Vomiting, Adult

Basics

Description

  • An involuntary, integrated movement of pharyngeal and thoracoabdominal smooth and voluntary muscles to expel stomach content
  • 3 phases:
    • Nausea: Unpleasant sensation prior to vomiting
    • Retching: Rhythmic contractions of diaphragm, abdominal muscles, and intercostals that bring gastric contents up the esophagus
    • Vomiting: Forceful retrograde expulsion of gastric contents through the mouth
  • Vomiting center in medulla coordinates vomiting through vagus, phrenic, spinal nerves
  • Irritated by impulses from the GI tract, pharynx, vestibular system, heart, genitalia, or via stimulation of chemoreceptor trigger zone (CTZ) in the area postrema of the brain by medications, toxins, or hormones in circulation
  • CTZ response mediated by dopamine D2, serotonin (5-HT3), cholinergic, and histamine receptors:
    • Medications that provide symptomatic treatment of vomiting antagonize these receptors

Etiology

  • GI:
    • Appendicitis
    • Boerhaave syndrome
    • Bowel obstruction or ischemia
    • Cholecystitis/biliary colic
    • Gastric outlet obstruction, gastroparesis
    • Gastritis
    • Gastroenteritis (viral/bacterial/parasitic)
    • GI bleeding
    • Hepatitis
    • Inflammatory bowel disease
    • Pancreatitis
    • Peptic ulcer disease/dyspepsia
    • Perforated viscus
    • Peritonitis
  • Neurologic:
    • Elevated intracranial pressure (ICP)
    • Intracranial blood
    • Labyrinthitis/vertigo
    • Meningitis
    • Migraine
    • Stroke
    • Tumor
  • Endocrine:
    • Adrenal insufficiency
    • Diabetic ketoacidosis (DKA)
    • Hypoparathyroid, hyperparathyroid
    • Hypothyroid, hyperthyroid
    • Uremia
  • Pregnancy:
    • Hyperemesis gravidarum
    • Nausea/vomiting of pregnancy
  • Drug toxicity:
    • Acetaminophen
    • Aspirin
    • Digoxin
    • Theophylline
  • Therapeutic medication use:
    • Antibiotics
    • Aspirin
    • Chemotherapy
    • Ibuprofen
  • Drugs of abuse:
    • Opioid/opioid withdrawal
    • Alcohols
    • Cannabinoid hyperemesis
  • Genitourinary:
    • Gonadal torsion
    • Nephrolithiasis
    • UTI/pyelonephritis
  • Miscellaneous:
    • Acute coronary syndrome
    • Carbon monoxide or organophosphate poisoning
    • Electrolyte disorders
    • Glaucoma
    • Motion sickness
    • Pain
    • Postprocedural (after anesthesia)
    • Psychiatric (eating disorders)
    • Sepsis/shock

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