Approach To A Nausea & Vomiting Patient Mnemonic

• A – Abdominal Pain: Vomiting can relieve abdominal pain from a bowel obstruction but has no effect in pancreatitis or cholecystitis.
• P – Physical Examination: The physical examination complements the history. Look for signs like orthostatic hypotension, reduced skin turgor, pulmonary abnormalities, etc.
• P – Palpable Masses: Neoplasm is suggested by palpable masses or adenopathy.
• R – Rumination Syndrome: Vomiting minutes after meal consumption prompts consideration of rumination syndrome.
• O – Obstruction Types: Different types of vomiting may indicate different obstructions, e.g., bilious vomiting excludes gastric obstruction, while feculent emesis is noted with distal intestinal or colonic obstruction.
• A – Anemia: Iron-deficiency anemia mandates exclusion of mucosal causes.
• C – Chronic Illness: Established illnesses evoke chronic complaints in nausea and vomiting.
• H – Headaches and Visual Changes: Intracranial sources are considered if there are headaches or visual changes.
• N – Neurologic Disease: Neurologic disease presents with papilledema, visual loss, or focal neural abnormalities.
• A – Anatomic Studies: Anatomic studies are indicated if initial testing is nondiagnostic.
• U – Ulcers and Malignancy: Upper endoscopy detects ulcers, malignancy, and retained food in gastroparesis.
• S – Supine and Upright Abdominal Radiographs: These may show intestinal air-fluid levels and reduced colonic air with small-bowel obstruction.
• E – Electrolyte Replacement: Electrolyte replacement is indicated for hypokalemia or metabolic alkalosis.
• A – Alternatives to Scintigraphy: A nonradioactive 13C-labeled gastric emptying breath test is an alternative to scintigraphy.

Mnemonic :  APPROACH NAUSEA