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Vomiting




:''Emesis redirects here. For the Genus of Metalmark Butterflies , see '' Emesis (butterfly) .
:''Heaving redirects here. For the up-and-down motion, see Heave .''


  Name Vomiting
  ICD10
  ICD9


Vomiting (also '''throwing up''' or '''emesis''') is the forceful expulsion of the contents of one's Stomach through the Mouth and sometimes the Nose . '''Vomiting''' may result from many causes, ranging from Gastritis or Poison ing to Brain Tumor s, or elevated Intracranial Pressure (ICP). The feeling that one is about to vomit is called Nausea . It usually precedes, but does not always lead to vomiting. Antiemetic s are sometimes necessary to suppress nausea and vomiting, and in severe cases where Dehydration develops, Intravenous fluid may need to be administered to replace fluid volume.
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The medical branch investigating vomiting, emetics and antiemetics is called emetology.


MECHANISM


Vomiting center

Vomiting is coordinated in the vomiting center in the lateral medullary Reticular Formation in the Pons . Receptors on the floor of the Fourth Ventricle of the brain represent a Chemoreceptor Trigger Zone , stimulation of which can lead to vomiting. The chemoreceptor zone lies outside the Blood-brain Barrier , and can therefore be stimulated by blood-borne drugs that can Stimulate Vomiting , or Inhibit It .

There are various sources of input to the vomiting center:


Vomiting act

The vomiting act encompasses three types of outputs initiated by the medulla: Motor, Parasympathetic Nervous System (PNS) and Sympathetic Nervous System (SNS). Collectively, they are as follows:

  • Increased Saliva tion to protect the Enamel of Teeth from stomach acids (excessive vomiting leads to Caries ). This is part of the PNS output.

  • Retroperistalsis , starting from the middle of the Small Intestine , sweeping up the contents of the digestive tract into the stomach, through the relaxed pyloric sphincter.

  • A lowering of intrathoracic pressure (by inspiration against a closed Glottis ), coupled with an increase in abdominal pressure as the Abdominal Muscles contract, propels stomach contents into the Esophagus without involvement of retroperistalsis. The Lower Esophageal Sphincter relaxes. This is part of the motor output, and it is also important to note that the stomach itself does not contract in the process of vomiting.

  • Vomiting is ordinarily preceded by Retching .

  • Vomiting also initiates a SNS response causing both sweating and increased heart rate.


The Neurotransmitter s that regulate vomiting are poorly understood, but inhibitors of Dopamine , Histamine and Serotonin are all used to suppress vomiting, suggesting that these play a role in the initiation or maintenance of a vomiting cycle. Vasopressin and Neurokinin may also participate.


CONTENT

Since the stomach secretes acid, vomit contains a high concentration of Hydronium Ion s and is thus strongly Acidic . Recent food intake will be reflected in the gastric vomit.

The content of the vomitus (vomit) may be of medical interest. Fresh Blood in the vomit is termed Hematemesis ("blood vomiting"). Old blood bears resemblance to coffee grounds (as the Iron in the blood is Oxidized ), and when this matter is identified the term "coffee ground vomiting" is used. Bile can enter the vomit during subsequent heaves due to Duodenal contraction if the vomiting is severe. Fecal Vomiting is often a consequence of Intestinal Obstruction , and is treated as a warning sign of this potentially serious problem ("signum mali ominis"); such vomiting is sometimes called "miserere". If food has recently been consumed, then partly digested food may show up in the vomit.

If the vomiting reflex continues for an extended period of time with no appreciable vomitus, the condition is known as non-productive emesis or '''dry heaves''', which can become both extremely painful and debilitating.


COMPLICATIONS OF VOMITING


Aspiration of vomit

Vomiting can be very dangerous if the gastric content gets into the respiratory tract. Under normal circumstances the Gag Reflex and Coughing will prevent this from occurring, however these protective reflexes are compromised in persons under narcotic influences such as Alcohol or Anesthesia . The individual may choke and Asphyxiate or suffer an Aspiration Pneumonia .


Dehydration and electrolyte imbalance

Prolonged and excessive vomiting will deplete the body of water (dehydration) and may alter the electrolyte status. The loss of acids leads to Metabolic Alkalosis (increased blood PH ), and the electrolyte imbalance shows Hypokalemia ( Potassium depletion) and Hypochloremia ( Chlorine depletion). The hypokalemia is an indirect result of the Kidney compensating for the loss of acid. With the loss of intake of food the individual will become Cachectic .


CAUSES

Vomiting may be due to a large number of causes, and protracted vomiting has a long Differential Diagnosis .


Digestive tract

Causes in the Digestive Tract :


Sensory system and brain

Causes in the Sensory System :

Causes in the brain:

Metabolic disturbances (these may irritate both the stomach and the parts of the brain that coordinate vomiting):

Pregnancy:

Drug reaction (vomiting may occur as an acute Somatic response to):


Other

  • Self-induced

  • --- Eating Disorder s ( Anorexia Nervosa or Bulimia Nervosa )

  • --- Sexual Fetish ( Emetophilia )

  • --- To remove a poison in case such has been ingested (some poisons should not be vomited as they may be more toxic when inhaled or aspirated; it is generally considered better to ask for help before inducing vomiting)

  • --- Some people who are engaged in Binge Drinking will induce vomiting in order to make room in their stomachs for further alcohol consumption. In the United Kingdom, this practice is known as ''tactical chundering,'' and as ''boot and rally'' or ''pulling the trigger'' in the United States.

