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Vomiting, Adult Reviewed 10/2010

Scott G. Weiner
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BASICS

  • Description
  • Etiology

DIAGNOSIS

  • Signs and Symptoms
  • Essential Workup
  • Tests

TREATMENT

  • Pre-hospital
  • Initial Stabilization
  • ED Treatment
  • Medication (Drugs)
  • In-patient Considerations

ONGOING CARE

  • Follow-Up Recommendations
The following is an excerpt....
BASICS
Description
  • 3 phases:
    • Nausea: Unpleasant sensation prior to vomiting
    • Retching: Rhythmic contractions of diaphragm, abdominal muscles, intercostals that bring gastric contents up the esophagus
  • Vomiting: Forceful retrograde expulsion of gastric contents through the mouth
  • Vomiting center in medulla coordinates vomiting through vagus, phrenic, spinal nerves
  • Irritated by impulses from the GI tract, pharynx, vestibular system, heart, genitalia, or via stimulation of chemoreceptor trigger zone (CTZ) in the area postrema of the brain by medications or toxins in circulation
  • CTZ response mediated by dopamine D2, serotonin (5-HT3), cholinergic, and histamine receptors:
  • Medications providing symptomatic treatment of vomiting antagonize these receptors
Etiology
  • GI:
    • Appendicitis
    • Boerhaave syndrome
    • Bowel obstruction or ischemia
    • Cholecystitis, biliary colic
    • Gastric outlet obstruction, gastroparesis
    • Gastritis, gastroenteritis ...

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FIG. 1.11. A 6-week-old infant with a 1-week history of vomiting. A supine radiograph demonstrates a dilated gastric air bubble with the "caterpillar sign" suggesting active peristalsis.Credit: From Fleisher GR, MD, Ludwig S, MD, Baskin MN, MD. Atlas of Pediatric Emergency Medicine. Philadelphia: Lippincott Williams & Wilkins, 2004.