Vomiting Bile : Causes, Symptoms, Diagnosis & Treatment

• Causes Of Vomiting Of Bile
• Cholelithiasis
• Duodeno-Gastric Reflux
• Diseases Of The Pancreas
• Acute Surgical Pathology
• Acute Intoxications
• Pregnancy
• Worm Infestations
• Survey
• Symptomatic Therapy

Vomiting of bile is a reflex act of secreting the contents of the duodenum and stomach with inclusions of bile acids, due to spontaneous contraction of the smooth muscles of the stomach, abdominal muscles and diaphragm. Often combined with other dyspeptic disorders, indicates diseases of the gastrointestinal tract and hepatobiliary system. Sometimes vomiting with an admixture of bile occurs with surgical pathology, acute poisoning, pregnancy. X-ray, endoscopic, ultrasound and laboratory methods are used to identify the causes. To stop the symptom, herbal remedies, prokinetics, choleretics are used.

Causes of vomiting of bile

In most cases, the discharge of vomit containing bile components is caused by non-infectious and infectious diseases of the digestive tract, however, there are a number of situations in which the condition is noted once or occasionally against the background of nutritional errors. Violation of the normal digestion of products in the lumen of the duodenum with the occurrence of acute duodenostasis, reflux of chyme into the stomach and further vomiting of bile contents is possible when overeating fatty foods, especially in combination with alcohol.

Cholelithiasis

With lesions of the hepatobiliary system, vomiting of bile is visceral in nature, develops due to overstretching of the walls of the gallbladder and bile ducts. Often vomiting occurs at the height of pain, accompanied by the release of a small amount of mucus and bile acids, does not alleviate the patient's condition. The symptom can be observed with dysregulation of the mechanisms of bile formation and bile secretion, which is due to organic disorders in the biliary tract. The main causes of vomiting of duodenal contents with bile in pathology associated with cholelithiasis:

• Cholangitis . In acute inflammation of the bile ducts, vomiting is associated with the phenomena of general intoxication of the body, does not bring relief to the patient. Dyspeptic disorders are secondary signs of the disease, the triad of symptoms comes to the fore: pain in the projection of the gallbladder, high fever, jaundice. In severe cases, there may be impaired consciousness, a drop in blood pressure.
• Choledocholithiasis . Vomiting due to obstruction of the bile duct by a calculus is usually reflex in nature and is due to viscero-visceral interactions of the autonomic nerves. The symptom manifests itself against the background of severe pain in the right hypochondrium, which occurs due to stretching of the gallbladder wall. Also, choledocholithiasis is characterized by yellowing of the skin and mucous membranes, discoloration of feces, the appearance of dark urine.
• Postcholecystectomy syndrome . After surgical removal of the gallbladder, pathological circulation of bile develops, which disrupts the processes of digestion and absorption of nutrients. Dyspeptic disorders (belching bitter, bloating, vomiting) are combined with intense pain, observed in 70% of patients. With an exacerbation of the process, fever, jaundice is observed.
• Biliary dyskinesia . Discoordination of the contraction of the sphincters of the hepatic and bile ducts leads to a change in the normal rhythm of the release of bile into the intestine, which is accompanied by the appearance of pain, dyspeptic symptoms - nausea, vomiting of bile, flatulence, loss of appetite. The hypermotor variant is characterized by the predominance of pain syndrome, with hypomotor dysfunction, dyspeptic manifestations prevail.

