Norwalk virus enteritis [top]

  • Vomiting with diarrhoea acute episode diarrhoea
  • Typically occurs in large outbreaks, for example schools, cruise ship

Gastric ulcer [top]


Migraine [top]

  • Acute headache usually with previous similar episodes
  • Typically unilateral and described as pulsating
  • Often preceded by visual, auditory or other aura
  • May be severe with associated nausea, vomiting, photophobia, vertigo
  • May cause transient neurological deficit

Acute pancreatitis [top]

  • Vomiting
  • Epigastric / abdominal pain
  • Hypotensive, tachycardic

Cerebellar stroke [top]

  • Sudden onset of vertigo, headache acute headache, vomiting and ataxia
  • May be complicated by loss of consciousness, brainstem signs or hydrocephalus

Drug overdose [top]

  • Vomiting
  • Hypotension, tachycardia, confusion
  • Relevant history

Intussusception [top]

  • Vomiting
  • Child
  • Colickly abdominal pain
  • Red currant jelly stool, rectal bleeding
  • Sausage-shaped mass right upper quadrant

Appendicitis [top]

  • Central abdominal pain then right lower quadrant pain
  • Anorexia
  • Right lower quadrant pain, tenderness, guarding
  • Nausea, vomiting, anorexia
  • Fever

Gastric carcinoma [top]

  • Epigastric pain
  • Persistent vomiting, haematemesis, melaena
  • Weight loss
  • Early saiety
  • Troisier's sign - palpable supraclavicular lymph node

Pyelonephritis [top]

  • Flank pain
  • Fever, rigors
  • Dysuria, urinary frequency
  • Nausea, vomiting

Vibrio cholera enteritis [top]

  • Very large volumes of acute watery diarrhoea, vomiting, fever
  • Incubation period up to 5 days
  • Faecal-oral transmission or undercooked sea food

Large bowel obstruction [top]

  • Lower abdominal pain
  • Vomiting, Abdominal distension, Constipation
  • Dilated loops on AXR

Hiatus hernia [top]

  • Vomiting after heavy meal
  • Epigastric pain
  • Worse on lying flat
  • Reflux, occasional haematemesis

Food poisoning: bacillus cereus [top]

  • Acute episode diarrhoea, vomiting
  • <6 hours incubation
  • Contaminated rice

Meniere's disease [top]

  • Recurrent attacks of Vertigo, tinnitus with vomiting
  • Hearing loss
  • Sensation of fullness
  • Recurrent attacks of vertigo dizziness lasting up to 24 hours
  • Unilateral or bilateral progressive hearing loss or tinnitus
  • Sensation of fullness or pressure in one or both ears

Meningitis [top]

  • Acute headache
  • Photophobia, neck stiffness, meningism, Kernig's sign positive
  • Fever, vomiting, seizure
  • Non-blanching purpuric rash with bacterial meningitis

Malaria [top]

  • Intermittent fever
  • Rigors
  • Travel to tropical area
  • Vomiting
  • Pre-hepatic jaundice

Gastric outlet obstruction [top]

  • Vomiting after eating
  • Bloating

Lead poisoning [top]

  • Anorexia, nausea, vomiting
  • Personality change
  • Cognitive deficits
  • Muscle weakness
  • Paresthesia
  • Unusual taste in mouth

Severe hypertension [top]

  • Headache
  • Vomiting
  • Visual disturbance

Inferior myocardial infarction [top]

  • Chest pain
  • Abdominal pain
  • Nausea, Vomiting

Gastroenteritis [top]


Rotavirus enteritis [top]

  • Acute episode diarrhoea usually in children usually less than 5
  • Vomiting, fever

Duodenal ulcer [top]

  • Burning epigastric pain
  • Relieved by food
  • Vomiting after eating, weight loss
  • Haematemesis or melaena if bleeding

Addison's disease [top]

  • Hyperpigmentation
  • Nausea / vomiting
  • Malaise, fatigue
  • Postural hypotension
  • Weight loss

Achalasia [top]

  • Frequent dysphagia
  • Intermittent vomiting
  • Regurgitation of undigested food
  • Weight loss

Autonomic neuropathy [top]

  • Vomiting after eating, Intermittent diarrhoea
  • Abdominal bloating
  • Diabetes is most common cause

Acute intermittent porphyria [top]

  • Episodic - acute attacks
  • Abdominal pain, vomiting
  • Peripheral neuropathy
  • Motor weakness
  • Dark urine
  • Family history

Mesenteric artery ischaemia [top]

  • Central abdominal pain
  • Lactic acidosis
  • Vomiting, diarrhoea
  • Hypotension, tachycardia

Salpingitis [top]

  • Lower abdominal pain, tenderness, guarding
  • Fever, nausea, vomiting
  • Dyspareunia
  • Malodourous cervical discharge

Ectopic pregnancy [top]

