Vomiting - Revision history

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2025-04-08T19:11:39Z

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			{{SI}}
			{{Infobox medical condition
			\| name = Vomiting
			\| image = [[File:49-aspetti_di_vita_quotidiana,_vomito,Taccuino_Sanitatis,_Ca.jpg\|250px]]
			\| caption = Illustration of vomiting from a medieval manuscript
			\| field = [[Gastroenterology]]
			\| synonyms = Emesis
			\| symptoms = [[Nausea]], [[retching]], [[abdominal pain]]
			\| complications = [[Dehydration]], [[electrolyte imbalance]], [[aspiration pneumonia]]
			\| onset = Sudden
			\| duration = Varies
			\| causes = [[Gastroenteritis]], [[motion sickness]], [[pregnancy]], [[migraine]], [[food poisoning]], [[alcohol intoxication]], [[medications]]
			\| risks = [[Dehydration]], [[malnutrition]]
			\| diagnosis = Based on [[medical history]] and [[physical examination]]
			\| differential = [[Gastroesophageal reflux disease]], [[cyclic vomiting syndrome]], [[bowel obstruction]]
			\| treatment = [[Rehydration]], [[antiemetics]]
			\| medication = [[Ondansetron]], [[metoclopramide]], [[promethazine]]
			\| frequency = Common
			}}
	{{short description\|Forceful expulsion of stomach contents through the mouth}}		{{short description\|Forceful expulsion of stomach contents through the mouth}}
	{{Use dmy dates\|date=March 2025}}		{{Use dmy dates\|date=March 2025}}
	[[File:Civo.jpg\|thumb\|Vomiting is a complex reflex response that involves the brain, digestive system, and nervous system.]]		[[File:Civo.jpg\|left\|thumb\|Vomiting is a complex reflex response that involves the brain, digestive system, and nervous system.]]

	'''Vomiting''', also known as '''emesis''', is the involuntary and forceful expulsion of stomach contents through the mouth, and occasionally through the nose.<ref name="MedlinePlus">{{cite web\|title=Vomiting\|url=https://medlineplus.gov/ency/article/003118.htm\|publisher=MedlinePlus\|access-date=2023-05-09}}</ref> It is a protective reflex controlled by the brainstem that serves to expel harmful substances, toxins, or irritants from the digestive system.<ref name="Guyton">{{cite book\|last=Guyton\|first=Arthur C.\|title=Textbook of Medical Physiology\|publisher=Elsevier\|year=2016}}</ref>		'''Vomiting''', also known as '''emesis''', is the involuntary and forceful expulsion of stomach contents through the mouth, and occasionally through the nose.<ref name="MedlinePlus">{{cite web\|title=Vomiting\|url=https://medlineplus.gov/ency/article/003118.htm\|publisher=MedlinePlus\|access-date=2023-05-09}}</ref> It is a protective reflex controlled by the brainstem that serves to expel harmful substances, toxins, or irritants from the digestive system.<ref name="Guyton">{{cite book\|last=Guyton\|first=Arthur C.\|title=Textbook of Medical Physiology\|publisher=Elsevier\|year=2016}}</ref>

	== Causes ==		== Causes ==
	Vomiting can result from a wide range of conditions, including:		Vomiting can result from a wide range of conditions, including:
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	* Medications and treatments – Chemotherapy, anesthesia, radiation therapy, opioids.		* Medications and treatments – Chemotherapy, anesthesia, radiation therapy, opioids.
	* Motion sickness – Disturbance in the inner ear balance system due to movement (e.g., car, boat, plane).		* Motion sickness – Disturbance in the inner ear balance system due to movement (e.g., car, boat, plane).

