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Vomiting (also known as emesis and throwing up) is the involuntary, forceful expulsion of the contents of one's
stomach The stomach is a muscular, in the of humans and many other animals, including several s. The stomach has a dilated structure and functions as a vital organ. In the digestive system the stomach is involved in the second phase of digestion, ...

stomach
through the
mouth In animal anatomy Anatomy (Greek ''anatomē'', 'dissection') is the branch of biology concerned with the study of the structure of organism In biology, an organism (from Ancient Greek, Greek: ὀργανισμός, ''organismos'') is ...

mouth
and sometimes the
nose A nose is a protuberance in vertebrates that houses the nostrils, or nares, which receive and expel air for Respiration (physiology), respiration alongside the mouth. Behind the nose are the olfactory mucosa and the Paranasal sinus, sinuses. Be ...
. Projectile vomiting is an intense form of vomiting, sometimes seen in infants, that may include vomit exiting out the nostrils. Vomiting can be the result of ailments like food
poison In biology, poisons are Chemical substance, substances that can cause death, injury or harm to organs, Tissue (biology), tissues, Cell (biology), cells, and DNA usually by chemical reactions or other activity (chemistry), activity on the molecul ...

poison
ing,
gastroenteritis Gastroenteritis, also known as infectious diarrhea and gastro, is inflammation of the gastrointestinal tract The gastrointestinal tract, (GI tract, GIT, digestive tract, digestion tract, alimentary canal) is the tract from the mouth to the ...

gastroenteritis
, pregnancy, motion sickness, or hangover; or it can be an aftereffect of diseases such as
brain tumor A brain tumor occurs when abnormal cells form within the brain A brain is an organ Organ may refer to: Biology * Organ (anatomy) An organ is a group of Tissue (biology), tissues with similar functions. Plant life and animal life rely on ...
s, elevated
intracranial pressure Intracranial pressure (ICP) is the pressure exerted by fluids such as cerebrospinal fluid Cerebrospinal fluid (CSF) is a clear, colorless found within the that surrounds the and of all . CSF is produced by specialised in the of the ...
, or overexposure to
ionizing radiation Ionizing radiation (or ionising radiation), including nuclear radiation, consists of s or s that have sufficient to s or s by detaching s from them. The particles generally travel at a speed that is greater than 1% of , and the electromagnetic w ...
. The feeling that one is about to vomit is called
nausea Nausea is a diffuse sensation of unease and discomfort, often perceived as an urge to vomiting, vomit. While not painful, it can be a debilitating symptom if prolonged and has been described as placing discomfort on the chest, upper abdomen, or ...

nausea
; it often precedes, but does not always lead to vomiting. Impairment due to alcohol or anesthesia can cause inhalation of vomit, leading to suffocation. In severe cases, where
dehydration In physiology, dehydration is a lack of total body water In physiology Physiology (; ) is the scientific study of functions and mechanisms in a living system. As a sub-discipline of biology Biology is the natural science that studie ...

dehydration
develops,
intravenous Intravenous therapy (abbreviated as IV therapy) is a medical technique that delivers fluids, medications and nutrition directly into a person's vein. The intravenous route of administration is commonly used for rehydration or to provide nutrition ...
fluid may be required.
Antiemetic An antiemetic is a drug Uncoated tablets, consisting of about 90% acetylsalicylic acid, along with a minor amount of inert fillers and binders. Aspirin is a pharmaceutical drug A medication (also referred to as medicine, pharmaceutic ...
s are sometimes necessary to suppress nausea and vomiting. Self-induced vomiting can be a component of an eating disorder such as
bulimia Bulimia nervosa, also known as simply bulimia, is an eating disorder characterized by binge eating followed by purging. Binge eating refers to eating a large amount of food in a short amount of time. Purging refers to the attempts to get rid of ...
, and is itself now classified as an eating disorder on its own,
purging disorderPurging disorder is an eating disorder An eating disorder is a mental disorder defined by abnormal eating behaviors that negatively affect a person's health, physical or mental health, mental health. Only one eating disorder can be diagnosed at a g ...
. Vomiting is different from regurgitation, though the terms are often used interchangeably. Regurgitation is the return of undigested food back up the
esophagus The esophagus (American English American English (AmE, AE, AmEng, USEng, en-US), sometimes called United States English or U.S. English, is the set of varieties of the English language native to the United States. Currently, American E ...

esophagus
to the mouth, without the force and displeasure associated with vomiting. The causes of vomiting and regurgitation are generally different.


