Emesis in the adult population can be nebulous, with varying time points, preceding factors, and ranges of severity. Determining the etiology requires an extensive dive into the patient’s history. A common language must be established with the patient while determining associated symptoms and durations. “Alarm signs” such as unintended weight loss, progressive dysphagia, persistent vomiting, evidence of gastrointestinal bleeding, family history of gastric cancer, altered mental status, severe pain, or age greater than 55 years require immediate biochemical and radiographic testing to allow for diagnosis and intervention. Those without alarm signs can be categorized into potential diagnosis allowing for workup prior to subspecialist referral.