	== Pathophysiology ==		== Pathophysiology ==
	The act of vomiting is a complex reflex controlled by the vomiting center in the medulla oblongata of the brainstem. The vomiting process is triggered by:		The act of vomiting is a complex reflex controlled by the vomiting center in the medulla oblongata of the brainstem. The vomiting process is triggered by:
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	* Higher brain centers – Psychological stimuli such as fear, anxiety, or unpleasant sights/smells.		* Higher brain centers – Psychological stimuli such as fear, anxiety, or unpleasant sights/smells.
	* The vestibular system – Controls balance and motion detection, contributing to motion sickness.		* The vestibular system – Controls balance and motion detection, contributing to motion sickness.

	Phases of Vomiting		Phases of Vomiting
	1. Nausea – Subjective feeling of discomfort and urge to vomit.		1. Nausea – Subjective feeling of discomfort and urge to vomit.
	2. Retching (Dry heaving) – Rhythmic contractions of abdominal muscles without expelling contents.		2. Retching (Dry heaving) – Rhythmic contractions of abdominal muscles without expelling contents.
	3. Expulsion – Sudden forceful contraction of abdominal muscles, opening of the lower esophageal sphincter, and expulsion of stomach contents.		3. Expulsion – Sudden forceful contraction of abdominal muscles, opening of the lower esophageal sphincter, and expulsion of stomach contents.

	== Clinical Significance ==		== Clinical Significance ==
	Vomiting can be a symptom of many conditions, ranging from minor to life-threatening. Chronic or frequent vomiting can lead to:		Vomiting can be a symptom of many conditions, ranging from minor to life-threatening. Chronic or frequent vomiting can lead to:
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	* Mallory-Weiss syndrome – Tears in the esophagus due to forceful retching.		* Mallory-Weiss syndrome – Tears in the esophagus due to forceful retching.
	* Tooth enamel erosion – Chronic exposure to stomach acid can wear down teeth.		* Tooth enamel erosion – Chronic exposure to stomach acid can wear down teeth.

	== Treatment ==		== Treatment ==
	Treatment depends on the underlying cause. Common management approaches include:		Treatment depends on the underlying cause. Common management approaches include:

	1. Symptomatic Treatment		1. Symptomatic Treatment
	* Antiemetics (anti-nausea medications):		* Antiemetics (anti-nausea medications):
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	* Bland foods (e.g., BRAT diet – Bananas, Rice, Applesauce, Toast).		* Bland foods (e.g., BRAT diet – Bananas, Rice, Applesauce, Toast).
	* Avoidance of fatty, spicy, or dairy-rich foods.		* Avoidance of fatty, spicy, or dairy-rich foods.

	2. Addressing Underlying Causes		2. Addressing Underlying Causes
	* Gastrointestinal conditions – Proton pump inhibitors (PPIs) for GERD, antibiotics for infections.		* Gastrointestinal conditions – Proton pump inhibitors (PPIs) for GERD, antibiotics for infections.
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	* Motion sickness – Scopolamine patches, dimenhydrinate (Dramamine).		* Motion sickness – Scopolamine patches, dimenhydrinate (Dramamine).
	* Chemotherapy-induced vomiting – Combination antiemetics (5-HT3 receptor antagonists + corticosteroids + neurokinin-1 receptor antagonists).		* Chemotherapy-induced vomiting – Combination antiemetics (5-HT3 receptor antagonists + corticosteroids + neurokinin-1 receptor antagonists).

	== Prevention ==		== Prevention ==
	Preventative measures depend on the cause of vomiting:		Preventative measures depend on the cause of vomiting:
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	* For chemotherapy-induced nausea – Pre-medication with antiemetics before treatment.		* For chemotherapy-induced nausea – Pre-medication with antiemetics before treatment.
	* For pregnancy-related vomiting – Frequent small meals, ginger supplements, acupressure bands.		* For pregnancy-related vomiting – Frequent small meals, ginger supplements, acupressure bands.

