2. Nausea refers to an unpleasant sensation that is often localized to the
abdomen and typically interpreted as an urge to vomit.
Vomiting is the forceful oral expulsion of gastric contents
Retching is a strong involuntary unproductive effort to vomit. It is
associated with contraction of abdominal muscles but without expulsion of
stomach contents through the mouth.
Regurgitation is the act by which food is brought back into the mouth
without the abdominal and diaphragmatic muscular activity that
characterizes vomiting
Rumination is Chewing and swallowing of regurgitated food that has come
back into the mouth through a voluntary increase in abdominal pressure
within minutes of eating or during eating
Definitions
3.
4. Mechanism of vomiting
Synchronous contraction of the diaphragm, intercostal muscles and
abdominal muscles raises intra-abdominal pressure. This is combined
with relaxation of the lower esophageal sphincter and causes forcible
ejection of contents of the stomach.
7. Life threatening causes of vomiting
1. Acute Coronary Syndrome
2. Acute Pancreatitis
3. Mechanical Bowel Obstruction
4. DKA
5. Meningitis
6. Hyperemesis gravidarum
7. Poisoning
8. Adrenal Crisis
9. Drug Overdose
Other Causes
1. Postoperative nausea and vomiting (PONV)
2. Chemotherapy-induced nausea and vomiting (CINV)
3. Uncomplicated first-trimester nausea and vomiting
4. Infectious gastroenteritis
5. Migraine
8. Red flags for nausea and vomiting
Abdominal
• Persistent vomiting
• Hematemesis
• Feculent vomiting
• Melena
• Hematochezia
• Acute and/or severe abdominal pain
• Progressive dysphagia
• Unintentional weight loss
Neurologic
• Altered mental status
• Focal neurological deficit
• Meningeal signs
Pulmonary/cardiovascular
• Dyspnea
• Chest tightness
• Feeling of impending doom
9.
10.
11. a sudden and severe rise in the esophageal intraluminal pressure results in
tearing of the esophageal mucous membrane, as well as the submucosal arteries
and veins
12. causes
• Severe vomiting
• Blunt abdominal trauma
• Strained defecation
Predisposing conditions
• Alcoholism
• Bulimia nervosa
• GERD
• Hiatal hernia
Clinical features
• May be asymptomatic
• Hematemesis
• Epigastric or back pain
• Possible shock