  • Constant lower abdominal pain referred to shouldr
  • Amenorrhoea, vaginal bleeding
  • Positive pregnancy test
  • Vomiting

Raised intracranial pressure [top]

  • Subacute headache, particularly in the morning
  • May have associatednausea, vomiting
  • Precipitated by coughing and leaning forward
  • Associated papilloedema

Subarachnoid haemorrhage [top]

  • Acute headache, very sudden onset 'like being kicked in the back of the head'
  • May be drowsy / unconscious loss of consciousness, vomiting
  • Signs of meningism:neck stiffness, photophobia
  • Acute neurological deficit

Pharngeal pouch [top]

  • Dysphagia, vomiting
  • Halitosis
  • Sensation of lump in throat
  • Regurgitation of undigested food

Viral labyrinthitis [top]

  • Acute onsetvertigo, nystagmus
  • Nausea, vomiting

Oesophagitis [top]

  • Retrosternal / epigastric pain
  • Vomiting
  • Waterbrash

Viral gastroenteritis [top]

  • Acute episode diarrhoea
  • Vomiting
  • Abdominal pain
  • Fever
  • Contact with infective individuals / contaminated water

Food poisoning: Salmonella typhi [top]

  • Acute episode diarrhoea, fever, vomiting
  • Abdominal cramps, headache
  • Undercooked poultry / eggs

Hypercalcaemia [top]

  • Nausea, vomiting
  • Bone pain
  • Abdominal pain, change in bowel habit
  • Polyuria
  • Psychiatric disturbance

Oesophageal carcinoma [top]

  • Progressive dysphagia to liquids then solids which stick in throat
  • Epigastric pain
  • Weight loss
  • Vomiting, haematemesis, melaena

Phaeochromocytoma [top]

  • Episodic
  • Anxiety
  • Sweating
  • Hypertension
  • Headache
  • Shortness of breath
  • Rare
  • Episodes of Sweating, Palpitations, Tachycardia
  • Nausea, vomiting
  • Headache
  • Hypertension

Gastric ulcer or erosion [top]

  • Burning epigastric pain
  • Worsened by food
  • Vomiting after eating, Weight loss
  • Consumption of NSAIDs or excessive alchohol
  • Haematemesis or melaena if bleeding

Small bowel obstruction [top]

  • Colicky central abdominal pain
  • Vomiting, constipation
  • Abdominal distension
  • Dilated loops on AXR

Small bowel tumour [top]

  • Vomiting after eating
  • Weight loss
  • Abdominal pain

Food poisoning: Staphylococcus aureus [top]

  • Acute episode diarrhoea, vomiting
  • <6 hours incubation
  • Contaminated meat

Chronic renal failure [top]

  • Progressive fatigue, anorexia
  • Nausea, vomiting
  • Lemon tinge to skin

Viral hepatitis [top]

  • Hepatic jaundice
  • Hepatomegaly, right upper quadrantabdominal pain
  • Fever, vomiting
  • Hepatitis A: Faecal-oral spread
  • Hepatitis B, C: IVDU, blood transfusion, tattoos

Functional [top]

  • Vomiting soon after meal
  • No symptoms / signs of organic disease

Renal colic [top]

  • Abdominal pain
  • Vomiting
  • Haematuria

Cholecystitis [top]

  • Colicky Abdominal pain, Right upper quadrant pain, epigastric pain
  • Vomiting after eating
  • Murphy's sign positive
  • Worse with fatty food

Anaphylaxis [top]

  • Sudden onset (minutes)
  • Shortness of breath
  • Wheeze
  • Facial swelling, tongue swelling
  • Urticaria
  • Hypotension and tachycardia
  • Vomiting

Food poisoning: Vibrio para haemolyticus [top]

  • Acute episode diarrhoea, vomiting
  • Incubation 24 hours
  • Contaminated seafood

Intracranial haemorrhage [top]

  • Acute neurological deficit: dysphasia, hemiparesis, hemianopia
  • Acute headache, vomiting
  • History of anticoagulant therapy or bleeding diathesis

Pregnancy [top]

  • Morning sickness, vomiting
  • Amenorrhoea
  • Obstructive jaundice
  • Amenorrhoea
  • Female of child-bearing age
  • History of sexual intercourse

Acute glaucoma [top]

  • Acute headache
  • Unilateral red eye, Reduced visual acuity
  • Appearance of halos around lights vomiting

Food poisoning [top]


Toxic shock syndrome [top]

  • High fever
  • Generalized rash
  • Vomiting
  • Diarrhoea
  • Hypotension, tachycardia

Oesophageal stricture [top]

  • Vomiting
  • Weight loss
  • Dysphagia
  • Dysphagia to solids
  • Previous f, radiation, ingestion of corrosive substances

Food poisoning: Clostridium perfringens [top]

  • Acute episode diarrhoea, minimalvomiting
  • Incubation 12 hours
  • Contaminated meat