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A 40-yr old man presents has vomiting for past 2 days. (Key questions to…
A 40-yr old man presents has vomiting for past 2 days.
Systemic (e.g. Diarrhea, myalgias, malaise, headache, contact with ill persons
Viral gastroenteritis
Do you also have diarrhea? Do others in your community
(family, day care, cruise ship, summer camp) also have
vomiting and diarrhea?
Diarrhea, headache, myalgia, or fever?
Hepatitis
Jaundice, dark urine, or light stools?
Bacterial food poisoning
Did the symptoms occur within a few hours after eating or
drinking something?
Is anyone else who ate or drank the same thing also having
nausea and vomiting?
Iatrogenic/other
Medications
Chemotherapeutics
Antibiotics
Analgesics
Toxins
Did the symptoms occur within a few hours after eating or
drinking something?
Radiation
CNS symptoms (e.g. Headache, stiff neck, vertigo, focal neurologic deficits)
Head injury
Meningitis
Headache, neck stiffness, altered mentation, or
photophobia?
Labyrinthitis
Does the room feel like it is moving? (vertigo)
Increased intracranial pressure
Is vomiting projectile?
Do you vomit: In the morning before breakfast?
Abdominal pain (e.g. RUQ, epigastric, severe pain, severe pain that precedes vomiting)
Peritonitis
Abdominal pain that worsens with jolting movements?
Did the bumps in the car ride make your abdominal pain
worse?
Pancreatitis
Epigastric abdominal pain radiating to the back?
Biliary disease
Upper abdominal pain (biliary colic)?
Intestinal obstruction
Is the vomitus bilious (containing green bile)?
Is it feculent?
Crampy, colicky abdominal pain?
Key questions to ask
Onset of symptoms: Abrupt or insidious?
Timing of symptoms: Before, during or directly after eating, 1 to 4 hours after a meal, continuous, irregular?
Nature of vomited matter: Undigested food, partially digested food, bile, feculent or odorous, large volume?
Associated symptoms/findings: weight loss, diarrhea, early satiety, postprandial bloating, abdominal discomfort, repetitive migraine headaches or symptoms of irritable bowel syndrome?
History: Current medicine/drug history, Previous history of surgeries, Previous medical history