Clinical features

Causes (examples)

Vomiting in the morning

Pregnancy (first trimester), uremia, alcohol-related gastritis, malignancy or other CNS tumors

Vomiting shortly after eating (<1 h)

Functional or mechanical esophageal abnormality, pyloric stenosis (PUD, neoplasm), acute cholecystitis, acute pancreatitis, gastritis, food hypersensitivity, anorexia nervosa, bulimia, major depressive disorder

Vomiting >4-6 h after eating

Gastric atony, distal GI stenosis

Feculent emesis

Distal GI obstruction, GI fistula

Projectile vomiting

Intestinal obstruction, increased intracranial pressure

Hematemesis or coffee-ground vomitus

Hemorrhage from gastric or duodenal ulcers, hemorrhagic gastropathy, gastric or esophageal cancer, bleeding esophageal varices, Mallory-Weiss syndrome

Bile-stained vomitus

Prolonged vomiting, obstruction below the ampulla of Vater

Vomitus containing undigested food

Achalasia, esophageal diverticula (eg, Zenker diverticulum), significant esophageal stenosis (ulcer, cancer), food hypersensitivity (immediate reaction)

Vomitus containing partially digested food

Pyloric stenosis, gastric atony, food hypersensitivity (delayed reaction)

Headache, visual disturbances, altered mental status, neck stiffness

CNS disorders (meningitis/encephalitis, tumor, migraine)a

Chest pain

Myocardial infarction

Abdominal pain

Depending on location (see table 1.29-1)

Diarrhea and fever

GI infection

Dysphagia

Esophageal disorders (GERD, cancer, diverticula, stenosis, achalasia, dysmotility)

Jaundice

Liver and biliary tract disorders (inflammation, gallstones)

Weight loss

Chronic organic GI tract disorder, malignancy

Dizziness, tinnitus

Labyrinth disorder

Drug use

Antitumor chemotherapy, opioids, analgesics, AEDs

a In such patients vomiting is often without nausea, effortless, and projectile.