Differenzialdiagnostik und Therapie von Übelkeit und Erbrechen

Übelkeit und Erbrechen können physiologisch sein (Schwangerschaft) oder durch Erkrankungen des Gastrointestinaltrakts, anderer abdomineller Organe oder des zentralen Nervensystems bedingt sein. Auch infektiöse, toxische, metabolische oder endokrine Ursachen können Übelkeit und Erbrechen zugrunde liegen. Trotz vieler Differenzialdiagnosen lässt sich die Ursache meist mit einer sorgfältigen Anamnese und gezielten ergänzenden Untersuchungen finden.

Kernaussagen

• Bei der Evaluation von Übelkeit und Erbrechen müssen die Symptome von Regurgitation und Rumination sicher abgegrenzt werden.

• Übelkeit und Erbrechen sind mit hoher Morbidität und verminderter Lebensqualität vergesellschaftet.

• Übelkeit und Erbrechen können gemeinsam, aber auch getrennt voneinander vorkommen.

• Akute Übelkeit und Erbrechen bestehen bis zu 7 Tage, chronische Formen eher länger als 4 Wochen.

• Bei der Diagnostik stehen eine sorgfältige Anamnese und eine körperliche Untersuchung im Vordergrund.

• Bei Erstevaluation einer Patientin oder eines Patienten mit Übelkeit und Erbrechen muss geprüft werden, ob eine Dehydratation oder eine Elektrolytentgleisung vorliegt.

• Häufig liegen akuter Übelkeit und Erbrechen virale oder bakterielle Gastroenteritiden, systemische virale Erkrankungen, lebensmittelbedingte Erkrankungen, akute Migräne mit Kopfschmerzen, Störung des Vestibularapparats, frühe Schwangerschaft und Nebenwirkungen neu eingenommener Medikamente zugrunde.

• Die Ursachen für chronische Übelkeit und Erbrechen sind vielfältig. Dazu gehören Erkrankungen des Gastrointestinaltrakts, Infektionen, metabolische und endokrine Erkrankungen, neurologische und psychiatrische Erkrankungen oder Medikamente bzw. Toxine.

Schlüsselwörter

Brechzentrum - N. vagus - funktionelle Dyspepsie - Stenosen - Gastroparese

Publication History

Article published online:
12 June 2025

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