Gastroenteritis (vital or bacterial)

Most common cause in all age groups; acute onset; may be accompanied by diarrhea, mild fever, crampy abdominal pain, and muscle aches; may be associated with indigestion of contaminated food

Hyperactive bowel sounds; minimal abdominal tenderness on palpation

Gastritis

Acute or chronic nausea/vomiting (N/V) occurs after eating; can be induced by alcohol ingestion or drugs or be associated with ulcers that result from irritation, spasm, and edema of the pyloric muscle

Pancreatitis

Repeated episodes of N/V, abdominal pain that radiates to the back; associated with excessive alcohol intake

Elevated serum amylase

Appendicitis

Anorexia, N/V early symptoms in most patients; pain precedes vomiting

Elevated leukocytes

Binge drinking

Excessive alcohol consumption; early morning N/V and dry heaves

Esophogeal obstruction

Vomiting of undigested food, odorless, early AM or after meals

Endoscopy

Pyloric obstruction

In children: persistent projectile vomiting of large amounts of food, especially in infants <3 months; in adults: associated with tumor or scar formation from an ulcer

Palpable mass; weight loss

Lower bowel

Abdominal distension with no or very small amount of stool; green bile in vomitus; breath may have fecal odor

Decreased/absent bowel sounds

Labyrinthine disorders

N/V accompanied by vertigo, tinnitus, and motion sickness

Nystagmus

ICP

Sudden, forceful vomiting not accompanied by nausea; headache; symptoms get progressively worse over hours or days

Positive neurological findings; changes in mentation; motor function

Morning sickness

N/V occurring in early morning during first trimester of pregnancy that usually ends by the fourth month

Last menstrual period > 6 weeks ago Elevated human chorionic gonadotropin (HCG) level

Bulimia

Self-induced vomiting after binge eating; usually in young women with poor self-image and preoccupation with being thin; may be accompanied by laxative abuse

Metabolic etiologies

Seventy-five percent of those with diabetic ketoacidosis
Ninety percent of those with Addison’s crisis

Check blood sugar levels

Drug induced

Associated with cancer treatment either drug (especially cisplatin) or radiation therapy, producing pever N/V caused by serotonin released from cells activating receptors an stimulating the vomiting center and chemoreceptor trigger zone; with opiate drug withdrawal, vomiting begins 36 hours after last dose, accompanied by sweats, chills, and restlessness; peaks at 72 hours