Complications


Aspiration

Vomiting is dangerous if gastric content enters the
respiratory tract The respiratory tract is the subdivision of the respiratory system The respiratory system (also respiratory apparatus, ventilatory system) is a biological system A biological system is a complex network which connects several biologically re ...

respiratory tract
. Under normal circumstances the
gag reflex The pharyngeal reflex or gag reflex is a reflex In biology Biology is the natural science that studies life and living organisms, including their anatomy, physical structure, Biochemistry, chemical processes, Molecular biology, molecular int ...
and
coughing A cough is a sudden expulsion of air through the large breathing passages that can help clear them of fluids, irritants, foreign particles and Microorganism, microbes. As a protective reflex, coughing can be repetitive with the cough reflex follow ...
prevent this from occurring; however, these protective reflexes are compromised in persons who are under the influence of certain substances (including
alcohol In chemistry, alcohol is an organic compound that carries at least one hydroxyl functional group (−OH) bound to a Saturated and unsaturated compounds, saturated carbon atom. The term alcohol originally referred to the primary alcohol ethan ...

alcohol
) or even mildly anesthetized. The individual may choke and
asphyxiate Asphyxia or asphyxiation is a condition of deficient supply of oxygen Oxygen is the chemical element with the chemical symbol, symbol O and atomic number 8. It is a member of the chalcogen Group (periodic table), group in the period ...
or suffer
aspiration pneumonia Aspiration pneumonia is a type of lung infection that is due to a relatively large amount of material from the stomach or mouth entering the lungs. Signs and symptoms often include fever Fever, also referred to as pyrexia, is defined as havi ...
.


Dehydration and electrolyte imbalance

Prolonged and excessive vomiting depletes the body of water (dehydration), and may alter the electrolyte status. Gastric vomiting leads to the loss of acid (protons) and chloride directly. Combined with the resulting
alkaline tideAlkaline tide refers to a condition, normally encountered after eating a meal, where during the production of hydrochloric acid Hydrochloric acid, also known as muriatic acid, is an aqueous solution of hydrogen chloride. It is a colorless solu ...
, this leads to hypochloremic
metabolic alkalosis Metabolic alkalosis is a metabolic Metabolism (, from el, μεταβολή ''metabolē'', "change") is the set of life Life is a characteristic that distinguishes physical entities that have biological processes, such as signal ...
(low
chloride The chloride ion An ion () is an atom An atom is the smallest unit of ordinary matter In classical physics and general chemistry, matter is any substance that has mass and takes up space by having volume. All everyday objects th ...

chloride
levels together with high and and increased blood
pH
pH
) and often
hypokalemia Hypokalemia is a low level of potassium Potassium is a chemical element upright=1.0, 500px, The chemical elements ordered by link=Periodic table In chemistry Chemistry is the science, scientific study of the properties and b ...
(
potassium Potassium is a chemical element In chemistry Chemistry is the study of the properties and behavior of . It is a that covers the that make up matter to the composed of s, s and s: their composition, structure, properties, b ...

potassium
depletion). The hypokalemia is an indirect result of the
kidney The kidneys are two reddish-brown bean-shaped organs An organ is a group of tissues with similar functions. Plant life and animal life rely on many organs that co-exist in organ systems. A given organ's tissues can be broadly categorized ...

kidney
compensating for the loss of acid. With the loss of intake of food the individual may eventually become cachectic. A less frequent occurrence results from a vomiting of intestinal contents, including bile acids and , which can cause
metabolic acidosis Metabolic acidosis is a serious electrolyte disorder characterized by an imbalance in the body's acid-base balance. Metabolic acidosis has three main root causes: increased acid production, loss of bicarbonate, and a reduced ability of the kidney ...
.


Mallory–Weiss tear

Repeated or profuse vomiting may cause erosions to the
esophagus The esophagus (American English American English (AmE, AE, AmEng, USEng, en-US), sometimes called United States English or U.S. English, is the set of varieties of the English language native to the United States. Currently, American E ...

esophagus
or small tears in the esophageal mucosa ( Mallory–Weiss tear). This may become apparent if fresh red blood is mixed with vomit after several episodes.


