiting"). Old blood bears resemblance to coffee grounds (as the [[iron]] in the blood is [[oxidation|oxidized]]), and when this matter is identified the term "coffee ground vomiting" is used. [[Bile]] can enter the vomit during subsequent heaves due to [[duodenum|duodenal]] contraction if the vomiting is severe. [[Fecal vomiting]] is often a consequence of [[intestinal obstruction]], and is treated as a warning sign of this potentially serious problem ("signum mali ominis"); such vomiting is sometimes called "miserere". If food has recently been consumed, then partly digested food may show up in the vomit.
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| If the vomiting reflex continues for an extended period of time with no appreciable vomitus, the condition is known as '''non-productive emesis''' or '''dry heaves''', which can become both extremely painful and debilitating.
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| ==Causes of Vomiting==
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| Vomiting may be due to a large number of causes, and protracted vomiting has a long [[differential diagnosis]].
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| ===Digestive tract===
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| Causes in the [[digestive tract]]:
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| * [[Gastritis]] (inflammation of the gastric wall, usually by [[virus]]es)
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| * [[Pyloric stenosis]] (in babies - this typically causes a very forceful "projectile vomiting" and is an indication for urgent surgery)
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| * [[Bowel obstruction]]
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| * [[Acute abdomen]] and/or [[peritonitis]]
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| * [[Ileus]]
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| * [[Cholecystitis]], [[pancreatitis]], [[appendicitis]], [[hepatitis]]
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| * Food [[allergy|allergies]]
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| * In children, it can be caused by an allergic reaction to cow's milk proteins ([[milk allergy]])
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| ===Sensory system and brain===
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| Causes in the [[sensory system]]:
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| * Movement: [[motion sickness]] (which is caused by overstimulation of the labyrinthine canals of the ear)
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| * [[Ménière's disease]]
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| Causes in the brain:
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| * [[Concussion]]
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| * [[Cerebral hemorrhage]]
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| * [[Migraine]]
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| * [[Brain tumor]]s, which can cause the chemoreceptors to malfunction
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| * [[Benign intracranial hypertension]] and [[hydrocephalus]]
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| Metabolic disturbances (these may irritate both the stomach and the parts of the brain that coordinate vomiting):
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| * [[Hypercalcemia]] (high [[calcium in biology|calcium]] levels)
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| * [[Uremia]] ([[urea]] accumulation, usually due to [[renal failure]])
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| * [[Adrenal insufficiency]]
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| * [[Hypoglycemia]]
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| Pregnancy:
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| * [[Hyperemesis]], [[Morning sickness]]
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| Drug reaction (vomiting may occur as an acute [[somatic]] response to):
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| * [[alcohol]] (being sick whilst being [[drunkenness|drunk]] or being sick the next morning suffering from the after-effects, i.e. the [[hangover]]).
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| * [[opioid]]s
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| * [[selective serotonin reuptake inhibitor]]
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| * many [[chemotherapy]] drugs
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| * some [[entheogen]]s (such as [[peyote]] or [[ayahuasca]])
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| ===Other===
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| * Self-induced
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| ** [[Eating disorder]]s ([[anorexia nervosa]] or [[bulimia nervosa]])
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| ** Sexual fetish ([[emetophilia]])
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| ** To remove a poison in case such has been ingested (some poisons should not be vomited as they may be more toxic when inhaled or aspirated; it is generally considered better to ask for help before inducing vomiting)
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| ** Some people who are engaged in [[binge drinking]] will induce vomiting in order to make room in their stomachs for further alcohol consumption. In the United Kingdom, this practice is known as ''tactical chundering,'' and as ''boot and rally'' or ''pulling the trigger'' in the United States.
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| * After [[surgery]] ([[postoperative nausea and vomiting]])
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| * Disagreeable sights, smells or thoughts (such as decayed matter, others' vomit, thinking of vomiting), etc.
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| * Extreme pain, such as intense [[headache]] or [[myocardial infarction]] (heart attack)
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| * Violent emotions (including laughing)
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| * [[Cyclic vomiting syndrome]] (a poorly understood condition with attacks of vomiting)
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| * High doses of [[ionizing radiation]] will sometimes trigger a vomit reflex in the victim.
