On seeing the patient you arrive at a diagnosis and decide on further management of the vomiting. Which of the following options should be considered in the first instance?

d. The prescription of anti-emetic medication should always be with caution; the cause for vomiting should be assessed and a diagnosis made before starting anti-emetics. Serious causes for vomiting, e.g. gastrointestinal obstruction, must be excluded. Erect chest radiographs are useful if perforation is suspected; however, in this case the clinical index of suspicion is low and would not be a useful investigation. Abdominal radiographs are useful only in cases of suspected gastrointestinal obstruction, as a crude assessment of renal tract stones (a KUB – kidneys, ureter, bladder radiograph is far superior) and often as a useful method of confirming constipation in elderly patients who complain of abdominal pain and difficulty in passing stool! Nasogastric tube passage would be an option if vomiting were severe or unlikely to settle with anti-emetics. However, it would not be necessary to feed a patient like this via nasogastric tube in the short term and thus would be an unnecessary hindrance to recovery of normal oral intake. Proton pump inhibitors such as omeprazole are not required in a young patient without documented peptic ulcer disease and in this example would not afford any significant benefit in the immediate management of vomiting caused by post-operative ileus.