Dentistry

Recurrent vomiting, such as observed in
bulimia nervosa Bulimia nervosa, also known as simply bulimia, is an eating disorder An eating disorder is a mental disorder defined by abnormal eating behaviors that negatively affect a person's health, physical or mental health, mental health. Only one eat ...
, may lead to the destruction of the
tooth enamel #REDIRECT Tooth enamel #REDIRECT Tooth enamel#REDIRECT Tooth enamel Tooth enamel is one of the four major Tissue (biology), tissues that make up the tooth in humans and many other animals, including some species of fish. It makes up the normally ...
due to the acidity of the vomit.
Digestive enzyme Digestive may refer to: Biology *Digestion Digestion is the breakdown of large insoluble food Food is any substance consumed to provide nutritional Nutrition is the biochemical Biochemistry or biological chemistry, is the study of c ...
s can also have a negative effect on oral health, by degrading the tissue of the
gums The gums or gingiva (plural: ''gingivae'') consist of the mucosal A mucous membrane or mucosa is a membrane Image:Schematic size.jpg, up150px, Schematic of size-based membrane exclusion A membrane is a selective barrier; it allows some things ...
.


Pathophysiology

Receptors on the floor of the
fourth ventricle The fourth ventricle is one of the four connected fluid-filled cavities within the human brain. These cavities, known collectively as the ventricular system, consist of the left and right lateral ventricles, the third ventricle, and the fourth ve ...

fourth ventricle
of the brain represent a chemoreceptor trigger zone, known as the
area postrema The area postrema, a paired structure in the medulla oblongata of the brainstem The brainstem (or brain stem) is the posterior stalk-like part of the brain that connects the cerebrum with the spinal cord The spinal cord is a long, thin, tu ...

area postrema
, stimulation of which can lead to vomiting. The area postrema is a
circumventricular organ Circumventricular organs (CVOs) ( circum-: around ; ventricular: of ventricle) are structures in the brain characterized by their extensive and highly permeable Permeability, permeable, and semipermeable may refer to: Chemistry *Semiperm ...
and as such lies outside the
blood–brain barrier The blood–brain barrier (BBB) is a highly selective semipermeable membrane, semipermeable border of endothelium, endothelial cells that prevents solution, solutes in the circulating blood from ''non-selectively'' crossing into the extracellular ...
; it can therefore be stimulated by blood-borne drugs that can
stimulate vomiting
stimulate vomiting
or inhibit it. There are various sources of input to the vomiting center: * The chemoreceptor trigger zone at the base of the fourth ventricle has numerous dopamine D2 receptors, serotonin 5-HT3 receptors,
opioid receptor Opioid receptors are a group of inhibitory G protein-coupled receptor G protein-coupled receptors (GPCRs), also known as seven-(pass)-transmembrane domain receptors, 7TM receptors, heptahelical receptors, serpentine receptors, and G protein-lin ...
s,
acetylcholine receptor Acetylcholine An acetylcholine receptor (abbreviated AChR) is an integral membrane protein that responds to the binding of acetylcholine, a neurotransmitter. Classification Like other transmembrane receptors, acetylcholine receptors are classi ...
s, and receptors for
substance P Substance P (SP) is an undecapeptide Peptides (from Greek language πεπτός, ''peptós'' "digested"; derived from πέσσειν, ''péssein'' "to digest") are short chains of between two and fifty amino acids, linked by peptide bonds. Chain ...

substance P
. Stimulation of different receptors are involved in different pathways leading to emesis, in the final common pathway substance P appears involved. * The
vestibular system The vestibular system, in vertebrate Vertebrates () comprise all species of animal Animals (also called Metazoa) are multicellular A multicellular organism is an organism In biology, an organism () is any organic, life, ...
, which sends information to the brain via
cranial nerve VIII The vestibulocochlear nerve (auditory vestibular nerve), known as the eighth cranial nerve Cranial nerves are the nerve A nerve is an enclosed, cable-like bundle of nerve fibers called axon An axon (from Greek ἄξων ''áxōn'', axis) ...
(vestibulocochlear nerve), plays a major role in
motion sickness Motion sickness occurs due to a difference between actual and expected motion. Symptoms commonly include nausea Nausea is a diffuse sensation of unease and discomfort, often perceived as an urge to vomit. While not painful, it can be a debilit ...
, and is rich in
muscarinic receptors - the natural agonist of muscarinic and nicotinic receptors. - an agonist used to distinguish between these two classes of receptors. Not normally found in the body. Muscarinic acetylcholine receptors, or mAChRs, are acetylcholine receptors t ...
and histamine H1 receptors. * The
cranial nerve X The vagus nerve, historically cited as the pneumogastric nerve, is the tenth cranial nerve or CN X, and interfaces with the parasympathetic control of the heart, lungs, and digestive tract. The vagus nerves are normally referred to in the singular ...
(vagus nerve) is activated when the
pharynx The pharynx (plural: pharynges) is the part of the throat behind the human mouth, mouth and nasal cavity, and above the esophagus and trachea – the tubes going down to the stomach and the lungs. It is found in vertebrates and invertebrates, thou ...

