- Vomiting?
Why: establish the duration, frequency and intensity of vomiting, and particularly its relationship to eating. Also establish the contents of the vomit which may help to determine the level of bowel obstruction.
- Abdominal pain or discomfort, if so can you point to exactly where the discomfort is and where it radiates to?
Why: must consider acute cholecystitis (inflammation of the gallbladder usually due to obstruction from a gallstone), acute appendicitis, pyelonephritis (bacterial infection of the kidney), pancreatitis, renal stones and peritonitis.
- Fever?
Why: may suggest a localized abdominal condition (e.g. cholecystitis , acute appendicitis) or a systemic condition (e.g. tuberculosis, brucellosis, yellow fever).
- Waterbrash (excess secretion of saliva into the mouth)?
Why: may suggest peptic ulcer.
- Pain on swallowing?
Why: may suggest stomach cancer.
- Vertigo (a sensation of a whirling motion , either of oneself or of external objects)?
Why: must consider inner ear diseases such a Meniere's disease and labyrinthitis.
- Headache?
Why: must consider migraine, concussion, brain tumors, meningitis and subarachnoid hemorrhage.
- Diarrhea?
Why: may suggest gastroenteritis, Crohn's disease.
- Symptoms of angina or heart attack?
Why: a common mistake is to attribute the discomfort of angina or a heart attack to a disorder of the gastro-intestinal tract. Must consider heartburn symptoms to be ischemic heart disease until proved otherwise. Angina and heart attack may be associated with nausea.
- Significant weight loss?
Why: may suggest stomach cancer, intestinal or mesenteric ischemia, chronic pancreatitis, chronic gastritis, renal failure and congestive heart failure.
- Tinnitus?
Why: consider Meniere's disease.
- Symptoms of gastroenteritis?
Why: e.g. nausea, vomiting, fever, diarrhea.
- Symptoms of peptic ulcer?
Why: e.g. intermittent symptoms of gnawing or burning-type pain in the epigastrium (midline, under the ribs) which can be located by finger point, pain is worse before meals and relieved by taking antacids or food. Pain may waken the person at night. Nausea may accompany the pain, but vomiting is not frequent.
- Symptoms of acute pancreatitis?
Why: e.g. deep boring upper abdominal pain, often radiating through to the back. Nausea and vomiting accompany the pain in most cases.
- Symptoms of gallstones?
Why: e.g. gradual onset of severe constant right upper abdominal pain which may pass into the back. It can be associated with nausea and vomiting. Symptoms are induced by a fatty meal.
- Symptoms of irritable bowel syndrome?
Why: e.g. alternating diarrhea and constipation, pellet-like stools, abdominal bloating, flatulence, belching and nausea.
- Symptoms of mesenteric ischemia (blockage of the major small bowel arteries)?
Why: e.g. severe, poorly localized abdominal pain, nausea, vomiting, diarrhea 30 minutes after a meal, constipation. It is predominantly a disease of the elderly.
- Symptoms of pregnancy?
Why: e.g. missing periods, breast tenderness, breast enlargement - In the first trimester of pregnancy, nausea and vomiting are common.
- Symptoms of acute cholecystitis?
Why: e.g. right upper abdominal pain radiating to the right side of the upper back. Fever, nausea and vomiting are often present, but the vomiting is rarely severe.
- Symptoms of pyloric or intestinal obstruction?
Why: e.g. vomiting, usually without pain. Vomiting is projectile and huge in volume, and the vomit contains particles of the previous day's food. May be due to active or healed peptic ulcer, stomach cancer or pancreas cancer.
- Symptoms of diabetic gastroparesis?
Why: e.g. early satiety, abdominal fullness after a meal, nausea and loss of appetite.
- Migraine headache?
Why: e.g. unilateral headache which may be accompanied by a prodrome of visual disturbances, nausea and vomiting.
