Nausea and vomiting
Summary/Definition
Nausea and vomiting are common symptoms that can occur for various reasons. Prolonged nausea and vomiting lasting more than 4 weeks are usually considered as chronic symptoms, while acute nausea and vomiting usually last less than 7 days.
Nausea is an unpleasant sensation accompanied by vomiting and symptoms such as tightness in the chest, increased salivation, cold sweat, etc. Nausea may occur in combination with various gastrointestinal symptoms, such as vomiting and dyspepsia, or may occur separately. Vomiting is the process of contraction of the diaphragm and abdominal muscles with the displacement of food from the mouth or gastric juice from the upper gastrointestinal tract (esophagus, stomach, duodenum).
Nausea and vomiting can occur for various reasons, including infectious diseases, such as gastroenteritis, or taking certain medications, and sometimes they can manifest without an obvious reason. In most cases, they occur suddenly under the influence of internal factors, for example, infections of the gastrointestinal tract, damage to the musculoskeletal system or the use of medications, including anti-cancer drugs. Functional disorders of the digestive system accompanied by nausea and vomiting may include syndromes such as cyclic vomiting syndrome and chronic nausea and vomiting syndrome. These syndromes are characterized by the presence of symptoms for more than 6 months, with manifestation within the last 3 months.
The causes of nausea and vomiting can be divided into problems with the digestive system and problems with the non-digestive system. Problems with the digestive system that cause vomiting may include inflammation of the gastrointestinal tract, enlargement of the intestine, obstruction of the esophagus or stomach, etc. In the case of functional digestive disorders, nausea after eating may be the main complaint, although vomiting as a symptom rarely occurs. The causes of nausea and vomiting associated with the non-digestive system may include myocardial infarction, increased intracranial pressure, mental disorders, disorders in the labyrinth, the organ of the inner ear, as well as motion sickness. Medicinal and metabolic factors, such as the use of anti-cancer drugs, antibiotics and endocrine disorders, including diseases of the thyroid gland, parathyroid gland and adrenal glands, can also cause nausea and vomiting.
There are characteristic signs that help distinguish some causes of vomiting from others: for example, abdominal pain that disappears after vomiting may indicate possible intestinal obstruction, especially small intestine. In the case of pancreatitis or cholecystitis, the pain remains unchanged even after vomiting. Involuntary weight loss accompanied by vomiting may indicate the possibility of a malignant tumor or intestinal obstruction. An elevated temperature may indicate the presence of an infection. Headache, diplopia, trembling and narrowing of the visual field may indicate problems with the brain. Morning deterioration, accompanied by headaches, frequent nausea and vomiting, requires examination to exclude a brain tumor. Dizziness and tinnitus may indicate diseases of the inner ear.
< Table: Causes of nausea and vomiting >
| Causes of the digestive tract | Enterohepatitis (viral, bacterial), Inflammatory bowel disease Cholecystitis, pancreatitis, Appendicitis, Hepatitis, Obstruction (pyloric obstruction, small bowel obstruction, superior mesenteric artery syndrome), Sensorineural disorders (paresis of the stomach, pseudoobstruction), Gastro-esophageal reflux, Chronic idiopathic nausea, Functional vomiting, cyclic vomiting syndrome, Biliary colic, Irradiation of the abdominal area |
| Causes of non-digestive system | Cardiopulmonary diseases (cardiomyopathy, myocardial infarction), Diseases of the labyrinth apparatus (motion sickness, labyrinthitis, tumors), Intracranial diseases (tumor, cerebral hemorrhage, brain abscess, hydrocephalus), Endocrine/metabolic diseases (pregnancy, uremia, ketonemia, thyroid/parathyroid gland diseases, adrenal insufficiency), Medicines (anti-cancer drugs, antibiotics, drugs for the treatment of arrhythmia, cardiotonic drugs, oral hypoglycemic agents, oral contraceptives), Mental disorders (anorexia nervosa /bulimia, depression), Vomiting after surgery, Alcoholism |
Nausea and vomiting are reflex symptoms, and the vomiting reflex is regulated by the vomiting center in the brain. The upper parts of the digestive tract function due to the well-coordinated coordination of autonomic nerves, neurotransmitters and muscles of the gastrointestinal system. The interaction between the gastrointestinal tract and the central nervous system plays a crucial role in ensuring the proper functioning of these movements and digestive functions. When the nerves of the digestive tract are irritated for various reasons, signals are transmitted to the vomiting center through various nerve pathways, which can cause a feeling of nausea and vomiting.
