Vomiting shortly after food

Some differential diagnoses and typical outline evidence

Gastritis/peptic ulcer disease	Suggested by: epigastric pain, dull or burning discomfort, (gastric ulcer pain typically exacerbated by food and duodenal ulcer pain relieved by it), ‘waterbrash’.
	Confirmed by: oesophagogastroscopy, barium meal and pH study.
Gastroparesis due to diabetes mellitus	Suggested by: intermittent vomiting, abdominal fullness or bloating, distended upper abdomen, succussion splash, history of diabetes.
	Confirmed by: oesophagogastroscopy, double contrast barium meal showing normal mucosa but dilatation.
Gastric outlet obstruction e.g. carcinoma, lymphoma, chronic scarring, congenital pyloric stenosis in newborn	Suggested by: intermittent vomiting, abdominal fullness or bloating, distended upper abdomen, succussion splash.
	Confirmed by: oesophagogastroscopy, double contrast barium meal shows structural abnormality.
Small intestinal tumour e.g. lymphoma	Suggested by: abdominal pain, anorexia, weight loss.
	Confirmed by: small bowel barium meal and follow-through showing filling defect, CT abdomen showing abnormal tumour in wall, flexible enteroscopy with biopsy showing abnormal histology.
Acute cholecystitis due to cholelithiasis	Suggested by: symptoms after fatty food with colicky abdominal pain.
	Confirmed by: ↑serum amylase, ultrasound scan of biliary tree/gallbladder.
	Management: OHCM pp484–5.
Acute pancreatitis	Suggested by: severe epigastric/central abdominal pain, jaundice, tachycardia, Cullen's sign (periumbilical discolouration) or Grey Turner's sign (discolouration at the flank).
	Confirmed by: ↑↑serum amylase, ↓Ca2+.
	Management: OHCM p478.