	== Complications ==		== Complications ==
	If vomiting is not properly managed, complications can arise:		If vomiting is not properly managed, complications can arise:
	* Severe dehydration – Requiring hospitalization for IV fluids.		* Severe dehydration – Requiring hospitalization for IV fluids.
	* Malnutrition – Chronic vomiting leads to weight loss and nutrient deficiencies.		* Malnutrition – Chronic vomiting leads to weight loss and nutrient deficiencies.
	* Esophageal damage – Repeated exposure to acid can cause ~~Barrett’s~~ esophagus, ulcers, and strictures.		* Esophageal damage – Repeated exposure to acid can cause Barrett‚Äôs esophagus, ulcers, and strictures.
	* Psychological distress – Associated with eating disorders like bulimia nervosa.		* Psychological distress – Associated with eating disorders like bulimia nervosa.

	== Vomiting in Other Animals ==		== Vomiting in Other Animals ==
	Vomiting is a defensive reflex observed in many animals, helping expel toxins or foreign objects. However, some animals cannot vomit, including:		Vomiting is a defensive reflex observed in many animals, helping expel toxins or foreign objects. However, some animals cannot vomit, including:
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	* Horses – Have a strong lower esophageal sphincter preventing regurgitation.		* Horses – Have a strong lower esophageal sphincter preventing regurgitation.
	* Rabbits – Digestive system lacks the coordination needed to vomit.<ref>{{cite journal\|last=Andrews\|first=Paul L. R.\|title=Emesis in dogs: a review\|journal=Veterinary Journal\|year=2004\|volume=167\|issue=2\|pages=165–181}}</ref>		* Rabbits – Digestive system lacks the coordination needed to vomit.<ref>{{cite journal\|last=Andrews\|first=Paul L. R.\|title=Emesis in dogs: a review\|journal=Veterinary Journal\|year=2004\|volume=167\|issue=2\|pages=165–181}}</ref>

	== Cultural and Historical Aspects ==		== Cultural and Historical Aspects ==
	Vomiting has been referenced in various cultures:		Vomiting has been referenced in various cultures:
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	* Ayurveda – Describes therapeutic vomiting ("Vamana") as part of detoxification.		* Ayurveda – Describes therapeutic vomiting ("Vamana") as part of detoxification.
	* Medieval medicine – Linked to the humoral theory, where vomiting was believed to balance bodily fluids.		* Medieval medicine – Linked to the humoral theory, where vomiting was believed to balance bodily fluids.

	== See Also ==		== See Also ==
	* [[Nausea]]		* [[Nausea]]
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	* [[Bulimia nervosa]]		* [[Bulimia nervosa]]
	* [[Food poisoning]]		* [[Food poisoning]]

	== External Links ==		== External Links ==
	{{Digestive system and abdomen symptoms and signs}}		{{Digestive system and abdomen symptoms and signs}}

Prab at 04:01, 20 March 2025

2025-03-20T04:01:40Z

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Prab at 03:15, 10 May 2023

2023-05-10T03:15:55Z

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'''Vomiting''', also known as '''emesis''', is the involuntary, forceful expulsion of the contents of one's stomach through the mouth and occasionally through the nose.<ref name="MedlinePlus">{{cite web|title=Vomiting|url=https://medlineplus.gov/ency/article/003118.htm|publisher=MedlinePlus|access-date=2023-05-09}}</ref> Vomiting is a complex process managed by the central nervous system and typically occurs as a protective response to harmful substances or conditions within the body.<ref name="Guyton">{{cite book|last=Guyton|first=Arthur C.|title=Textbook of Medical Physiology|publisher=Elsevier|year=2016}}</ref>
[[File:Civo.jpg|thumb|Civo]]

== Causes ==
Vomiting can be triggered by a multitude of conditions that range from gastrointestinal disorders to systemic diseases. Common inducers of vomiting include [[gastroenteritis]], [[pregnancy]] (often in the form of [[morning sickness]]), [[migraines]], [[food poisoning]], [[appendicitis]], [[concussion]], and certain medications. Psychiatric conditions, such as [[bulimia nervosa]], and certain forms of stress can also induce vomiting.<ref name="MedlinePlus"/>