pharynx
is irritated, leading to a
gag reflex The pharyngeal reflex or gag reflex is a reflex In biology Biology is the natural science that studies life and living organisms, including their anatomy, physical structure, Biochemistry, chemical processes, Molecular biology, molecular int ...
. * The vagal and
enteric nervous system The enteric nervous system (ENS) or intrinsic nervous system is one of the main divisions of the autonomic nervous system The autonomic nervous system (ANS), formerly referred to as the vegetative nervous system, is a division of the peripheral n ...
inputs transmit information regarding the state of the
gastrointestinal system The gastrointestinal tract, (GI tract, GIT, digestive tract, digestion tract, alimentary canal) is the tract from the mouth to the anus which includes all the organs of the digestive system in humans and other animal Animals (also c ...

gastrointestinal system
. Irritation of the GI mucosa by chemotherapy, radiation, distention, or acute infectious
gastroenteritis Gastroenteritis, also known as infectious diarrhea and gastro, is inflammation of the gastrointestinal tract The gastrointestinal tract, (GI tract, GIT, digestive tract, digestion tract, alimentary canal) is the tract from the mouth to the ...

gastroenteritis
activates the 5-HT3 receptors of these inputs. * The
CNS
CNS
mediates vomiting that arises from psychiatric disorders and stress from higher brain centers. * The medulla plays an important role for triggering the vomiting act. The vomiting act encompasses three types of outputs initiated by the chemoreceptor trigger zone: Motor,
parasympathetic nervous system The parasympathetic nervous system (PSNS) is one of the three divisions of the autonomic nervous system The autonomic nervous system (ANS), formerly the vegetative nervous system, is a division of the peripheral nervous system that supplies s ...
(PNS), and
sympathetic nervous system The sympathetic nervous system (SNS) is one of two divisions of the autonomic nervous system, along with the parasympathetic nervous system. The enteric nervous system is sometimes considered part of the autonomic nervous system, and sometimes co ...
(SNS). They are as follows: * Increased
saliva Saliva (commonly referred to as spit) is an extracellular fluid In cell biology Cell biology (also cellular biology or cytology) is a branch of biology Biology is the natural science that studies life and living organisms, including t ...
tion to protect
tooth enamel #REDIRECT Tooth enamel #REDIRECT Tooth enamel#REDIRECT Tooth enamel Tooth enamel is one of the four major Tissue (biology), tissues that make up the tooth in humans and many other animals, including some species of fish. It makes up the normally ...
from stomach acids. (Excessive vomiting leads to dental erosion.) This is part of the PNS output. * The body takes a deep breath to avoid aspirating vomit. * Retroperistalsis starts from the middle of the
small intestine The small intestine or small bowel is an organ (anatomy), organ in the human gastrointestinal tract, gastrointestinal tract where most of the #Absorption, absorption of nutrients from food takes place. It lies between the stomach and large intes ...

small intestine
and sweeps up digestive tract contents into the stomach, through the relaxed
pyloric sphincter The pylorus ( or ), or pyloric part, connects the stomach to the duodenum. The pylorus is considered as having two parts, the ''pyloric antrum'' (opening to the body of the stomach) and the ''pyloric canal'' (opening to the duodenum). The ''pyloric ...
. * Intrathoracic pressure lowers (by
inspiration Inspiration, inspire, or inspired often refers to: * Artistic inspiration, sudden creativity in artistic production * Biblical inspiration, the doctrine in Judeo-Christian theology concerned with the divine origin of the Bible * Creative inspirati ...

inspiration
against a closed
glottis The glottis is the opening between the vocal folds In humans, vocal cords, also known as vocal folds or voice reeds, are folds of tissue in the throat that are key in creating sounds through vocalization. The size of vocal cords affects the ...
), coupled with an increase in abdominal pressure as the
abdominal muscles The abdomen (colloquially called the belly, tummy, midriff or stomach) is the part of the body between the thorax The thorax or chest is a part of the anatomy of humans, mammals, other tetrapod animals located between the neck and the abdomen. I ...

