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Box 15-2

Vomiting may lead to serious fluid, electrolyte, and acid-base disturbances and can occur for a variety of reasons. By carefully observing the characteristics of the vomitus and, as needed, questioning the patient, you may gain clues as to the underlying disorder. Here's what the vomitus may indicate.

Bile stained (greenish)

Obstruction below the pylorus, as from a duodenal lesion

Bloody

Upper GI bleeding, as from gastritis or peptic ulcer (if bright red) or from gastric or esophageal varices (if dark red)

Brown with a fecal odor

Intestinal obstruction or infarction

Burning, bitter tasting

Excessive hydrochloric acid in gastric contents

Coffee-ground consistency

Digested blood from slowly bleeding gastric or duodenal lesions

Undigested food

Gastric outlet obstruction, as from gastric tumor or ulcer