Duodeno-gastric reflux

The reflux of the contents digested in the duodenum develops with various organic and functional pathologies of the gastrointestinal tract. The release of vomit with bile is due to disturbances in the pyloroduodenal zone, which is manifested by periodic gaping of the pyloric sphincter, an increase in pressure in the upper part of the duodenum. When aggressive contents enter the stomach, an involuntary contraction of smooth muscles and abdominal muscles occurs, which causes vomiting. The appearance of bile in vomit is most often associated with the following diseases:

• hyperacid states . An increase in hydrochloric acid production leads to a pronounced decrease in pH and frequent opening of the pyloric sphincter, accompanied by regurgitation of bile into the stomach. The development of chronic gastritis or peptic ulcer worsens the patient's condition, provokes the appearance of nausea and repeated vomiting. There is a pronounced pain syndrome, which has a characteristic rhythm associated with food intake.
• Acute duodenitis . Dyspeptic disorders, along with intense night and morning pain in the epigastrium, always occur with inflammatory processes in the duodenum. Overflow and stretching of the upper intestines potentiates the relaxation of the pylorus and the reflux of contents into the stomach cavity. In the initial stages of duodenitis, the patient complains of bitter belching and heartburn, which are aggravated by vomiting with bile.
• Acute dilatation of the stomach . The stretching of the walls of the organ, due to an acute violation of innervation, leads to the lowering of the stomach down and squeezing the intestinal loops. As a result, a retrograde current of intestinal contents is formed, vomiting occurs with the presence of bile acids, which abundantly enter the enlarged stomach. The disease is characterized by the release of a large amount of vomit (up to 7-8 liters per day).
• Functional disorders of the stomach . The appearance of bile vomiting in such patients is associated with primary dysmotility of the upper gastrointestinal tract, discoordination of the work of smooth muscles and sphincters. The severity of the symptom increases after taking fatty foods that stimulate the secretion of bile. For functional dyspepsia, variability and inconstancy of complaints, a combination with psychasthenia, is typical.
• Stenosis of the duodenum . The presence of bile in the excreted vomit is characteristic of the narrowing of the descending intestine. In this case, a prolonged stagnation of partially digested chyme occurs, which causes overdistension of the intestine and retrograde duodenal-gastric current. In the later stages of the disease, vomit acquires a fetid odor due to prolonged fermentation and rotting of food.

Diseases of the pancreas

Dyspeptic symptoms in combination with severe pain are leading in the clinical picture of pancreatic lesions. Vomiting of bile often occurs in the chronic course of pancreatitis, due to relaxation of the muscles of the pyloric sphincter, an increase in the amount of bile acids in the intestinal lumen. Perhaps the manifestation of a symptom in violation of intestinal patency due to compression of pancreatic neoplasia with stagnation of the contents of the intestine, reverse peristalsis. The most common pancreatic causes of bile entering vomit are:

• Chronic pancreatitis . For inflammation of the pancreas, repeated debilitating vomiting is characteristic, first with gastric contents and food eaten, and then with bile and mucus. The symptom is noted against the background of intense girdle pain with irradiation to the region of the heart, left arm and shoulder blade. Various stool disorders are also observed: alternation of constipation with diarrhea, the appearance of fat and food debris in the feces.
• Tumors of the pancreas . Neoplasms of the head of the pancreas, with an increase in volume, compress the duodenum, leading to duodenostasis and high intestinal obstruction. Vomiting of bile can be noted in the initial stages of the disease, until complete obstruction of the sphincter of Oddi, then the vomit acquires a putrid odor and contains partially digested food.

Acute surgical pathology

The development of vomiting of bile is due to a reflex reaction of the autonomic ganglia and higher centers of the medulla oblongata to intense inflammation in the abdominal cavity. Such a symptom is often observed with appendicitis, peritonitis, acute cholecystitis, when, against the background of a forced restriction of food intake, repeated vomiting occurs with the release of duodenal contents. In acute intestinal obstruction and violation of the passage of feces, vomiting occurs as a reaction of the smooth muscle layer of the gastric wall to an increase in pressure in the intestine.

Acute intoxications

Vomiting in case of poisoning is caused by stimulation of the vomiting center by impulses from the autonomic nerves and irritation by toxic substances of the trigger zone in the medulla oblongata. Often, an admixture of bile in vomiting is observed with acute alcohol intoxication. This is due to the irritating effect of ethanol and its metabolites on the pancreas and liver, activation of proteolytic enzymes, and increased contractions of the gallbladder muscles. Vomiting on the background of alcohol poisoning is combined with reddening of the face, impaired consciousness, psychomotor agitation.

