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vomiting

vomiting / emesis

see also:

introduction

  • vomiting is a highly non-specific symptom
    • vomiting with significant abdominal pain suggests an abdominal cause rather than a vestibular or neurologic cause
    • vomiting without diarrhea should not be dismissed as just gastroenteritis
    • vomiting with the sensation of the room spinning suggests a vestibular cause
  • the main issues for the ED doctor are:
    • deciding upon the main type of condition causing the vomiting as this will dictate Rx
    • control of the vomiting for symptom relief
    • Dx and Rx of underlying condition causing the vomiting
    • Mx of any complications

4 important inputs into the vomiting centre

chemoreceptor trigger zone (CTZ)

vestibular system

  • via cranial nerve VIII
  • rich in muscarinic M1 and histamine H1 receptors
  • this is why vertigo is often association with nausea and vomiting

GIT afferent nerves

  • mainly vagal and spinal afferents which are rich in 5-HT3 receptors
  • intestinal irritation results in release of mucosal serotonin which activates these receptors and stimulate vagal input into both the vomiting centre and the CTZ

CNS inputs

  • central neural inputs have a role in vomiting due to stress, anxiety, anticipatory vomiting and psychiatric conditions

aetiology

primary abdominal conditions

vertigo / cerebellar / vestibular causes

other causes

complications of vomiting

vomiting.txt · Last modified: 2021/01/21 13:42 by gary1