  • After Surgery ( Postoperative Nausea And Vomiting )

  • Disagreeable sights, smells or thoughts (such as decayed matter, others' vomit, thinking of vomiting), etc.

  • Extreme pain, such as intense Headache or Myocardial Infarction (heart attack)

  • Violent emotions (including laughing)

  • Cyclic Vomiting Syndrome (a poorly understood condition with attacks of vomiting)

  • High doses of Ionizing Radiation will sometimes trigger a vomit reflex in the victim.

  • Violent fits of Coughing or Hiccups

  • Nervousness



RELATED MEDICATION


Emetics

An ''emetic'', such as Syrup Of Ipecac , is a substance that induces vomiting when administered orally or by injection. An emetic is used medically where a substance has been ingested and must be expelled from the body immediately. Inducing vomiting can remove the substance before it is absorbed into the body. Ipecac abuse can lead to detrimental health effects.


Antiemetics

An Antiemetic is a Drug that is effective against vomiting and Nausea . Antiemetics are typically used to treat Motion Sickness and the Side Effects of some Opioid Analgesic s and Chemotherapy directed against Cancer .

Antiemetics act by inhibiting the receptor sites associated with emesis. Hence, anticholinergics, antihistamines, dopamine antagonists, serotonin antagonists and cannabinoids are used as anti-emetics.


SOCIAL IMPLICATIONS


Nausea inducement in groups

It is quite common that when one person vomits, others nearby will become nauseated, particularly when smelling the vomit of others, often to the point of vomiting themselves. It is believed that this is an '' (1983), '' Saving Private Ryan '' (1998), and '' Stand By Me '' (1986), while in the computer game Theme Hospital , it is referred to as a 'vomit wave' and can spread through the hospital quickly.

Intense vomiting in s of the Amazon , in helping to clear Parasite s from the gastrointestinal system. Andritzky, W. (1989). Sociopsychotherapeutic functions of ayahuasca healing in Amazonia. Journal of Psychoactive Drugs. 21(1), 77-89.

There have also been documented cases of a single ill and vomiting individual inadvertently causing others to do so, when they are especially fearful of also becoming ill, through a form of Mass Hysteria .


Context

Most people try to contain their vomit by vomiting into a sink, toilet, or trash can, as both the act and the vomit itself are widely considered embarrassing; vomit is also difficult to clean. On airplanes and boats, special bags are supplied for sick passengers to vomit into. Alternatively, a special disposable bag is available containing absorbent material that solidifies the vomit quickly, making it convenient and safe to keep (leakproof, puncture resistant, odorless) until there is an opportunity to dispose of it conveniently.

People who vomit chronically (e.g. as part of an Eating Disorder such as Bulimia Nervosa ) may devise various ways to hide this disorder.


Sound


According to an online study of 30 traditionally bad sounds, the sound of vomiting is the worst sound in the world {Link without Title} . Professor Cox of the University Of Salford 's Acoustic Research Centre said that "We are pre-programmed to be repulsed by horrible things such as vomiting, as it is fundamental to staying alive to avoid nasty stuff". It is thought that the thought of disgust is triggered by the sound of vomiting to protect food from those possibly diseased nearby1.


In language

As with other physiological processes involving body wastes, vomiting has ). Reference to vomiting is often made in speech (e.g. "it makes me sick", "I need a bucket") or by gesturing to signify being disgusted by someone or something.


Slang terms for the act of vomiting include: "hurling", "throwing up", "upchucking", "booting", "puking", "ralphing", "barfing", "keeling", "chucking up", "sicking up", "spewing", "spewing chunks", "chundering", "tossing cookies", "a technicolor yawn", "making street pizza", "shouting groceries", and "boking".

" Wallace And Gromit " has recently become Cockney Rhyming Slang for vomit. {Link without Title}

"Puke" and "puking" date from at least the 16th century.Concise Oxford Dictionary In ''As You Like It'', Shakespeare talks of the infant 'Mewling and puking in the nurse's arms'.


Vomit Phobia

Vomit phobia, or Emetophobia , as it is also known, is the sixth most common phobia in the world, according to the International Emetophobia Society. In addition to the actual phobia, there are many other disorders and phobias that sufferers may suffer from, such as IBS and agoraphobia. People with emetophobia tend to avoid eating in public, socialising and going to parties. They may hardly eat at all, and for this reason may be diagnosed as anorexic. Emetophobes will go to extraordinary lengths to avoid vomiting or seeing someone vomit. Some emetophobics have the distinct ability to actually prevent themselves from vomiting, called "vomit continence". They are able to fight the feeling of nausea before the feeling eventually subsides.


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