Nausea and Vomiting

Nausea

Is a sensation of unease and discomfort in the Upper Stomach with an urge to vomit.

Vomitting

Emesis:

The Reflex action of ejecting the contents of the stomach through the mouth. Vomiting is controlled by a special center in the brain that maybe stimulated by drugs (eg Apomorphine acting directly on it; or by the impulses transmitted through nervous substances or in stomach diseases, such as peptic ulcers or from the inner ear (in motion sickness).

The stimulated vomiting center sets off a chain of nerve impulses producing coordinated contractions of the diaphragm and abdominal muscle, relaxation of the muscle at the entrance to stomach etc causing the stomach contents to be expelled.

Color of vomit

Bright red in the vomit suggests bleeding from the esophagus Dark red vomit with liver-like clots suggests profuse bleeding in the stomach, such as from a perforated ulcer.

Coffee ground-like vomit suggests less severe bleeding in the stomach, because the gastric acid has had time to change the composition of the blood.

Yellow vomit suggests bile. This indicates that the pyloric valve is open and bile is flowing into the stomach from the duodenum. (This is more common in older people.)

Common Causes

• Gastroenteritis.
• Food Poisoning.
• Medication Side-Effects.
• 1st Signs of Pregnancy.
• Disequilibrium-Motion Sickness.
• Serious: Pancreatitis, Meningitis, Appendicitis, Cholecystitis, Hepatitis, Diabetic Ketoacidosis.
• Kidney diseases (for example, kidney stones, infection, kidney failure)
• Inflammatory Bowel Disease.
• Some forms of Cancer.

Central Causes

• Head Injury: Any illness or injury that increases intracranial pressure eg. Meningitis, Concussion or trauma,

tumour.

• Inner Ear: Labyrinthitis, Motion Sickness, Meniere’s Disease, Vertigo.
• Noxious Stimulus: Certain smells or sounds.
• Heat Related Illness: Dehydration, heat exhaustion, extreme Sunburn.

Diagnoses

Often no investigations needed. Basic Lab tests. Abdominal X-Ray if suspected bowel obstruction.

Treatment

If dehydration is present due to loss of fluids from severe vomiting and/or accompanying diarrhea, rehydration with oral electrolyte solutions is preferred. If this is not effective or possible, intravenous rehydration may be required.

Antiemetics: Dimenhydrinate (Gravol) Ondansetron (Zofran) Pyridoxine or metoclopramide are the first line treatments for pregnancy related nausea and vomiting.

Links

References

CLARK'S, Kumar. Clinical Medecine. 8. edition. 2012. ISBN 9780702044991.