Some Causes and Features of Nausea and Vomiting
Cause | Common Features* | Tests†,‡ |
|---|---|---|
Digestive tract disorders | ||
Appendicitis or another sudden, severe disorder within the abdomen (such as a perforated intestine, gallbladder inflammation, or pancreatitis) | Significant abdominal pain Abdomen that is tender to the touch | Abdominal imaging tests (such as x-rays, ultrasonography, and/or CT) |
No bowel movements and no flatus Cramping abdominal pain that comes and goes Distended abdomen Usually in people who are known to have a hernia or who have had abdominal surgery | Abdominal x-rays taken with the person in flat and upright positions | |
Vomiting and diarrhea Little or no abdominal pain (except during vomiting) Rarely fever or blood in stool Normal abdominal examination | A doctor’s examination alone | |
Gastroparesis (poor stomach emptying) | Vomiting of partially digested food a few hours after ingestion Often occurs in diabetics who have elevated blood sugar (glucose) or after abdominal surgery | A doctor’s examination Abdominal x-rays taken when the person is laying down and when upright Nuclear scanning to evaluate stomach emptying in people who may have gastroparesis |
Mild to moderate nausea for many days and sometimes vomiting A general feeling of illness (malaise) Darkening of the urine, then yellowing of the skin and whites of the eyes (jaundice) Loss of appetite Mild discomfort in the upper right part of the abdomen | Blood tests | |
Ileus (temporary absence of the contractile movements of the intestine) | Vomiting and abdominal bloating May occur after surgery, in severe illness, or with severe electrolyte disturbances | X-rays or CT scan |
Ingestion usually clear based on the person's history Various other symptoms depending on the substance ingested | Depends on the substance ingested but may include blood tests and liver function tests | |
Brain and nervous system disorders | ||
Head injury (such as caused by a recent motor vehicle crash, sports injury, or fall) | Injury clear based on the person's history Often headache, confusion, and difficulty remembering recent events | CT of the head |
Sudden, often severe headache Confusion | CT of the head Spinal tap if CT results are normal | |
Brain infection (such as meningitis) | Gradual headache and confusion Often fever and pain with tilting head forward May cause a reddish purple rash of tiny dots on the skin (petechiae) if due to meningococcal meningitis§ | Spinal tap (sometimes preceded by CT of the head) |
Severe nausea and vomiting with headache and/or dizziness | CT or MRI of the head | |
Cannabis (marijuana) use (cannabis hyperemesis syndrome) | Nausea and vomiting (sometimes severe) and sometimes weight loss Usually develops after longstanding cannabis use | A doctor's examination Urine drug test Relief after a hot shower or marijuana cessation Sometimes blood tests |
Increased pressure within the skull (such as caused by a blood clot or tumor) | Headache, confusion, and sometimes problems with nerve, spinal cord, or brain function | CT of the head |
Labyrinthitis (inflammation of the inner ear) | A false sensation of movement (vertigo), rhythmic jerking movement of the eyes (nystagmus), and symptoms worsened by motion of the head Sometimes ringing in the ears (tinnitus) | A doctor’s examination Sometimes MRI |
Usually a moderate to severe headache Headache sometimes preceded by seeing flashing lights and blind spots (aura) Sometimes sensitivity to light (photophobia) or temporary disturbances in balance or muscle strength Often a history of repeated similar attacks | A doctor’s examination Sometimes CT or MRI of the head and spinal tap (if results of the examination unclear) | |
Trigger clear based on the person's history | A doctor’s examination alone | |
Psychologic disorders (for example, anorexia nervosa and bulimia nervosa) | No diarrhea or abdominal pain Vomiting that often occurs with stress Consumption of food considered repulsive | A doctor’s examination alone |
Systemic (bodywide) conditions | ||
An increased volume of urine excreted each day (polyuria), excessive thirst (polydipsia), and often significant dehydration | Blood tests | |
Drug side effects or toxicity | Ingestion of a drug or substance clear based on the person's history | Depends on the substance ingested but may include blood tests |
Often jaundice in advanced liver disease Ammonia odor to the breath in kidney failure Often in people known to have the disorder A crude flapping motion of the hands (asterixis) | Blood and urine tests to evaluate liver and kidney function Blood tests to determine the level of ammonia in the blood | |
Pregnancy | Nausea and/or vomiting often in the morning or triggered by food Normal examination (except the person may be dehydrated) Often a missed or late menstrual period | Pregnancy test |
Exposure usually clear based on the person's history Severe nausea, vomiting, and diarrhea | A doctor’s examination alone | |
* Features include symptoms and the results of the doctor's examination. Features mentioned are typical but not always present. | ||
† Although a doctor's examination is always done, it is mentioned in this column only if the diagnosis can sometimes be made by the doctor's examination alone, without any testing. | ||
‡ Doctors usually do a urine pregnancy test for all girls and women of childbearing age. | ||
§ Sometimes forceful vomiting (caused by any disorder or condition) causes petechiae on the upper torso and face, which may resemble petechiae caused by meningococcal meningitis, a particularly dangerous form of meningitis. People with meningococcal meningitis are usually very ill, whereas people with petechiae caused by vomiting are often otherwise quite well. | ||
CT = computed tomography; MRI = magnetic resonance imaging. | ||