Vomiting

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">

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</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">Arthur C.,

 Textbook of Medical Physiology, 
  
 Elsevier, 
 2016,</ref>

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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">

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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">

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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">

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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>Andrews, Paul L. R.,

 Emesis in dogs: a review, 
 Veterinary Journal, 
 2004,
 Vol. 167(Issue: 2),
 pp. 165–181,</ref>

See Also

• Nausea
• Gastroenteritis
• Food poisoning
• Hyperemesis gravidarum
• Cyclic vomiting syndrome

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