Vomiting is an involuntary reflex eruption of the contents of the stomach, less often the intestines through the esophagus, pharynx, oral cavity or nasal passages. Physiologically, the gag reflex performs a protective function, ensuring the removal of toxic substances and metabolites from the body. It is observed in case of poisoning, intestinal infections, diseases of the gastrointestinal tract, cerebral pathology, acute and terminal conditions, endogenous intoxications, etc. It is diagnosed using endoscopy, ultrasound, radiography, CT, MRI of various organs and systems, electrophysiological studies, laboratory tests. To alleviate the patient's condition, sedatives and antiemetics are used.
At the time of vomiting, the patient experiences an uncontrolled contraction of the abdominal muscles and diaphragm, leading to a sharp release of gastric, and in some cases, intestinal contents. The secreted masses may contain remnants of undigested food, mucous, bloody and bile inclusions, and other pathological impurities. Often an attack is preceded by nausea, profuse salivation, weakness, sweating. Perhaps dizziness, unsteadiness of gait, palpitations. After an episode of vomiting, a sour, bitter, putrid taste or smell remains in the mouth and sometimes in the nasal passages.
From the outside, the patient looks confused, pale, sweat drops are often visible on the forehead. The appearance of vomiting should always be regarded as a threatening condition in which a medical examination is necessary. If after the discharge of the vomit the patient's condition has improved, a visit to the therapist or family doctor may be planned. If indomitable vomiting occurs, blood, bile, mucus and feces are detected in it, a symptom is combined with hyperthermia, intense pain of any localization, diarrhea, stupor, disorientation and convulsions, it is necessary to call an ambulance.
Vomiting is the result of a complex reflex response in which the uncontrolled contraction and relaxation of various muscle groups results in the release of gastric chyme. The reflex is activated by impacts on different links of the neural circuit. Neuroreceptors that stimulate the vomiting center are located in the pharynx, stomach, intestines, bile ducts, peritoneum, coronary and mesenteric vessels, and a number of other organs. Their activation is caused by irritation of the mucous membranes with bacteria toxins, the release of bioactive substances, pressure, vasospasm, and other visceral effects.
Impulses from peripheral receptors arrive through the vagal and sympathetic fibers to the vomiting center of the medulla oblongata. Neurons of the reticular formation can also be activated by the direct influence of toxic substances on the chemosensitive zone of the bottom of the fourth cerebral ventricle, an increase in intracranial pressure. Less commonly, the gag reflex is triggered by impulses from the vestibular apparatus, the impact of mental stimuli, or intense pain of any origin.
The motor part of the reflex arc is represented by the V, IX, X pairs of cranial nerves that innervate the soft palate, larynx, pharynx, esophagus, stomach and diaphragm, spinal nerves that provide contraction of the striated intercostal muscles and the muscles of the anterior abdominal wall. Since the vomiting center is located next to the cough, vasomotor, respiratory and other autonomic centers, their simultaneous activation causes hypersalivation, a drop in blood pressure, blanching and other parasympathetic reactions.
When efferent impulses are received against the background of a deep breath, the diaphragm descends, the epiglottis closes the entrance to the respiratory tract, the larynx and palate rise, preventing the chyme from being thrown into the trachea, bronchi and lungs. The tension of the diaphragmatic and abdominal muscles against the background of compression of the pylorus and relaxation of the cardia provides an increase in intra-abdominal and intra-gastric pressure, which ends with an attack of vomiting. In some conditions, antiperistaltic movements of the intestinal wall occur, due to which the contents of the intestine enter the stomach, and then into the vomit.
When systematizing the clinical variants of a symptom, its connection with gastrointestinal diseases, the frequency of manifestation, the mechanism of development, and the characteristics of vomit are taken into account. Vomiting associated with diseases of the digestive tract is called primary, which arose against the background of other pathological conditions - secondary. Depending on the leading development mechanism, there are:
A symptom can appear once (usually against the background of food errors, poisoning, intestinal infections), repeatedly (several times within a short time up to indomitable vomiting in severe intoxications and cerebral disorders), periodically (in diseases of the gastrointestinal tract, other chronic pathology). From a diagnostic point of view, it is important to consider the nature of the vomit. According to the features of impurities, there are variants of vomiting of undigested food, blood (scarlet and coffee grounds), bile, foamy mucus, intestinal contents.
Vomit with an admixture of bile has a greenish color, after vomiting a bitter taste is felt in the mouth, a yellow-green coating remains on the tongue. Vomiting of bile can be a sign of the following pathological conditions:
Nausea and vomiting may occur at various times after eating. In the vomit, the remnants of what was eaten are clearly visible. The most common causes of food vomiting are:
Vomiting masses such as "coffee grounds" or with an admixture of fresh blood always indicate bleeding from the gastrointestinal tract. Vomiting blood occurs in the following diseases of the digestive tract:
Nausea and vomiting in pregnant women can occur both due to the gestation itself and changes occurring in the body, and in the case of the development of various pathologies. Possible reasons:
Vomiting of intestinal contents is always a sign of a surgical pathology that requires an urgent response. Fecal vomiting can occur in the following conditions:
The development of vomiting is most often due to diseases of the gastrointestinal tract, so a gastroenterologist is involved in a comprehensive examination. Diagnostic search involves the study of the structural and functional features of the digestive system, the exclusion of concomitant pathologies. The most informative for establishing the causes of vomiting:
In case of damage to the hepatobiliary system, duodenal sounding with microscopic examination of bile, targeted ultrasound of the liver and gallbladder is recommended. If vomiting is caused by an infectious process, serological tests are performed to determine the type of pathogen and the amount of specific antibodies. A gynecologist is required to examine pregnant women. After all organic causes have been ruled out, autonomic examination may be required.
With profuse vomiting, oral or parenteral rehydration is performed
You can reduce discomfort and the number of vomiting with the help of diet therapy: patients are advised to give up fatty foods, a large number of pastries, smoked meats. To reduce the load on the gastrointestinal tract, food should be taken 5-6 times a day, in small portions. It is permissible to use herbal remedies (green tea, decoctions of chamomile and mint), enterosorbents. Repeated vomiting, combined with abdominal pain or other symptoms, is an indication for visiting a doctor who will determine its cause and select the optimal treatment regimen.
After verifying the cause of vomiting, patients are prescribed complex treatment using medications, physiotherapy and diet therapy. Medical tactics involves the use of therapeutic nutrition, the list of permitted products depends on the disease. In case of pathologies of the pancreas, fasting for several days is sometimes advised to create a functional rest of the organ. For the treatment of patients with complaints of vomiting, the following groups of drugs are indicated:
Repeated vomiting of bile or intestinal contents can serve as a symptom of acute surgical diseases of the gastrointestinal tract, which requires emergency surgical intervention. The type of operation depends on the specific disease: debridement and drainage of the abdominal cavity, resection of a section of the intestine, elimination of intestinal obstruction, cholecystectomy can be performed. Pyloroplasty is recommended for decompensated pyloric stenosis. In oncopathology, the surgical method is combined with radiation therapy and chemotherapy.