The document discusses the physiological aspects of vomiting (emesis) and its various manifestations, causes, and consequences, including complications such as aspiration pneumonia and metabolic acidosis. It describes mechanisms involved in inducing vomiting, including the roles of mechanoreceptors and chemoreceptors, the central emesis pathways in the brain, and contraindications for emetic use. It also touches on related conditions like Mallory-Weiss syndrome, esophageal varices, and portal hypertension, emphasizing the clinical significance in panchakarma treatments.

1. APPLIED PHYSIOLOGY RELATED
TO VAMANA KARMA(EMESIS)
Presented by
Dr DINESH S
2ND
YEAR PG SCHOLAR
DEPT OF PANCHAKARMA
Guided by
Dr ASHVINI KUMAR M
PROFESSOR AND HOD
DEPT OF PANCHAKARMA

2. Vomiting is the forceful expulsion of contents of the stomach and often, the
proximal small intestine.(duodenum)
It is a manifestation of a large number of conditions, many of which are not
primary disorders of the gastrointestinal tract.
 Regardless of cause, vomiting can have serious consequences, including acid-
base derangments, volume and electrolyte depletion, malnutrition and aspiration
pneumonia.
INTRODUCTION

3. NAUSEA
Nausea is an unpleasant and difficult to describe psychic
experience in humans and probably animals.
Physiologically, nausea is typically associated with decreased
gastric motility and increased tone in the small intestine.
Additionally, there is often reverse peristalsis in the proximal small
intestine.

4. RETCHING
• Retching (“dry heaves”) refers to spasmodic respiratory movements conducted with a
closed glottis.
• While this is occurring, the antrum of the stomach contracts and the fundus and
cardia relax.
•Studies with cats have shown that during retching there is repeated herniation of the
abdominal esophagus and cardia into the thoracic cavity due to the negative pressure
engendered by inspiratory efforts with a closed glottis.

5. EMESIS
Emesis or vomition is when gastric and often small intestinal contents are propelled up to and out of
the mouth.
A deep breath is taken, the glottis is closed and the larynx is raised to open the upper esophageal
sphincter. Also, the soft palate is elevated to close off the posterior nares.
The diaphragm is contracted sharply downward to create negative pressure in the thorax, which
facilitates opening of the esophagus and distal esophageal sphincter.
Simultaneously with downward movement of the diaphragm, the muscles of the abdominal walls
are vigorously contracted, squeezing the stomach and thus elevating intragastric pressure.
• With the pylorus closed and the esophagus relatively open, the route of exit is clear.

6. MECHANO AND CHEMO RECEPTOR
Mechanoreceptors are tension receptors that initiate emesisin response to
distension and contraction e.g. From bowel obstruction.
Detecting mechanical stimuli like distension, pressure changes, or stretching
within the stomach and intestines, sending signals to the brain via the vagus
nerve, which ultimately leads to the initiation of vomiting when stimulated
significantly.
Chemoreceptors respond to a variety of toxins in the intestinal
luminadetecting toxins and harmful substances in the bloodstream and sending
signals to the vomiting center, ultimately triggering the vomiting reflex to expel
these substances from the body;

7. Controls the act of vomiting.
Not a discrete anatomical site, but represents inter-related neuronal networks.
Inputs include: vagal sensory pathways from the gastro-intestinal tract and
neuronal pathways from the labyrinths, higher centres of the cortex, intracranial
pressure receptors and the chemoreceptor trigger zone.
When activated induces: vomiting via stimulation of the salivary and respiratory
centres and the pharyngeal, gastrointestinal and abdominal muscles.
Final common pathway for efferent responses that produce emesis
VOMITING CENTRE

8. CHEMORECEPTOR TRIGGER ZONE
CTZ is located in the area postrema (AP) of the medulla oblongata
Present in the area prostrema of the 4th
ventricle of the brain acts as the entry
point for emetic stimuli
CTZ is outside the blood-brain barrier ➖therefore responds to stimuli from
either the cerebral spinal fluid (CSF) or the blood.
Impulses from CTZ pass to area of brainstem called vomiting centre that
control and integrate the visceral and somatic functions involved in vomiting

9. CTZ

10. MECHANISM

11. EMETICS
Emetics are two types
1.Reflex emetics(gastric emetics)
2.Central emetics.
►Gastric emetics stimulates the gastric musoca, from there it stimulates vagus
/sympathetic n. Stimulation, from there it stimulates vomiting center in the brain. Ex.
Znso4, Alum, Bicorbonate, mustard.
►Central emetics stimulates Medulla of the brain (near resp. Center), from there it
stimulates vomiting center in the brain, contraction of amashaya, annanalika,
abd.muscles, peristalsis, vomiting Ex: Ipecac, Apomorphine, digitalis

12. RECEPTOR MECHANISM

13. CONTRAINDICATIONS OF EMETICS
All emetics contraindicated in;
• Corrosive (alkali, acid) poisoning: there is risk of perforation and further injury to
esophageal
• CNS stimulant drug poisoning: bse they may precipitate convulsion
• Kerosine (petroleum) poisoning: risk of aspiration of liquids due low viscosity and
chemical pneumonia
• Unconscious patient: may aspirate vomitis bse of lanyngeal reflex is impaired
• Morphine or phenothiazone poisoning b’se of emetic may fail to act

14. COMPLICATIONS OF EXCESSIVE VOMITING
Aspiration of the vomitus into the air passage and lungs.Aspiration leads to
choking, asphyxiation and aspiration pneumonia.
• It can be life threatening and may lead to respiratory failure if not detected
and treated early
• Hypochloremic metabolic acidosis
• Damage to gums and teeth – bulimia nervosa
• Tear of the esophageal mucosa- mallory-weiss tear.