Diagnostics
Since the causes of nausea and vomiting can be diverse, the diagnosis should be established on the basis of anamnesis, clinical examination and, possibly, the results of additional laboratory and instrumental methods. In most cases, to determine the cause, it is enough to analyze the anamnesis and conduct a clinical examination, so patients do not have to take blood tests, undergo radiological examinations or endoscopy. In cases of functional nausea and vomiting, the decision on the need for additional tests should be made based on the response to treatment after diagnosis.
Collecting anamnesis
When collecting an anamnesis, it is important to find out the following aspects: the moment of onset of symptoms, the relationship with diet, characteristics of vomiting (including color and consistency), the presence of abdominal pain, possible increase in body temperature, the presence of jaundice, involuntary weight loss, possible visual impairment, headache, impaired coordination of movements, dizziness, symptoms, typical for diabetes, as well as information about previous operations, kidney diseases, angina pectoris and current medication intake.
Medical examination
A medical examination allows you to assess the presence of signs of significant fluid loss by measuring the pulse and blood pressure in both horizontal and vertical positions of the patient’s body. During the examination, it is also necessary to estimate the time required to restore the elasticity of the skin after pressing it, which may indicate the degree of dehydration. Despite the fact that the problems are associated with the abdominal cavity, it is also important to examine the organs of the chest. If any abnormalities are detected during auscultation of the lungs, this may indicate a possible ingestion of vomit material into the lungs. When examining the abdomen, an assessment should be carried out for intestinal obstruction, bloating and soreness, as well as to identify the presence of abdominal or inguinal hernias. In some cases, it may be necessary to take off your underwear to check. If necessary, additional eye examinations are carried out in order to identify signs indicating possible pathologies of the brain.
Clinical examination
As a rule, clinical tests are carried out in the absence of a response to treatment or when it is difficult to determine the cause of nausea and vomiting.
1) Blood test
As the main tests, general blood tests, measurement of erythrocyte sedimentation rate, electrolyte tests, biochemical studies are carried out. If poisoning with medications is suspected, the level of the drug in the blood is checked. In some cases, an analysis for pancreatic enzymes or hormones (adrenal glands) may be performed.
2) Radiological examination
Radiological examination is carried out selectively on the basis of medical history and examination.
- Simple visualization of the abdominal cavity (X-ray examination of the abdominal cavity)
- Gastroscopy
- Ultrasound of the abdominal cavity or computed tomography (CT) of the abdominal cavity.
- Computed tomography (CT) or magnetic resonance imaging (MRI) of the head.
- Study of gastrointestinal motility
Treatment and course of the disease
Nausea and vomiting, in most cases, have a favorable prognosis, but in rare cases may indicate serious diseases. In most situations, their cause can be identified based on the analysis of anamnesis and the results of a medical examination, but in some cases additional examinations may be required. To identify possible organic causes of chronic nausea and vomiting, patients are recommended to undergo an extensive examination, including gastroscopy.
The main principle of treatment is the assessment and correction of dehydration and electrolyte imbalance. The principle is to find a medical or surgical cause and carry out appropriate treatment. However, if the assessment of the cause is delayed, then treatment is based on symptom relief. Patients suffering from severe dehydration and unable to drink liquid through the mouth even after nausea or vomiting may be offered hospitalization. As soon as the patient is able to take fluids through the mouth again, it is recommended to switch to a diet consisting of liquid food, easily swallowed, and low in fat, since fat takes a long time to digest in the stomach. It is also recommended to avoid foods that leave a large amount of indigestible residues, as they can linger in the stomach for a long time.
Treatment – Medical treatment
The main purpose of nausea and vomiting control is to correct complications associated with vomiting, for example, dehydration, electrolyte imbalance and metabolic disorders. To relieve symptoms, treatment involving the use of gastrointestinal motility stimulants and antiemetics can be applied. In addition, antacids and antispasmodics can be used. However, the essence of treatment is to identify and eliminate the underlying cause of nausea and vomiting. The medications used in the treatment may vary depending on the specific disease that caused the symptoms.