== Pathophysiology ==
The act of vomiting is regulated by the ''[[vomiting center]]'' located in the [[medulla oblongata]] of the brain. This area receives signals from the peripheral and central nervous systems, including the gastrointestinal tract and the [[chemoreceptor trigger zone]] (CTZ). When the vomiting center receives sufficient input to surpass a certain threshold, it initiates the physiological sequence leading to vomiting. This sequence includes deep breath, closure of the glottis to prevent aspiration into the lungs, and contraction of the abdominal muscles, which increases intra-abdominal pressure and forces the stomach contents out through the esophagus.<ref name="Guyton"/>

== Clinical Significance ==
Vomiting can serve as a diagnostic symptom for numerous medical conditions and can be a cause of harm itself. Chronic or frequent vomiting can lead to serious health complications such as [[dehydration]], [[electrolyte imbalances]], [[malnutrition]], [[aspiration pneumonia]], and damage to the [[esophagus]]. This damage could manifest as [[esophagitis]], [[Mallory-Weiss syndrome]], or [[Barrett's esophagus]].<ref name="MedlinePlus"/>

== Treatment ==
The treatment strategy for vomiting primarily depends on identifying and addressing its cause. Symptomatic treatment may include the use of [[antiemetic]] drugs like [[ondansetron]], [[promethazine]], and [[metoclopramide]] to curb nausea and vomiting. Rehydration therapy, either orally or intravenously, is often necessary to replace lost fluids and electrolytes, particularly in cases of severe or prolonged vomiting. Dietary modifications and psychological interventions may also be recommended depending on the underlying cause.<ref name="NHS">{{cite web|title=Vomiting in adults|url=https://www.nhs.uk/conditions/vomiting-in-adults/|publisher=NHS|access-date=2023-05-09}}</ref>

== Prevention ==
Prevention strategies for vomiting depend on the underlying cause. For instance, to prevent foodborne illness, it's important to follow food safety guidelines such as proper food handling and storage. For individuals prone to motion sickness, avoiding reading in a moving vehicle, choosing the seat with the least motion (driver's seat in a car, wing seat in an airplane), and over-the-counter medications like [[dimenhydrinate]] (Dramamine) may be helpful. For those undergoing chemotherapy, prophylactic administration of antiemetic medications can be beneficial.<ref name="MedlinePlus">{{cite web|title=Vomiting|url=https://medlineplus.gov/ency/article/003118.htm|publisher=MedlinePlus|access-date=2023-05-09}}</ref>

== Complications ==
If not properly managed, vomiting can lead to serious complications. These include [[dehydration]], [[electrolyte imbalance]], [[aspiration pneumonia]], [[malnutrition]], and damage to the [[esophagus]]. Repeated vomiting can also lead to [[tooth decay]] due to the acidic content of vomit.<ref name="NHS">{{cite web|title=Vomiting in adults|url=https://www.nhs.uk/conditions/vomiting-in-adults/|publisher=NHS|access-date=2023-05-09}}</ref>

== In Other Animals ==
Vomiting is not only observed in humans but also in many other animals. It is often a protective reflex to expel ingested toxins or foreign objects. However, not all animals can vomit. For example, rats and horses are physically incapable of vomiting.<ref>{{cite journal|last=Andrews|first=Paul L. R.|title=Emesis in dogs: a review|journal=Veterinary Journal|year=2004|volume=167|issue=2|pages=165–181}}</ref>

== See Also ==
* [[Nausea]]
* [[Gastroenteritis]]
* [[Food poisoning]]
* [[Hyperemesis gravidarum]]
* [[Cyclic vomiting syndrome]]
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{{Digestive system and abdomen symptoms and signs}}
[[Category:Vomiting| ]]
[[Category:Reflexes]]
[[Category:Symptoms and signs: Digestive system and abdomen]]
[[Category:Body fluids]]
[[Category:Emetics]]