Differential Diagnosis in Primary Care, 4th Edition

Vomitus

The numerous causes of vomiting are discussed under functional changes (see page 321). It is worthwhile, however, to discuss a few of the important causes of nonbloody vomitus here. Like other “discharges,” simply by visualizing the anatomy of the “tree” one can assimilate the causes of nonbloody vomitus.

In the posterior pharynx and larynx, mucus may be regurgitated from a postnasal drip of sinusitis or material that cannot be swallowed because of a stricture, myasthenia gravis, or bulbar palsy. There may also be drainage from a retropharyngeal abscess. In the upper esophagus, a foreign body, diverticulum stricture, or web of Plummer–Vinson syndrome may cause regurgitation of food, mucus, and saliva. In the lower esophagus, lye strictures, esophagitis, cardiospasm, and carcinomas are responsible for regurgitation of food and mucus. Extrinsic pressure and the resulting obstruction from an aneurysm, cardiomegaly, or a mediastinal tumor may also cause a nonbloody “discharge.”

Nonbloody vomitus from the stomach is usually due to gastritis, ulcer, pyloric obstruction, or carcinoma of the stomach. When intestinal obstruction occurs beyond the pyloris or when there is ulceration or obstruction because of a gastrojejunostomy, the vomitus is often bile-stained. The many other causes of intestinal obstruction may produce a nonbloody vomitus. If there is a gastrocolic fistula, the vomitus may be feculent.

Extrinsic causes of vomiting such as migraine, labyrinthitis, or glaucoma usually cause a nonbloody vomitus with or without bile stain. If it becomes bloody, one should consider a complicating Mallory–Weiss syndrome. The approach to the diagnosis of vomiting is discussed on page 322.

 

Vomitus 



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