Vomiting with abdominal pain alone (unrelated to food and no fever)—non-metabolic causes

This is associated with a wide variety of GI and systemic disorders it is non-specific.

Some differential diagnoses and typical outline evidence

Large bowel obstruction e.g. malignancy, strangulated hernia	Suggested by: faecal vomiting, abdominal distension.
	Confirmed by: AXR showing bowel dilation, barium enema, colonoscopy.
	Management: OHCM p492.
Hepatic carcinoma, primary or secondary	Suggested by: RUQ pain and mass, jaundice.
	Confirmed by: weight loss over weeks to months, ultrasound/CT of liver showing hepatic mass.
	Management: OHCM pp242–3.
Mesenteric artery occlusion	Suggested by: periumbilical pain, diarrhoea, melaena.
	Confirmed by: mesenteric angiography showing filling defect.
	Management: OHCM p488.
Intussusception	Suggested by: child, usually between 6–18 months of life, acute onset of colicky intermittent abdominal pain, red currant ‘jelly’ PR bleed, ± a sausage shape mass in upper abdomen.
	Confirmed by: barium enema, may reduce with appropriate hydrostatic pressure.
	Management: OHCM p494.
Ectopic pregnancy, miscarriage	Suggested by: cramping pain, spotting, PV bleeding.
	Confirmed by: positive pregnancy test, USS of pelvis.
	Management: OHCS p262–3.
Renal calculi	Suggested by: colicky loin pain, haematuria.
	Confirmed by: plain abd X-ray, ultrasound, IVU.
	Management: OHCM p264.
Acute inferior myocardial infarction	Suggested by: retrosternal chest pain, sweating, nausea.
	Confirmed by: ↑ST on ECG, ↑cardiac enzymes e.g. CK-MB or troponin.
	Management: OHCM pp120–4.
Congestive cardiac failure (and liver congestion)	Suggested by: dyspnoea, orthopnoea, PND, liver enlargement and tenderness, leg oedema.
	Confirmed by: CXR and echocardiogram.
	Management: OHCM pp136–9