Vomiting, vomiting, vomitation, regurgitation, bile vomit colloquial synonyms: vomiting, spitting, herons Retrograde emptying of the gastrointestinal contents through the mouth due to involuntary contraction of the diaphragm and abdominal muscles. Vomiting has had an important place in history as therapeutic, i.e. intentionally induced, vomiting. Many eminent doctors, including Hippocrates, considered it to be an extremely effective remedy, as they believed it served to purify the body.
Vomiting always occurs when the vomiting center (area postrema) is irritated sufficiently. The postrema area is located in the medulla oblongata, the rearmost part of the brain. Mechanical or chemical influences (noxious agents, toxins/drugs) and mucous membrane damage caused by alcohol poisoning lead to activation of stretch and chemoreceptors in the gastrointestinal mucosa, which send their information via the vagus nerve to the vomiting center.
If drugs and toxins are taken, the vomiting center can detect them in the blood because there is no blood-brain barrier in the vomiting center. In the case of kinetosis, the unusual stimulus constellation of different sensors leads to excitation of the vestibular organ. This excitation is first sent to the thalamus, then to the hypothalamus, both parts of the diencephalon. From here, the excitation returns to the center of vomiting.
Most symptoms are caused by the loss of fluid and minerals during vomiting. You can find more information about this here: Dehydration
- Blood pressure drop
- Increased salivation to protect the mouth and esophagus from gastric acid
- Deep Breathing
- Closure of the glottis and the nasopharynx
- Transport movement of the food rice in the opposite direction from the small intestine back to the stomach: the intestinal contents can thus also be vomited. It also dilutes and buffers the acidic stomach contents through the basic secretion of the pancreas contained in the intestinal contents.
- Slackening of the stomach muscles and the ring muscles of the esophagus
- Contraction of the arbitrarily controlled muscles of the esophagus: The stomach is pulled up so that the angle between the stomach and the esophagus is less narrow.
- Sudden contraction of the abdominal muscles and diaphragm
- Pressure in the abdominal cavity is increased
- Stomach contents are pressed upwards
- Retrograde emptying
The diagnosis of vomiting is based on a precise questioning (anamnesis) of the patient.
The appearance of the vomit, the time of vomiting, the accompanying symptoms, previous illnesses and medication are particularly important. In the case of bloody vomit, a distinction must be made between light red and dark red blood, whereby light red is a sign of fresh bleeding, for example, bleeding from varicose veins in the esophagus (esophageal varices). Dark red blood (“coffee grounds-like” appearance), on the other hand, has already had contact with gastric acid, which leads to “coffee grounds-like” appearance and can occur in the case of a gastric ulcer (ulcus ventriculi) or a form of inflammation of the stomach (hemorrhagic gastritis).
If the vomit looks yellow-greenish, bile has been vomited; if it is clear-white, gastric juice has been vomited. If it is brown, it indicates vomiting (misery), which is a sign of intestinal obstruction (ileus). The smell of the vomit may also help in the diagnosis.
An acidic odor indicates involvement of gastric juice, a foul odor indicates spoiled food. The odour of acetone suggests the breakdown of fats, as occurs in sober people or diabetics. Vomiting in the morning indicates pregnancy, increased intracranial pressure or excessive alcohol consumption as a cause.
If vomiting occurs without prior nausea, this indicates a cause concerning the central nervous system. If vomiting occurs in a torrent, this is a sign of a passage obstruction in the stomach outlet (gastric outlet stenosis). The accompanying symptoms also point to certain causes.
Dizziness is a sign of a cause in the vestibular system, fever for an infectious cause, diarrhea for a disease of the entire gastrointestinal system, headache for migraine and eye pain for an acute attack of glaucoma.Radiating pain in the area of the thorax and abdomen can be a sign of a heart attack (myocardial infarction), belt-shaped pain indicates an inflammation of the pancreas (pancreatitis). Nausea and vomiting can occur as a side effect of certain drugs such as cytostatics, antibiotics or oral contraceptives. A physical examination is also carried out.
The abdomen is palpated and listened to, and the heart and lungs are also listened to. In addition, rough neurological examinations are carried out and the back of the eye is examined. Further examinations such as ultrasound in case of suspected gallstones, gastroscopy in case of suspected gastric ulcer or ECG in case of suspected heart attack are performed depending on the suspected diagnosis.