An important feature in clinically discriminating the level of gastrointestinal obstruction is the vomitus. The more proximal the obstruction, the earlier vomiting develops. This will occur even if no food or fluid is taken because secretions - saliva and gastrointestinal - continue to be produced and to enter the stomach.
In addition to this, the content of the vomitus provides clues to the level of obstruction. If the vomitus contains semi-digested food eaten a day or two previously then this is suggestive of gastric outflow obstruction, especially if there is no bile present. If there is copious vomiting of bile stained fluid, then this is suggestive of upper small bowel obstruction. Faeculent vomiting, which is thicker and foul-smelling, is suggestive of a more distal obstruction.
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