abdominal muscles
contract, propels stomach contents into the
esophagus The esophagus (American English American English (AmE, AE, AmEng, USEng, en-US), sometimes called United States English or U.S. English, is the set of varieties of the English language native to the United States. Currently, American E ...

esophagus
as the
lower esophageal sphincter The esophagus (American English American English (AmE, AE, AmEng, USEng, en-US), sometimes called United States English or U.S. English, is the set of varieties of the English language native to the United States. Currently, American E ...

lower esophageal sphincter
relaxes. The stomach itself does not contract in the process of vomiting except for at the angular notch, nor is there any retroperistalsis in the esophagus. * Vomiting is ordinarily preceded by
retching Retching (also known as dry heaving) is the reverse movement ( retroperistalsis) of the stomach and esophagus without vomiting. It can be caused by bad smells or choking, or by withdrawal from some medications after vomiting stops. Retching can also ...
. * Vomiting also initiates an
SNS Tin(II) sulfide is a chemical compound A chemical compound is a chemical substance composed of many identical molecules (or molecular entity, molecular entities) composed of atoms from more than one chemical element, element held together by ...
response causing both sweating and increased heart rate.


Phases

The vomiting act has two phases. In the retching phase, the abdominal muscles undergo a few rounds of coordinated contractions together with the diaphragm and the muscles used in respiratory inspiration. For this reason, an individual may confuse this phase with an episode of violent
hiccups A hiccup (scientific name ''singultus'', from a Latin word meaning "to catch one's breath while sobbing"; also spelled wikt:hiccough, hiccough) is an involuntary contraction (myoclonic jerk) of the diaphragm (anatomy), diaphragm that may repeat ...

hiccups
. In this retching phase, nothing has yet been expelled. In the next phase, also termed the expulsive phase, intense pressure is formed in the stomach brought about by enormous shifts in both the diaphragm and the abdomen. These shifts are, in essence, vigorous contractions of these muscles that last for extended periods of time—much longer than a normal period of muscular contraction. The pressure is then suddenly released when the upper esophageal sphincter relaxes resulting in the expulsion of gastric contents. Individuals who do not regularly exercise their abdominal muscles may experience pain in those muscles for a few days. The relief of pressure and the release of endorphins into the bloodstream after the expulsion causes the vomiter to feel better.


Contents

Gastric secretions and likewise vomit are highly
acid An acid is a or capable of donating a (hydrogen ion H+) (a ), or, alternatively, capable of forming a with an (a ). The first category of acids are the proton donors, or s. In the special case of , proton donors form the H3O+ and are ...
ic. Recent food intake appears in the gastric vomit. Irrespective of the content, vomit tends to be malodorous. The content of the vomitus (vomit) may be of medical interest. Fresh
blood Blood is a body fluid Body fluids, bodily fluids, or biofluids are liquid A liquid is a nearly incompressible In fluid mechanics or more generally continuum mechanics, incompressible flow (isochoric process, isochoric flow) refers t ...

blood
in the vomit is termed
hematemesis Hematemesis is the vomiting Vomiting (also known as puking, throwing up, barfing, emesis, among other names) is the involuntary, forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose. Vomiting can ...
("blood vomiting"). Altered blood bears resemblance to coffee grounds (as the
iron Iron () is a chemical element In chemistry Chemistry is the study of the properties and behavior of . It is a that covers the that make up matter to the composed of s, s and s: their composition, structure, properties, behav ...

iron
in the blood is
oxidized (mild reducing agent) are added to powdered potassium permanganate (strong oxidizing agent), a violent redox reaction accompanied by self-ignition starts. Redox (reduction–oxidation, pronunciation: or ) is a type of chemical reaction A ...

oxidized
) and, when this matter is identified, the term coffee-ground vomiting is used.
Bile Bile (from latin ''bilis''), or gall, is a dark-green-to-yellowish-brown fluid produced by the of most s that aids the of s in the . In humans, bile is produced continuously by the liver (liver bile) and stored and concentrated in the . After ...
can enter the vomit during subsequent heaves due to
duodenal The duodenum is the first section of the small intestine The small intestine or small bowel is an organ in the gastrointestinal tract The gastrointestinal tract, (GI tract, GIT, digestive tract, digestion tract, alimentary canal) is the tr ...

