Vomiting (Emesis): Examination

A comprehensive clinical examination is the basis for selecting further diagnostic steps:

  • General physical examination – including blood pressure, pulse, body temperature, body weight, body height; furthermore:
    • Inspection (viewing).
      • Skin, mucous membranes and eyes including sclerae (white part of the eye) [red eye/visual disturbances (glaucoma)].
      • Abdomen (abdomen):
        • Shape of the abdomen?
        • Skin color? Skin texture?
        • Efflorescences (skin changes)?
        • Pulsations? Bowel movements?
        • Visible vessels?
        • Scars? Hernias (fractures)?
    • Auscultation (listening) of the heart.
    • Examination of the abdomen
      • Percussion (tapping) of the abdomen
        • [Ascites (abdominal fluid): phenomenon of fluctuation wave. This can be triggered as follows: if one taps against one flank a wave of fluid is transmitted to the other flank, which can be felt by placing the hand on it (undulation phenomenon); flank attenuation.
        • Meteorism (flatulence): hypersonoric tapping sound.
        • Attenuation of the tapping sound due to enlarged liver or spleen, tumor, urinary retention?
        • Hepatomegaly (liver enlargement) and/or splenomegaly (spleen enlargement): estimate liver and spleen size.
        • Cholelithiasis (gallstones): tapping pain over gallbladder region and right lower rib]
      • Palpation (palpation) of the abdomen (abdomen) (tenderness?, knocking pain?, coughing pain?, defensive tension?, hernial orifices?, kidney bearing knocking pain?)
    • Digital rectal examination (DRU): examination of the rectum (rectum) and adjacent organs with the finger by palpation: assessment of the prostate in size, shape and consistency.
  • Ophthalmologic examination [glaucoma case].
  • Gynecological examination [in case of pregnancy; vomiting in the morning]
  • ENT medical examination [torsional vertigo?, tinnitus (ringing in the ears)?; neuronitis vestibularis, Meniere’s disease (disease of the inner ear characterized by attacks of torsional vertigo); labyrinthitis (inflammation of the inner ear)]
  • Neurological examination (meningismus?; headache?) [due todifferential diagnoses: cerebral abscess, cerebral hemorrhage, brain tumor, hydrocephalus (hydrocephalus; pathological expansion of the liquid-filled fluid spaces (cerebral ventricles) of the brain)]
  • Psychiatric examination [due todifferential diagnoses: anorexia nervosa (anorexia), bulimia nervosa (binge eating disorder), depression]
  • Urological examination [uremia (occurrence of urinary substances in the blood above normal values), urolithiasis (urinary stones)]

Square brackets [ ] indicate possible pathological (pathological) physical findings.