What questions should you ask a patient who presents with vomiting?

Opening and closing question marks

Smiley from the sMirC-series. puke
(Photo credit: Wikipedia)

When vomiting is the presenting symptom, be sure to ask the following question in order to narrow down the diseases that come into your head and finally reach a diagnosis:

• Amount (this is usually large in cases of projectile vomiting or protracted vomiting).

• Frequency (a single episode of vomiting in the morning is due to alcohol ingestion the earlier night, etc)

• Duration (protracted vomiting occurs for a prolonged time, etc).

• Time (early morning – pregnancy, after meals – gastric ulcer & gastric cancer, after coughing – chronic chest infection).

• Colour of the Vomitus (Green vomit indicated obstruction below the pylorus and is green due to the presence of bile, deep red blood in the vomitus is due to oesophageal variceal rupture or other causes in the oesophagus, bright red blood in the vomit indicated peptic ulcer rupture or gastritis, brown vomit with a fecal smell indicates obstruction in the large intestine, coffee-ground vomitus indicates that the blood present in it has been altered by gastric acid thus giving it the brown color, undigested food indicates an obstruction at the level of the gastric outlet which can be due to carcinoma, etc).

• Type (projectile or not?)

• Relief of pain after vomiting? (this occurs in peptic ulcer disease)

• Any relationship with ingestion of any drugs?

• Associated with vertigo, headache or visual problems? (to rule out central causes of vomiting).

• Other associated symptoms such as diarrhoea, constipation, melena, fever, flatus, polyuria & polydipsia (these two indicate diabetes), hematuria and flank pain (these indicate renal stones).

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