duodenal
contraction if the vomiting is severe. Fecal vomiting is often a consequence of
intestinal obstruction Bowel obstruction, also known as intestinal obstruction, is a mechanical or functional obstruction of the intestine The gastrointestinal tract, (GI tract, GIT, digestive tract, digestion tract, alimentary canal) is the tract from the mouth t ...
or a gastrocolic
fistula A fistula (plural: fistulas or fistulae ; from Latin ''fistula'', "tube, pipe") in anatomy is an abnormal anastomosis, connection between two hollow spaces (technically, two epithelium, epithelialized surfaces), such as blood vessels, intestin ...

fistula
and is treated as a warning sign of this potentially serious problem (''signum mali ominis''). If the vomiting reflex continues for an extended period with no appreciable vomitus, the condition is known as non-productive emesis or "dry heaves", which can be painful and debilitating. ;Color of vomit *Bright red in the vomit suggests bleeding from the esophagus *Dark red vomit with liver-like clots suggests profuse bleeding in the stomach, such as from a perforated ulcer *Coffee-ground-like vomit suggests less severe bleeding in the stomach because the gastric acid has had time to change the composition of the blood *Yellow vomit suggests bile, indicating that the
pyloric valve The pylorus ( or ), or pyloric part, connects the stomach The stomach is a muscular, hollow organ in the gastrointestinal tract of humans and many other animals, including several invertebrates. The stomach has a dilated structure and funct ...
is open and bile is flowing into the stomach from the duodenum (this is more common in older people)


Causes

Vomiting may be due to a large number of causes, and protracted vomiting has a long
differential diagnosis In healthcare, a differential diagnosis (abbreviated DDx) is a method of analysis of a patient's history and physical examination to arrive at the correct diagnosis. It involves distinguishing a particular disease A disease is a particu ...
.


Digestive tract

Causes in the
digestive tract The gastrointestinal tract (GI tract, digestive tract, alimentary canal) is the tract or passageway of the digestive system that leads from the mouth to the anus. The GI tract contains all the major organ (biology), organs of the digestive syst ...
*
Gastritis Gastritis is inflammation Inflammation (from la, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or irritants, and is a protective response involving immune cells ...
(
inflammation Inflammation (from la, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogen In biology Biology is the natural science that studies life and living organisms, including their anato ...
of the gastric wall) *
Gastroenteritis Gastroenteritis, also known as infectious diarrhea and gastro, is inflammation of the gastrointestinal tract The gastrointestinal tract, (GI tract, GIT, digestive tract, digestion tract, alimentary canal) is the tract from the mouth to the ...

Gastroenteritis
*
Gastroesophageal reflux disease Gastroesophageal reflux disease (GERD), is a chronic condition in which stomach contents rise up into the esophagus The esophagus (American English American English (AmE, AE, AmEng, USEng, en-US), sometimes called United States E ...
*
Celiac disease Coeliac disease or celiac disease is a long-term autoimmune disorder An autoimmune disease is a condition arising from an abnormal immune response to a functioning body part. There are at least 80 types of autoimmune diseases. Nearly any bo ...
*
Non-celiac gluten sensitivity Non-celiac gluten sensitivity (NCGS) or gluten sensitivity is "a clinical entity induced by the ingestion of gluten Gluten is a group of seed storage protein Proteins are large biomolecules or macromolecules that are comprised of one or more ...
*
Pyloric stenosis Pyloric stenosis is a stenosis, narrowing of the opening from the stomach to the first part of the small intestine (the pylorus). Symptoms include projectile vomiting without the presence of bile. This most often occurs after the baby is fed. The t ...
(in babies, this typically causes a very forceful "projectile vomiting" and is an indication for urgent surgery) *
Bowel obstruction Bowel obstruction, also known as intestinal obstruction, is a mechanical or Ileus, functional obstruction of the Gastrointestinal tract#Lower gastrointestinal tract, intestines which prevents the normal movement of the products of digestion. Eithe ...
*
Overeating Overeating is the excess food consumed in relation to the energy that an organism In biology, an organism (from Ancient Greek, Greek: ὀργανισμός, ''organismos'') is any individual contiguous system that embodies the Life#Biology ...
(stomach too full) *
Acute abdomen An acute abdomen refers to a sudden, severe abdominal pain Abdominal pain, also known as a stomach ache, is a symptom Signs and symptoms are the observed or detectable signs, and experienced symptoms of an illness, injury, or condition. A s ...
and/or
peritonitis Peritonitis is inflammation of the peritoneum, the lining of the inner wall of the abdomen and cover of the abdominal organs. Symptoms may include severe pain, swelling of the abdomen, fever, or weight loss. One part or the entire abdomen may be ...
*
Ileus Ileus is a disruption of the normal propulsive ability of the intestine The gastrointestinal tract, (GI tract, GIT, digestive tract, digestion tract, alimentary canal) is the tract from the mouth to the anus which includes all the organs of ...
* Food allergies (often in conjunction with
hives Hives, also known as urticaria, is a kind of with red, raised, itchy bumps. They may also burn or sting. Often the patches of rash move around. Typically they last a few days and do not leave any long-lasting skin changes. Fewer than 5% of case ...
or swelling) *
Cholecystitis Cholecystitis is inflammation Inflammation (from la, wikt:en:inflammatio#Latin, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or Irritation, irritants, and is a pr ...
,
pancreatitis Pancreatitis is a condition characterized by inflammation Inflammation (from la, wikt:en:inflammatio#Latin, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or Irrit ...
,
appendicitis Appendicitis is inflammation Inflammation (from la, wikt:en:inflammatio#Latin, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or Irritation, irritants, and is a pr ...