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| * Violent fits of [[coughing]] or [[hiccups]]
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| * [[Nervousness]]
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| == Differential Diagnosis of Causes of Nausea and Vomiting==
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| In alphabetical order. <ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>
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| === Main Cases ===
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| * [[Drugs]], toxins
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| * [[Gastroenteritis]]
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| * Spoiled foods
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| === Other Causes ===
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| * [[Achalasia]]
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| * [[Acoustic neuroma]]
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| * Acute [[high altitude sickness]]
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| * Acute [[infection]]s
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| * [[Adrenal failure]]
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| * [[Addison's Disease]]
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| * [[Afferent Loop Syndrome]]
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| * After brain [[radiation]]
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| * After [[radiation therapy]]
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| * [[AIDS]]
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| * [[Amyloidosis]]
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| * Anastomosis stenosis
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| * [[Anorexia Nervosa]]
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| * [[Anxiety]]
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| * [[Appendicitis]]
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| * [[Biliary colic]]
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| * [[Bulimia]]
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| * [[Carbon monoxide poisoning]]
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| * Cardiac [[arrhythmia]]
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| * [[Cholecystitis]]
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| * [[Cholecystolithiasis]]
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| * [[Crohn's Disease]]
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| * [[Depression]]
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| * [[Diabetes Mellitus]]
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| * [[Diabetic gastroparesis]]
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| * [[Diabetic Ketoacidosis]]
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| * [[Drugs]], toxins
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| * [[Dumping Syndrome]]
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| * [[Dysmenorrhea]]
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| * [[Ear infection]]
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| * [[Edema]]
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| * [[Encephalitis]]
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| * Erotic vomiting
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| * [[Esophageal diverticulum]]
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| * [[Esophageal stenosis]]
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| * [[Esophagitis]]
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| * Food poisoning
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| * Foreign bodies
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| * Fructose intolerance [[hypoglycemia]]
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| * Gall bladder disorders
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| * [[Gastric carcinoma]]
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| * [[Gastric outlet obstruction]]
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| * Gastrocolic fistula
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| * [[Gastroesophageal Reflux Disease]] (GERD)
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| * [[Glaucoma]]
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| * [[Heat stroke]]
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| * [[Head trauma]]
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| * [[Heart failure]]
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| * [[Hemorrhage]]
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| * [[Hepatic coma]]
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| * Hepatic [[porphyria]]
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| * [[Hepatitis]]
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| * [[Hernia]]
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| * [[Hydrocephalus]]
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| * [[Hypercalcemia]]
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| * [[Hyperemesis gravidarum]]
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| * [[Hyperparathyroidism]]
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| * [[Hypertension]]
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| * [[Hyponatremia]]
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| * Idiopathic
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| * [[Ileus]]
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| * Inflammation in the are of the vestibular organ
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| * [[Intussusception]]
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| * [[Ischemic bowel]]
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| * [[Kinetosis]]
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| * [[Labyrinthitis]]
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| * [[Malaria]]
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| * Malingering
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| * [[Meniere's Disease]]
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| * [[Meningitis]]
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| * [[Meningoencephalitis]]
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| * [[Mesenteric infarction]]
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| * [[Metabolic acidosis]]
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| * [[Migraine]]
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| * [[Morning sickness]]
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| * Motion sickness
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| * [[Myocardial Infarction]]
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| * Orthostatic reaction
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| * [[Ovarian torsion]]
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| * [[Pancreatitis]]
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| * [[Peptic Ulcer Disease]]
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| * [[Peritonitis]]
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| * Post-tussive emesis
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| * Postoperative
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| * Postviral
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| * [[Pregnancy]]
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| * Pseudo-obstruction
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| * [[Pulmonary embolism]]
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| * Psychogenic vomiting
