History Taking

Vomiting

by Dr.Masoud
Mustafa
 VOMITING

• vomiting a forceful expulsion of contents of stomach, usually

associated with contraction of abdominal wall muscle.
• Vomiting requires more details to decide the cause.
• Nausea is the unpleasant sensation to vomit often associated
with increased salivation. Retching is the intense urge to
vomit, involving contractions of involved muscles.
• Enquire whether the vomiting is projectile or not, frequency,
content, whether bilious or not, its relation with food, and
other associated symptoms. Persistent non-bilious vomiting in
a 2-3-week-old infant suggests congenital hypertrophic
pyloric stenosis; bilious vomiting in newborn suggests a more
lower obstruction like duodenal atresia.
 Continue of vomiting
• Bilious vomiting may occur with paralytic ileus also. Many
drugs can cause GI upset and vomiting. So ask for history of
drug intake. History of loss of weight indicates the severity
of vomiting. History of viral infection/ aspirin intake should
be elicited (Reye syndrome).
• Early morning projectile vomiting with headache suggests
increased intracranial tension. Persistent vomiting and
failure to thrive starting from introduction of specific foods
in the neonatal period or later suggests inborn errors of
metabolism or specific food intolerances (renal tubular
acidosis will be a close differential diagnosis for this
combination symptoms of failure to thrive and vomiting).
Gastroesophageal reflux, migraine, hepatitis, meningitis, etc,
are other causes of vomiting
 History
• Enquire about the frequency. Severity is indicated by dehydration (in
acute) or loss of weight (in chronic).
• Enquire about the urine output (decreased urine output may be due to
associated dehydration).
• Enquire whether it is associated with diar-rhoea. Diarrhea and vomiting
often go hand in hand.
• Enquire about urinary symptoms (fever and vomiting may be the
presentation of UTI).
• Enquire about vertigo and ear symptoms. Vomiting and vertigo are the
characteristic features of labyrinthitis.
• Look for jaundice: Vomiting is very common in infective hepatitis.
• Enquire about its association with headache, which is expected in
migraine.
• Enquire about its association with cough: Post-tussive vomiting is
common after paroxysmal cough in pertussis and asthma.
 Continue on History
• Enquire about the time of the day: Early morning vomiting is seen in intracranial
space-occupying lesions. Do not forget pregnancy as a cause in an adolescent!
• Enquire about antecedent symptoms: Abdominal pain indicates intestinal
problems; headache indicating ICSOL, meningitis or migraine. Projectile vomiting,
without antecedent nausea is supposed to be characteristic of a central nervous
system cause one finds it more commonly in textbooks rather than in patients
with CNS disorders! Hence students must not discard CNS cause because the
vomiting is not projectile).
• Contents of vomitus: Mention if it is food par-ticles, blood, bile, etc.
• History of drugs: Drugs such as digoxin, theo-phylline, aspirin, iron,
metronidazole, etc, can induce vomiting.
• Make sure it is not rumination when the child has recurrent vomiting but
remains well despite vomiting. Rumination is the repeated regurgitation of food
into the mouth and then chewing and swallowing it.
• One must not overlook surgical causes for vomiting like intestinal obstruction or
peritonitis.