Vomiting

Published on 23/05/2015 by admin

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Last modified 23/05/2015

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Vomiting

Vomiting is the forceful ejection of gastric contents through the mouth. It occurs when the vomiting centre in the medulla oblongata is stimulated. This may be due to direct stimulation of the centre (central vomiting) or via afferent fibres (reflex vomiting). Haematemesis (vomiting blood) is dealt with in a separate chapter on p. 195.

Causes

Central Vomiting

• Drugs, e.g. narcotic analgesics, chemotherapeutic agents

• Acute infections, especially in children

• Endocrine/metabolic

• Diabetic ketoacidosis

• Hypercalcaemia

• Addison’s disease

Reflex Vomiting

Gastrointestinal disease

Inflammation/irritation

• Appendicitis

• Cholecystitis

• Pancreatitis

• Peptic ulceration/acute gastritis (Fig. 66)

• Peritonitis

• Biliary colic

• Ureteric colic

• Gastroenteritis

• Bacteria, e.g. Campylobacter, Salmonella spp

• Drugs, e.g. aspirin, NSAIDs, alcohol, iron, antibiotics

• Emetics, e.g. sodium chloride, ipecacuanha

• Poisons, e.g. arsenic

Figure 66 Peptic ulcer.
There is a benign gastric ulcer on the lesser curvature of the stomach, seen at gastroscopy.

Obstruction

• Small bowel obstruction

• Pyloric stenosis

• Large bowel obstruction

CNS causes

• Raised intracranial pressure

• Labyrinthine disorders

• Head injury

• Motion sickness

• Ménière’s disease

Psychogenic

• Offensive sights and smells

• Psychiatric disorders, e.g. hysterical, bulimia nervosa, anorexia nervosa

Others

• Myocardial infarction

• Severe pain, e.g. testicular torsion, fractures

• Irradiation

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