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| * [[Pyelonephritis]]
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| * [[Q Fever]]
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| * Refractive error
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| * [[Renal colic]]
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| * [[Renal failure]]
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| * [[Scleroderma]]
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| * [[Spotted Fever]]
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| * Sub[[ileus]]
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| * [[Syndrome of inappropriate antidiuretic hormone]] ([[SIADH]])
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| * [[Tabes Dorsalis]]
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| * [[Testicular torsion]]
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| * [[Thyrotoxicosis]]
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| * Toxic ingestions
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| * Twisted [[ovarian cyst]]
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| * [[Uremia]]
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| * [[Urolithiasis]]
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| * [[Vagotomy]]
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| * Vertebro-Basilar Syndrome
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| * [[Vestibular neuritis]]
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| * [[Volvulus]]
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| * [[Zollinger-Ellison Syndrome]]
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| == Diagnosis ==
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| == Physical Examination ==
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| * Exams should include:
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| *:* Neurologic
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| *:* Ear
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| *:* Ophthalmagic
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| *:* Abdominal
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| == Laboratory Findings ==
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| * [[Complete blood count]] (CBC)
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| * [[Electrolytes]]
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| * [[Liver function tests]] (LFTs)
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| * [[Amylase]]
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| * [[Lipase]]
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| * [[Calcium]]
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| * [[Magnesium]]
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| * [[Salicylate]] level
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| * [[Hepatitis]] serologies
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| * [[Cerebrospinal fluid]] (CSF) analysis
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| * Toxicology screen
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| === Electrolyte and Biomarker Studies ===
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| * [[Electrolytes]]
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| === Electrocardiogram ===
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| * [[ECG]] to rule out an inferior [[MI]] or arrhythmia
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| === X Ray ===
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| * Plain kidney, ureter, bladder (KUB) X-rays
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| === MRI and CT ===
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| * Abdominal [[CT scan]] (with oral and IV contrast)
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| * Head [[CT scan]]
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| === Echocardiography or Ultrasound ===
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| * Abdominal/pelvic ultrasound
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| === Other Diagnostic Studies ===
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| * [[Endoscopy]]
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| * [[Colonoscopy]]
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| == Treatment ==
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| * Fluid resuscitation (due to vomiting-induced dehydration)
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| * Treat underlying disease etiologies
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| ===Treatment of Nausea===
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| While short-term nausea and vomiting are generally harmless, they may sometimes indicate a more serious condition, such as [[Coeliac disease]]. When associated with prolonged vomiting, it may lead to [[dehydration]] and/or dangerous electrolyte imbalances.
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| Symptomatic treatment for nausea and vomiting may include short-term avoidance of solid [[food]]. This is usually easy as nausea is nearly always associated with loss of [[appetite]]. Dehydration may require [[rehydration]] with oral or intravenous [[electrolyte]] solutions. If the cause is by [[motion sickness]], sitting down in a still environment may also help.
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| There are several types of [[antiemetic]]s, and researchers continue to look for more effective treatments. The main types used post operatively for surgical patients are [[ondansetron]], [[dexamethasone]], [[promethazine]], [[diphenhydramine]], and in small doses [[droperidol]]. [[Doxylamine]] is the drug of choice in pregnancy-related nausea. Anecdotally, another remedy used by recovery room nurses is to place an [[isopropyl alcohol]] swab under the patient's nose while he or she breathes through the nose. This may abate the nausea until the antiemetic medication takes effect. When ingested or inhaled, the chemical compound [[tetrahydrocannabinol]] has been shown to reduce nausea in some users.<ref>{{cite web | url = http://www.drugpolicy.org/marijuana/medical/challenges/litigators/medical/conditions/nausea.cfm | title = Medicinal Uses of Marijuana: Nausea, Emesis and Appetite Stimulation | accessdate = 2007-08-02 | date = 2001 | author = Drug Policy Alliance}}</ref> Also available are a variety of non-invasive (often untested) mechanical devices used to suppress nausea due to motion sickness.
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| The spice [[ginger]] is also used for centuries as a folk remedy to treat nausea, and recent research has supported this use.<ref>{{cite web | title = Ginger | author = University of Maryland Medical Centre | url = http://www.umm.edu/altmed/ConsHerbs/Gingerch.html | accessdate = 2007-08-02 | date = 2006 }}</ref>
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| ===Treatment of Vomiting===
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| === Acute Pharmacotherapies ===
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| * Antiemetics: An [[antiemetic]] is a [[medication|drug]] that is effective against vomiting and [[nausea]]. Antiemetics are typically used to treat [[motion sickness]] and the [[Adverse effect (medicine)|side effects]] of some [[opioid]] [[analgesic]]s and [[chemotherapy]] directed against [[cancer]]. Antiemetics act by inhibiting the receptor sites associated with emesis. Hence, anticholinergics, antihistamines, dopamine antagonists, serotonin antagonists and cannabinoids are used as anti-emetics.
