Absence of nausea is observed in CNS disorder, hysteria
Search for other upper GI symptoms such as Colic, distention of abdomen
Examination of other systems - CNS, renal, endocrine etc.
Examination of vomitus
1.Food material, quantity - Large in gastric outlet obstruction
2.Blood, coffee ground vomitus
3.Bilious vomitus - Absent in pyloric stenosis, increased in intestinal obstruction.
4.Time of day in pyloric stenosis, later part of day when large quantity of food has accumulated.
5.Mucus - Jelly like appearance is present in small quantity in most vomitus, large quantity of mucus in Catarrhal inflammation of stomach
6.Odor
- Sour odor due to acid presence offensiveness
- Faeculent Odor – in intestinal obstruction and fermentation of food in pyloric obstruction.