Clinical presentation	Suggested diagnoses	Suggested tests
Acute onset	Cholecystitis, gastroenteritis, medication-related effect, pancreatitis	Cholecystitis: right upper-quadrant ultrasonography1
		Pancreatitis: amylase and lipase levels, ultrasonography to assess for gallstones, contrast-enhanced abdominal computed tomography in patients with severe illness2
Associated with diarrhea, headache, and myalgias	Viral gastroenteritis	None
Bilious vomiting	Small bowel obstruction	Abdominal radiography or computed tomography4
Continuous vomiting	Conversion disorders	Electrolyte levels
Delayed vomiting (more than one hour after meals)	Gastric outlet obstruction, gastroparesis	Obstruction: abdominal radiography4
		Gastroparesis: gastric emptying study3
Feculent or foul odor to vomitus	Intestinal obstruction	Abdominal radiography4
Habitual postprandial, irregular vomiting	Major depression	Patient Health Questionnaire-9, Beck Depression Inventory
Insidious onset	Gastroesophageal reflux, gastroparesis, medication-related effect, metabolic disorders, pregnancy	Gastroesophageal reflux: esophagogastroduodenoscopy if patient has warning signs or does not improve with empiric therapy
		Gastroparesis: gastric emptying study3
		Metabolic disorders: pulse oximetry, arterial blood gases, serum chemistries, chest radiography
		Pregnancy: pregnancy test in women of childbearing age, with pelvic ultrasonography if ectopic pregnancy is suspected
Patient report of previous organic or functional gastrointestinal illness	Chronic psychogenic vomiting	Electrolyte levels, further evaluation if organic cause is suspected
Projectile vomiting, may not be preceded by nausea	Intracranial disorders, increased intracranial pressure (also associated with normal emesis)	Brain computed tomography
Regurgitation of undigested food	Achalasia, esophageal stricture, Zenker diverticulum	Esophagogastroduodenoscopy, upper gastrointestinal barium study
Vomiting before breakfast	Alcohol ingestion, increased intracranial pressure, pregnancy, uremia	Increased intracranial pressure: brain computed tomography
		Pregnancy: pregnancy test in women of childbearing age, with pelvic ultrasonography if ectopic pregnancy is suspected
		Uremia: renal function testing, electrolyte levels
Vomiting during or soon after meals	Anorexia, bulimia	Electrolyte levels
Vomiting partly digested food or chyme several hours after meals	Gastric outlet obstruction (no bile), gastroparesis	Obstruction: abdominal radiography4