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Vomiting
Definition
Vomiting (or emesis), which is the forceful ejection of contents of
the upper gut through the mouth.
Terms often confused with vomiting
- Retching involves coordinated, voluntary muscle activity of the abdomen
and thorax--in effect, a forced respiratory inspiration against a closed
mouth and glottis without discharge of gastric contents from the mouth.
- Regurgitation is the effortless return of gastric or esophageal contents
into the mouth without nausea, and it occurs without spasmodic, abdominal,
thoracic, or gastrointestinal muscular contractions (i.e. Retching).
Although it is doubtful if breaking separating the causes of
nausea from those of vomiting is clinically useful, it does help to
put the differential diagnosis into perspective.
1. Vomiting associated with nausea
This is most frequently due to a cause affecting the chemoreceptor
trigger zone (medulla oblongata).
1. Neurological
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Accompanying neurological
manifestations
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- Migraine
Clinical suspicion: nausea & headache
Diagnosis
- Labyrinthine disorders:
Clinical suspicion: nausea & vertigo
- Cerebral lesion (increase intracranial lesion)
Clinical suspicion: blurring of vision, headache, projectile vomiting,
focal neurological manifestations.
2. Metabolic
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Toxic, maybe delirious,
+
Abnormal Labs, pH, electrolytes
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- DKA
- Metabolic acidosis
- Electrolyte abnormalities
- Renal failure
- Hepatic failure
- Hypothyroidism
- Adrenal insufficiency
- Drugs & toxins
- Pregnancy (Morning sickness, hyperemesis gravidarum)
- Food allergy
3. GIT Causes
- Over-eating or drinking too much alcohol
- Many patients experience nausea after eating spoiled food
- Gallstones, gastroenteritis and stomach ulcer may cause nausea
and vomiting
4. Other Causes
- Motion sickness can be induced by traveling in a vehicle, plane,
or on a boat.
3. Psychogenic
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By exclusion
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Persistent, unexplained, or recurring nausea and vomiting can be
symptoms of a variety of serious illnesses. You should seek medical
assessment if:
- After eating rich or spoiled food or taking a new medication
- Repeatedly or for 48 hours or longer
- Following intense dizziness.
It is important to see a doctor if nausea and vomiting are
accompanied by:
- Jaundice
- Pain in the chest or lower abdomen
- Trouble with swallowing or urination
- Dehydration or extreme thirst
- Drowsiness or confusion
- Constant, severe abdominal pain
- A fruity breath odor
2. Vomiting without nausea
i.e. chemoreceptor trigger zone (CTZ) in the brain is not affected. Usually
a local gastro-intestinal cause.
1. Pain induced
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Vomiting & pain
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Visceral pain which is usually of GIT origin but maybe related to other
organs e.g. myocardial infarction.
- Gastro-duodenal: ulcer
- Gastro-intestinal: inflammation
- Hepatobiliary: inflammation
- Pancreas: inflammation, cancer
- Peritoneum: inflammation, cancer
- Other: Myocardial infarction.
2. Obstructive
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Vomiting, abdominal
swelling, absolute
constipation
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- Pyloric: copious brownish acid vomitus
- Duodenal: bile
- Intestinal: fecal
e.g. gastro-enteritis.
4. Other GIT causes
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vomiting & other GIT manifestations
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e.g. congestive heart failure leading to gut congestion.
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