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Here is a quick mnemonic “APPROACH NAUSEA to remember about Approach To A Nausea & Vomiting Patient

This can be valuable for patients as well as medical doctors, nurses & students doing their clinical rounds. You can also find it very useful for med exams like USMLE, NExT Medical Step 1&2, MBBS, NEET PG, INI-CET, FMGE,MCAT & NCLEX exams

Approach To A Nausea & Vomiting Patient : How To Remember Easily ?

  • 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.


Dr. Arin Nandi

Passionate About Medical Science & Helping Future Doctors Achieve Top Ranks In Medical Exams. He is professionally a dentist as well as a public health expert from JIPMER working in department