5-Minute Emergency Consult
Vomiting, Adult
Vomiting, Adult is a topic covered in the 5-Minute Emergency Consult.
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Basics
Description
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
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
-- To view the remaining sections of this topic, please log in or purchase a subscription --
Basics
Description
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
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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Citation
Schaider, Jeffrey J., et al., editors. "Vomiting, Adult." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307629/all/Vomiting_Adult.
Vomiting, Adult. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307629/all/Vomiting_Adult. Accessed March 28, 2023.
Vomiting, Adult. (2016). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (5th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307629/all/Vomiting_Adult
Vomiting, Adult [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2023 March 28]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307629/all/Vomiting_Adult.
* Article titles in AMA citation format should be in sentence-case
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ED - Wolfe,Richard E,
BT - 5-Minute Emergency Consult
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PB - Lippincott Williams & Wilkins
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