Symptom Finder - Nausea and Vomiting
Nausea and Vomiting
In cases of acute nausea and vomiting, especially with diarrhea and fever, the patient most likely has viral or bacterial gastroenteritis. This section does not concern these cases, nor does it concern cases of nausea and vomiting with abdominal pain. Evaluation of these cases is addressed under “Abdominal Pain”.
Physical examination of patients with chronic nausea and/or vomiting without abdominal pain begins with looking for hepatomegaly, an
abdominal mass, or focal abdominal tenderness. A rectal examination is performed, primarily to rule out melena. Obviously, a vaginal examination needs to be done in females to rule out pregnancy, a uterine fibroid, an ovarian cyst, or other gynecologic pathology.
Next, one should do a funduscopy to rule out papilledema and intracranial pathology. Also, perform an ENT examination to rule out otitis
media and inner ear pathology. Check for nystagmus and do the Hallpike maneuvers to rule out benign positional vertigo.
It may be necessary to consider giving the patient sublingual nitroglycerin to see if that precipitates an attack, which would point to
abdominal migraine as the cause. When all these examinations are unrewarding, the physician relies on the history and diagnostic tests to get
a diagnosis.
In cases of acute nausea and vomiting, especially with diarrhea and fever, the patient most likely has viral or bacterial gastroenteritis. This section does not concern these cases, nor does it concern cases of nausea and vomiting with abdominal pain. Evaluation of these cases is addressed under “Abdominal Pain”.
Physical examination of patients with chronic nausea and/or vomiting without abdominal pain begins with looking for hepatomegaly, an
abdominal mass, or focal abdominal tenderness. A rectal examination is performed, primarily to rule out melena. Obviously, a vaginal examination needs to be done in females to rule out pregnancy, a uterine fibroid, an ovarian cyst, or other gynecologic pathology.
Next, one should do a funduscopy to rule out papilledema and intracranial pathology. Also, perform an ENT examination to rule out otitis
media and inner ear pathology. Check for nystagmus and do the Hallpike maneuvers to rule out benign positional vertigo.
It may be necessary to consider giving the patient sublingual nitroglycerin to see if that precipitates an attack, which would point to
abdominal migraine as the cause. When all these examinations are unrewarding, the physician relies on the history and diagnostic tests to get
a diagnosis.
