Nausea or Vomiting, Differential Diagnosis

Don’t miss: Brain and Vestibular d/o. Most common: GI causes

Pregnancy (estrogens) – Test all woman of childbearing age with n/v.
Abdominal Causes (most common cause of nausea, vomiting)
GI Causes:
Gastroenteritis, gastritis
Nonulcer dyspepsia
Appendicitis
Bowel obstruction
GI dysmotility:
-Gastroparesis: From diabetes, postviral, postvagotomy, medications.
-Small intestine: Scleroderma, amyloidosis, familial myoneuropathies, Chronic intestinal pseudo-obstruction
Diabetic gastroenteropathy
Irritable bowel syndrome
Pancreatitis
Cholecystitis/cholangitis, cholelithiasis
Diverticulitis
Peptic ulcer disease
Hepatitis
Inflammatory bowel disease; Crohn’s disease
Mesenteric ischemia
Superior mesenteric artery syndrome
Pancreatic carcinoma
Pain (especially visceral)
Peritonitis
Spontaneous bacterial peritonitis
Perforated viscus
Food poisoning
Rotavirus
Lactose intolerance
Kidneys:
Pyelonephritis
Urinary tract infection
Nephrolithiasis
Brain & Vestibular System
Things that increase intracranial pressure
-Cerebrovascular accident (infarction/hemorrhage)
-Hydrocephalus
-Meningitis/encephalitis/intracranial abscess
-Closed head injury
-Brain tumor; Mass lesion
-Pseudotumor cerebri
-Intracranial hemorrhage
Vestibular system (balance and awareness of spatial orientation)
-Labyrinthitis
-Ménière’s disease
-Motion sickness
-Vertigo
-Acute otitis media
Others: Migraines, Seizure disorders
Chest
Severe coughing
Pneumonia
Myocardial infarction
Congestive heart failure
Infections: Any systemic infection; Brain, abdominal and pelvic infections.
Drugs & drug complications: Opioids, Overdoses/withdrawal (e.g. alcohol), Antibiotics, Radiation therapy, Iron, Chemotherapy, Antiarrhythmics, Anticonvulsants, Digoxin, Hormonal preparations, Illicit substances, NSAIDs;
Cannabinoid hyperemesis
Metabolic/Endocrine:
Adrenal insufficiency (Addison’s disease)
Diabetic ketoacidosis;
Paraneoplastic syndromes;
Parathyroid disorders;
Thyroid disorders;
Uremia
Carbon monoxide
Psychiatric disorders
Psychogenic /emotional vomiting, anxiety, depression
Anorexia nervosa
Bulimia nervosa
Conversion disorder
Serotonin syndrome (from psych meds, etc)
Toxins: Arsenic, Organophosphates/pesticides; Ricin
Others
Glaucoma
HIV
Lymphoma
Cyclic vomiting syndrome
Acute intermittent porphyria

Understanding the Differential Diagnosis
The differential diagnosis can be divided into GI causes vs. systemic causes. These could further be divided into categories according to the mechanism of disease.

Nausea or Vomiting, Differential Diagnosis

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