15. ASPIRATIONAL PNEUMONIA
Aspiration pneumonia is a bacterial infection in your lungs. It can happen when you
aspirate, or inhale, something other than air into your respiratory tract. This can be food,
liquid, saliva, stomach acid, vomit or even a small foreign object.
Many people with aspiration pneumonia don’t realize this has happened — called silent
aspiration. The infection can develop days or even weeks after aspirating.
Fever
Shortness of breath (dyspnoea) or wheezing
Coughing up blood or pus
Chest pain
Bad breath
Extreme tiredness

17. RISK FACTORS
Have had general anesthesia or dental procedures recently
Have trouble coughing or swallowing (dysphagia), which can happen after
stroke or brain injury, or if you have a nervous system disorder like
Parkinson’s disease or multiple sclerosis
Are impaired by alcoholic beverages or drugs
Are older than 65 or younger than 5

18. METABOLIC ACIDOSIS
Metabolic acidosis is a condition in which acids build up in your body. Causes include untreated
diabetes, the loss of bicarbonate in your body and kidney conditions.
Symptoms include an accelerated heartbeat, confusion and fatigue.
Blood and urine tests can help diagnose it.
Treatment may include sodium bicarbonate, IV fluids and insulin.
SYMPTOMS
-Tachycardia - Headache
-Fatigue - Nausea and vomiting.
-Loss of appetite.

19. MALLORY WEISS SYNDROME
In Mallory Weiss syndrome, the inner lining of your esophagus splits open and bleeds.
These splits, called Mallory Weiss tears, occur at or near where your esophagus meets
your stomach.
A Mallory Weiss tear usually looks like a crack that runs up and down your esophagus,
like a split hose. On average, tears are between 0.75 and 1.5 inches long, or the width of
one to two nickels. Some tears may extend into your upper stomach.
Severe vomiting or retching.
Heavy lifting or straining.
Prolonged coughing.
Trauma to the abdomen or chest
The most common symptom of a Mallory Weiss tear is vomiting blood, which occurs in
about 85% of cases. The blood can appear bright red or dark brown, like coffee grounds.

21. ESOPHAGEAL VARICES
Esophageal varices are enlarged veins in the esophagus, the tube that connects the throat and
stomach. Esophageal varices most often happen in people with serious liver diseases.
Esophageal varices develop when regular blood flow to the liver is blocked by a clot or scar tissue in
the liver. To go around the blockages, blood flows into smaller blood vessels that aren’t designed to
carry large volumes of blood. The vessels can leak blood or even burst, causing life-threatening
bleeding.
Vomiting large amounts of blood.
Black, tarry or bloody stools.
Lightheadedness due to blood loss.
Loss of consciousness in severe cases.

23. PORTAL HYPERTENSION
Portal hypertension is elevated blood pressure in your portal vein and the smaller
veins that branch off from it — your portal venous system. The portal venous system drains
blood from your stomach, intestines, pancreas and spleen into your liver through the portal
vein
When something blocks or slows the blood flow through your portal vein, it causes increased
pressure throughout your portal venous system
Symptoms
Blood in vomit.
Bloody stool
Bloated stomach with rapid weight gain (from fluid).
Swelling in your legs and feet (edema).
•Mental confusion or disorientation

25. RISK FACTORS

26. HIATUS HERNIA
A hiatal hernia happens when the upper part of the stomach bulges through the
large muscle that separates the abdomen and the chest.
The muscle is called the diaphragm.The diaphragm has a small opening called
a hiatus.
The tube used for swallowing food, called the esophagus, passes through the
hiatus before connecting to the stomach.
 In a hiatal hernia, the stomach pushes up through that opening and into the
chest.

27. TYPES
Type I
Also known as a sliding hiatal hernia, this is the most common type
Type II
Also known as a paraesophageal or rolling hiatal hernia, part of the
stomach pushes through the diaphragm and stays there.
Type III
A combination of a sliding and paraesophageal hernia.
Type IV
The stomach and another organ, like the colon or spleen, push into the
chest. This is the rarest type of hiatal hernia.

29. DISCUSSION
There is also considerable variability among species in the propensity for vomition.
Rats reportedly do not vomit.
Cattle and horses vomit rarely – this is usually an ominous sign and most frequently
a result of acute gastric distension.
Carnivores such as dogs and cats vomit frequently, often in response to such trivial
stimuli as finding themselves on a clean carpet.
Humans fall between these extremes, and interestingly, rare individuals have
been identified that seem to be incapable of vomiting due to congenital
abnormalities in the vomition centers of the brainstem

30. IMPORTANCE IN PANCHAKARMA
In case of Vamana this is the site of reverse peristalsis, the aushadha
pramana and teekshnata must be priorly and properly decided in order to
prevent any harm to the inner lining (mucosa) of the Oesophagus.

31. THANK YOU