Nausea & Vomiting

Nausea: Nausea is an intensely disagreeable sensation of sickness or queasiness, with a feeling of wanting to vomit’. It is often associated with autonomic effects including hyper salivation, pallor & sweating.

Vomiting: Expulsion of gastric contents through the mouth due to a forceful contraction of abdominal muscles and diaphragm.

Regurgitation: Appearance of previously swallowed food in the mouth without vomiting i.e an effortless reflux of liquid or food contents of stomach. It usually has an acid or bitter taste because of the presence of gastric juice or bile. This is due to contraction of the stomach muscles against closed pylorus.

The pathophysiology of vomiting is due to stimulation of medullary vomiting centre by four different sources of afferent input: i. afferent vagal fibres & splanchnic fibres from the gastrointestinal viscera, ii. fibres of the vestibular system, iii. higher central nervous system centres (viz. certain sights, smells, or emotional experiences may induce vomiting), iv. the chemoreceptor trigger zone, located outside the blood-brain barrier (which may be stimulated by drugs and chemotherapeutic agents, toxins, hypoxia, uremia, acidosis, and radiation therapy).

Causes of Nausea & Vomiting-

Infections:

Gastroenteritis,
Food poisoning,
Hepatitis A or B,
Acute systemic infections,
Urinary tract infections etc.

2. Gastrointestinal diseases:

Gastric outlet obstruction- peptic ulcer disease, malignancy
Small intestinal obstruction- adhesions, hernias, volvulus,
Crohn’s disease,
Carcinomatosis.
Gastroparesis- diabetic, medications, postviral, postvagotomy.

3. Acute abdominal conditions:

Peritonitis- due to perforation of gas containing hollow viscus,
Appendicitis,
Spontaneous bacterial peritonitis.
Cholecystitis,
Pancreatitis.

4. Hepatobiliary or pancreatic disorders:

Acute pancreatitis,
Cholecystitis or
Choledocho-lithiasis.

5. Drugs & irritants:

Alcohol
NSAIDs,
Oral antibiotics,
Opioids,
Anticonvulsants,
Antiparkinsonism drugs,
P-blockers,
Antiarrhythmics,
Digoxin,
Nicotine,
Oral contraceptives,
Oral anti-diabetics,
Cytotoxic drugs etc.

6. Cardiac diseases:

Acute myocardial infarction, congestive cardiac failure.

7. Urological disease: Stones, uremia.

8. CNS disorders:

Headache,
Migraine,
Vertigo,
Labyrinthitis,
Meniere’s syndrome,
Motion sickness,
Increased intracranial pressure due to CNS tumours,
Subdural or subarachnoid hemorrhage,
Meningitis,
Encephalitis,
Psychogenic causes.

9. Endocrine: Diabetic ketoacidosis, adrenocortical crisis, hypothyroidism, parathyroid disease.

10.Radiation therapy: Radiation therapy in malignancy.

11. Pregnancy: Specially in the 1st trimester.

Diagnostic points (Differential Diagnosis):

Pyloric stenosis- effortless projectile vomiting; frothy copious, recognizable old food with sour smell & no bile.
Peritonitis- small in amount & persistent vomiting.
Gastroenteritis- persistent vomiting with diarrhoea.
Peptic ulcer- ‘coffee ground’ coloured vomiting, after meal relieves pain. S. Oesophageal varices- copious amount fresh blood.
Nasopharynx, oropharynx- bright red blood.
Advanced intestinal obstruction- feculent vomit. Psychogenic- vomiting but no weight loss.
Acute appendicitis, acute cholecystitis, acute intestinal obstruction- sudden onset of vomiting; bile may be present.
Intracranial disease- vomiting without preceding nausea, headaches, stiff neck, vertigo, focal paresis or weakness.
Severe pain & vomiting suggest, peritoneal irritation, acute intestinal obstruction, pancreatobiliary disease.
Acute symptoms without or with mild abdominal pain caused by food poisoning, infectious gastroenteritis, drugs.
Vomiting immediately after meal suggests bulimia or .psychogenic causes.
Chronic vomiting- gastroparesis, psychogenic causes.

General Management:

Nothing should be given by mouth until the vomiting stops, when vomiting stops dry food in small amount to be given frequently.
Better to give cold food.
Simple acute vomiting due to morning sickness, dietary or alcoholic indiscretion may require little or no treatment.
Avoiding known aggravating factors and taking simple corrective dietary measures may sufficient.
If vomiting is severe and prolonged- attempt should be taken to determine the cause and specific medication.
Adequate hydration and correction of electrolyte imbalance by oral saline or 5-10% dextrose saline may be given intravenously.
Patient should get adequate rest and sleep.
Any complication (e.g. pulmonary aspiration of vomitus, malnutrition, hypokalemia, alkalosis) due to vomiting should be controlled immediately.

Homeopathic Medicine: According to ailments and patient’s individuality.