Red flag symptoms: Vomiting

Vomiting is an extremely common symptom. A speedy diagnosis is often difficult as there is such a huge differential

  •  Vomiting
  • Headache
  • Fever
  • Increased bowel sounds
  • Haematemesis
  • Weight loss
  • Dental erosion
  • Severe eye pain

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However, knowing a few key things to look out for can help distinguish between a self-limiting viral infection and a more serious condition.

Sudden acute vomiting is often a response to infection. Be aware of the patient presenting with vomiting accompanied by fever, headache and muscle pain. Headache and vomiting may be indicative of a migraine (check for a history) but it could also indicate meningitis.

Perform an abdominal examination. Increased bowel sounds and diarrhoea are often present with gastroenteritis, whereas the inability to pass stool or flatus may indicate an obstructed bowel. Take a travel and medication history. Vomiting may be a side-effect of medication.

Haematemesis
Haematemesis is a red flag symptom that can be alarming for the patient. Vomiting blood can be a sign of peptic ulcer disease, Mallory-Weiss tear or malignancy.

An FBC will allow you to assess the degree of blood lost. It is usually necessary to refer the patient for an upper GI endoscopy to establish the cause of the bleeding. As always, unexplained weight loss could be a sign of malignancy.

Other symptoms
Signs of dental erosion point to the vomiting being frequent and prolonged. This may be a sign of bulimia nervosa.

In a woman of childbearing age a concealed pregnancy may be revealed.

Acute primary closed angle glaucoma presents with acute loss of vision, severe periocular pain and, commonly, nausea and vomiting. It is a medical emergency and should be referred urgently to an opthalmology department.

It is important to consider the effects vomiting can have on the body. Prolonged vomiting can cause dehydration, which can be particularly hazardous in the elderly or the very young.

Possible causes

  • Gastroenteritis.
  • Migraine.
  • Meningitis.
  • Intestinal obstruction.
  • Pregnancy.
  • Bulimia nervosa.
  • Tear or ulcer.
  • Malignancy.
  • Poisoning.
  • Acute glaucoma

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