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| * Anticholinergics
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| === Surgery and Device Based Therapy ===
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| * Colonoscopy/endoscopy may also be used as therapy
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| == Complications of vomiting ==
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| ===Aspiration of vomit ===
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| Vomiting can be very dangerous if the gastric content gets into the respiratory tract. Under normal circumstances the [[gag reflex]] and [[coughing]] will prevent this from occurring, however these protective reflexes are compromised in persons under narcotic influences such as [[ethanol|alcohol]] or [[anesthesia]]. The individual may choke and [[asphyxiation|asphyxiate]] or suffer an [[aspiration pneumonia]].
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| === Dehydration and electrolyte imbalance ===
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| Prolonged and excessive vomiting will deplete the body of water (dehydration) and may alter the electrolyte status. The loss of acids leads to [[metabolic alkalosis]] (increased blood [[pH]]), and the electrolyte imbalance shows [[hypokalemia]] ([[potassium]] depletion) and [[hypochloremia]] ([[chlorine]] depletion). The hypokalemia is an indirect result of the [[kidney]] compensating for the loss of acid. With the loss of intake of food the individual will become [[cachexia|cachectic]].
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| == References ==
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| {{reflist|2}}
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| ==External links==
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| *[http://faq.emetophobia.net/emetophobia.html Emetophobia FAQ]
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| *[http://www.cvsa.org.uk Cyclical Vomiting Syndrome]
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| {{SIB}}
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| {{Gastroenterology}} | | {{Gastroenterology}} |
| {{Symptoms and signs}}
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| [[Category:Primary care]]
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| [[Category:Emergency medicine]]
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| [[Category:Gastroenterology]]
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| [[Category:Signs and symptoms]]
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| [[ar:قيء]]
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| [[da:Opkast]]
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| [[de:Erbrechen]]
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| [[es:Vómito]] | | [[es:Vómito]] |
| [[eo:Vomado]]
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| [[fr:Vomissement]] | | [[fr:Vomissement]] |
| [[it:Vomito]]
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| [[he:הקאה]]
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| [[hr:Povraćanje]]
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| [[la:Vomitus]]
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| [[lt:Vėmimas]]
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| [[mk:Повраќање]]
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| [[nl:Braken (lichaamsfunctie)]]
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| [[ja:嘔吐]] | | [[ja:嘔吐]] |
| [[no:Oppkast]]
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| [[pt:Emese]] | | [[pt:Emese]] |
| [[pl:Wymioty]] | | [[pl:Wymioty]] |
| [[ru:Рвота]] | | [[ru:Рвота]] |
| [[simple:Vomit]]
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| [[sk:Zvracanie]]
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| [[sr:Повраћање]]
| |
| [[fi:Oksennus]]
| |
| [[sv:Kräkning]]
| |
| [[uk:Блювання]]
| |
| [[wa:Rivômixhaedje]]
| |
| [[zh:呕吐]] | | [[zh:呕吐]] |
| [[da:Kvalme]]
| |
| [[de:Nausea]]
| |
| [[es:Náusea]] | | [[es:Náusea]] |
| [[eo:Vomemo]]
| |
| [[fa:تهوع]]
| |
| [[fr:Nausée (médecine)]] | | [[fr:Nausée (médecine)]] |
| [[io:Nauzeo]]
| |
| [[it:Nausea]]
| |
| [[he:בחילה]]
| |
| [[lt:Pykinimas]]
| |
| [[nl:Misselijkheid]]
| |
| [[ja:吐き気]] | | [[ja:吐き気]] |
| [[no:Kvalme og brekninger]]
| |
| [[pl:Nudności]] | | [[pl:Nudności]] |
| [[pt:Náusea]] | | [[pt:Náusea]] |
| [[simple:Nausea]]
| |
| [[sk:Nauzea]]
| |
| [[sv:Illamående]]
| |
| [[tr:Bulantı]] | | [[tr:Bulantı]] |
|
| |
|
| {{WH}} | | {{WH}} |
| {{WS}} | | {{WS}} |
| | |
| | [[Category:Symptoms]] |
| | [[Category:Signs and symptoms]] |
| | [[Category:Emergency medicine]] |
| | [[Category:Gastroenterology]] |
| | [[Category:Obstetrics]] |