Pregnancy

Vomiting of bile during pregnancy is most often observed in the first trimester, due to toxicosis. The symptom usually occurs in the morning, on an empty stomach, so when vomiting occurs, the contents of the upper part of the duodenum are released. Repeated vomiting, which makes it difficult to eat, is considered a pathological condition. Bile in the outgoing vomit sometimes appears due to exacerbation of chronic diseases of the biliary tract, which in pregnant women is due to hormonal changes and increased stress on all body systems.

Worm infestations

The occurrence of vomiting with bile impurities is usually observed when infected with protozoa and intestinal parasites that multiply in the gallbladder and ducts - opisthorchiasis, giardiasis. Microorganisms have both a mechanical irritating effect on the digestive organs, leading to inflammatory processes in the biliary system, and a general sensitizing effect with the development of allergic reactions. In addition to bilious vomiting, the patient is usually worried about bitter or rotten belching, nausea, flatulence, pain in the navel and right hypochondrium.

Survey

When a patient complains of vomiting of bile, a complex of laboratory and instrumental methods is needed to assess the state of the gastrointestinal tract. An examination prescribed by a gastroenterologist is aimed at determining the pathological condition that caused the release of vomit stained with bile. The most valuable diagnostic methods are such methods as:

• Endoscopy . FGDS is used to visualize the esophagus, stomach, upper duodenum. The method effectively reveals inflammatory changes in organs, ulcerative-destructive processes and disorders of the muscle sphincters. Additionally, a biopsy of pathologically altered tissue sections is performed for their histological analysis.
• X-ray methods . Performing x-rays of the gastrointestinal tract with oral contrast is aimed at studying the structure of all parts of the digestive tract, detecting nonspecific signs of inflammatory processes and peptic ulcer. For a detailed study of the hepatobiliary system, percutaneous or retrograde cholangiopancreatography is performed.
• duodenal sounding . The study of the functional activity of the gallbladder with an assessment of the microscopic properties of bile is often decisive for making the correct diagnosis; it is performed in all patients with vomiting with bile acids. If an infectious etiology of the disease is suspected, bacteriological culture is recommended.
• Ultrasound . Panoramic ultrasound of the abdominal organs is used as a non-invasive express method that detects signs of pathology in a specific section of the gastrointestinal tract. In biliary diseases, an ultrasound of the gallbladder is performed to study its morphological features and detect possible stones in the lumen of the organ.
• Fecal analysis . The appearance of bilious vomiting is often accompanied by various changes in the coprogram. By studying the macroscopic and microscopic properties of feces, the quality of food digestion is assessed, signs of a probable pathology of the biliary system are detected. If the patient has a general infectious syndrome, a bacterial culture of feces is performed.

Laboratory methods are used to clarify the diagnosis: an analysis of the content of free and bound bilirubin in the blood, the determination of the concentration of amylase and lipase, and the search for specific antibodies are often prescribed. After excluding the organic causes of the symptom, with the possible functional nature of the disorder, studies of the autonomic nervous system and the mental state of the patient can be carried out.

Gallbladder ultrasound

Symptomatic therapy

It is possible to reduce discomfort and the secretion of bile with the contents of the stomach by correcting the diet. To reduce the frequency of vomiting, it is necessary to eat in small portions 5-6 times a day, to exclude from the diet fatty and smoked foods that stimulate increased bile secretion. To stop other dyspeptic disorders that accompany vomiting, it is recommended to use more mucous soups and cereals, which protect the walls of the stomach from the aggressive effects of bile.

In order to reduce unpleasant manifestations before establishing the causes of vomiting of bile, you can use various herbal preparations (from valerian, rose hips, mint), which eliminate nausea and vomiting. Of the medications, prokinetics are often used to improve gastrointestinal motility, antispasmodics, choleretics. You should refrain from taking strong antiemetic drugs without a doctor's prescription, as this can be dangerous to your health.