Vomiting

• Gastroenteritis: Acute onset of vomiting with diarrhoea, often associated with fever and recent travel or food exposure.
• Peptic Ulcer Disease: Vomiting may occur with pain relieved by eating, history of NSAID use or Helicobacter pylori infection.
• Small Bowel Obstruction: Bilious vomiting, abdominal distension, history of prior surgery (adhesions).
• Acute Cholecystitis: Vomiting with right upper quadrant pain, fever, positive Murphy’s sign.
• Pancreatitis: Severe epigastric pain radiating to the back, vomiting, history of alcohol use or gallstones.
• Appendicitis: Vomiting with initial periumbilical pain that later localises to the right iliac fossa.
• Mesenteric Ischaemia: Severe, sudden abdominal pain with vomiting, typically in patients with cardiovascular risk factors.
• Gastroesophageal Reflux Disease (GORD): Vomiting with a history of heartburn, regurgitation, and nocturnal symptoms.
• Pyloric Stenosis (in infants): Projectile vomiting, typically after feeding, with palpable ‘olive’ mass in the abdomen.

• Raised Intracranial Pressure (e.g., tumour, haemorrhage): Morning vomiting, headache, papilloedema, altered mental state.
• Migraine: Vomiting associated with severe unilateral headache, photophobia, phonophobia.
• Vestibular Disorders (e.g., Labyrinthitis, Ménière’s): Vomiting with vertigo, tinnitus, hearing loss, nystagmus.
• Meningitis/Encephalitis: Vomiting with fever, neck stiffness, altered consciousness, photophobia.
• Cyclic Vomiting Syndrome: Recurrent episodes of severe vomiting, often with a history of migraine, triggered by stress or infection.
• Concussion: Vomiting following head injury, may be associated with confusion or loss of consciousness.

• Diabetic Ketoacidosis: Vomiting with polyuria, polydipsia, abdominal pain, deep rapid breathing, history of diabetes.
• Addisonian Crisis: Vomiting with abdominal pain, hypotension, hyperpigmentation, history of adrenal insufficiency.
• Hypercalcemia: Vomiting with polyuria, polydipsia, constipation, confusion, history of malignancy or hyperparathyroidism.
• Uraemia: Vomiting in the context of chronic kidney disease, with fatigue, pruritus, confusion.
• Thyrotoxicosis: Vomiting with weight loss, heat intolerance, tremor, palpitations.

• Chemotherapy-Induced Nausea and Vomiting: Vomiting following chemotherapy, associated with the treatment timeline.
• Alcohol Intoxication: Vomiting with confusion, ataxia, slurred speech.
• Opioid Use: Vomiting with constipation, drowsiness, miosis.
• Iron Overdose: Vomiting with abdominal pain, diarrhoea, potential history of supplement misuse.
• Toxins (e.g., mushrooms, lead): Vomiting with abdominal pain, neurologic symptoms, depending on the specific toxin.
• Food Poisoning: Acute vomiting after ingestion of contaminated food, often with diarrhoea and abdominal cramps.

Assess the specific symptoms presented by the patient:

• Onset and Duration: Acute vs. chronic vomiting, frequency, and timing (e.g., morning vomiting).
• Character of Vomitus: Presence of blood (haematemesis), bile, or faeculent material, undigested food.
• Associated Symptoms: Abdominal pain, headache, fever, dizziness, diarrhoea, weight loss, visual changes.
• Aggravating and Relieving Factors: Relationship to meals, stress, head position, medications.
• Hydration Status: Signs of dehydration, such as dry mucous membranes, decreased urine output, orthostatic hypotension.

Gather a detailed background including:

• Past Medical History: History of gastrointestinal disorders, neurological conditions, metabolic or endocrine diseases, recent infections.
• Drug History: Recent changes in medication, use of chemotherapy, recreational drugs, or known drug allergies.
• Family History: Any familial gastrointestinal, neurological, or metabolic conditions.
• Social History: Alcohol use, dietary habits, recent travel, exposure to toxins or sick contacts, psychosocial stressors.

• Full Blood Count (FBC): To assess for infection, anaemia, or other haematological abnormalities.
• Electrolytes and Renal Function Tests: To assess for dehydration, electrolyte imbalances, and renal function.
• Liver Function Tests (LFTs): To evaluate for liver disease, hepatitis, or cholecystitis.
• Serum Amylase/Lipase: To assess for pancreatitis, especially if there is epigastric pain.
• Arterial Blood Gas (ABG): If metabolic causes like DKA or uraemia are suspected.
• Toxicology Screen: If substance misuse or overdose is suspected.
• Pregnancy Test: In women of childbearing age, to rule out pregnancy as a cause of vomiting.
• Blood Cultures: If sepsis or an infectious cause is suspected.

• Abdominal X-ray: To assess for bowel obstruction, perforation, or abnormal gas patterns.
• Ultrasound of Abdomen: To evaluate for cholecystitis, pancreatitis, or other abdominal pathology.
• CT Scan of the Abdomen/Pelvis: If more detailed imaging is required, especially for suspected malignancy, obstruction, or ischaemia.
• Endoscopy: To investigate upper gastrointestinal causes such as peptic ulcer disease, gastritis, or malignancy.
• MRI of the Brain: If neurological causes such as raised intracranial pressure or a brain tumour are suspected.
• Electrocardiogram (ECG): If myocardial infarction or other cardiac causes are considered, particularly in older patients.