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  1. Accurately identify the most likely etiology when patients present with nausea and vomiting, through history, diagnostic tests, and appropriate patient findings on examination to enable the appropriate recommendation of effective treatment or referral to an appropriate provider.

  2. Use the knowledge of the pathophysiology, etiology, and common presentations of diseases with nausea and vomiting as a primary symptom to review prescription orders for appropriateness and to accurately educate patients about their disease and its treatment.

  3. Use the knowledge of the pathophysiology, etiology, and common presentation of diseases with nausea and vomiting as a primary symptom to accurately interpret the diagnostic process to advise regarding the most appropriate prescription therapy.


Nausea and/or vomiting is a common presentation in ambulatory and urgent care centers, serving as the chief complaint in 3.7% of emergency room visits. While most causes are self-limiting, it can be a symptom of a variety of diseases throughout the body, many of which are serious or life threatening, affecting the central nervous system, genitourinary tract, gastrointestinal and surrounding organ systems. In addition, nausea and vomiting can be caused by medications, toxins, cardiovascular disease, and metabolic diseases. Causes can be iatrogenic, infectious, inflammatory, and mechanical in nature. Given the broad variety of causes and the potential for involvement of multiple organ systems, a very careful and comprehensive history and physical examination are essential.


Because of the broad range of diagnostic possibilities, the key to identifying the cause of nausea and/or vomiting lies with the associated symptoms (Table 11.1). For example, gastroenteritis typically presents with a sudden onset, a history of exposure to potentially tainted foods, or others with similar symptoms. Most patients concurrently complain of abdominal discomfort, fever and diarrhea. Diagnostic accuracy is dependent on a careful history and physical examination, since there are few laboratory tests involving the gastrointestinal tract that can specifically diagnose the cause of nausea and vomiting. Laboratory tests and imaging studies are used primarily in diagnosing those causes not related to the stomach or intestines.

TABLE 11.1

Associated Symptoms–Based Differential Diagnosis of Nausea and Vomiting



Gastroenteritis can be caused by both viral and bacterial pathogens (Table 11.2). Common viral gastroenteritis pathogens include rotavirus, norovirus, and adenovirus. Bacterial gastroenteritis pathogens include Staphylococci, Campylobacter, E. coli, Shigella and Salmonella species. Onset can occur hours to days after ...

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