appendicitis
,
hepatitis Hepatitis is inflammation Inflammation (from la, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogen In biology Biology is the natural science that studies life and living or ...

hepatitis
*
Food poisoning Foodborne illness (also foodborne disease and colloquially referred to as food poisoning) is any Disease, illness resulting from the spoilage of food contaminant, contaminated food, pathogenic bacteria, viruses, or parasites that contaminate food, ...
* In children, it can be caused by an
allergic reaction Allergies, also known as allergic diseases, are a number of conditions caused by hypersensitivity Hypersensitivity (also called hypersensitivity reaction or intolerance) refers to undesirable reactions produced by the normal immune system, i ...
to cow's milk proteins (Milk allergy or lactose intolerance)


Sensory system and brain

Causes in the sensory system: * Movement leading to
motion sickness Motion sickness occurs due to a difference between actual and expected motion. Symptoms commonly include nausea Nausea is a diffuse sensation of unease and discomfort, often perceived as an urge to vomit. While not painful, it can be a debilit ...
(which is caused by overstimulation of the labyrinthine Ear canal, canals of the ear) * Ménière's disease *Vertigo Causes in the brain: * Concussion * Cerebral hemorrhage * Migraine * Brain tumors, which can cause the chemoreceptors to malfunction * Benign intracranial hypertension and hydrocephalus Metabolic disturbances (these may irritate both the stomach and the parts of the brain that coordinate vomiting): * Hypercalcemia (high calcium in biology, calcium levels) * Uremia (urea accumulation, usually due to kidney failure) * Adrenal insufficiency * Hypoglycemia * Hyperglycemia Pregnancy: * Hyperemesis gravidarum, Hyperemesis, morning sickness Drug reaction (vomiting may occur as an acute Somatic (biology), somatic response to): * alcohol (drug), Alcohol, which can be partially oxidized into acetaldehyde that causes the symptoms of hangover, including nausea, vomiting, shortness of breath, and fast heart rate. * Opioids * Selective serotonin reuptake inhibitors * Many chemotherapy drugs * Some entheogens (such as peyote or ayahuasca) Illness (sometimes colloquially known as "stomach flu"—a broad name that refers to gastric inflammation caused by a range of viruses and bacteria): * Norovirus (formerly Norwalk virus or Norwalk agent) * Swine influenza Psychiatric/behavioral: * Bulimia nervosa * Purging disorder


Emetics

An ''emetic'', such as syrup of ipecac, is a substance that induces vomiting when administered orally or by injection. An emetic is used medically when a substance has been ingested and must be expelled from the body immediately. (For this reason, many toxic and easily digestible products such as rat poison contain an emetic. This presents no problem for the effectiveness of the rodenticide as rodents are unable to vomit.) Inducing vomiting can remove the substance before it is absorbed into the body. Emetics can be divided into two categories, those which produce their effect by acting on the vomiting center in the medulla, and those which act directly on the stomach itself. Some emetics, such as ipecac, fall into both categories; they initially act directly on the stomach, while their further and more vigorous effect occurs by stimulation of the medullary center. Salt water and Mustard seed, mustard water, which act directly on the stomach, have been used since ancient times as emetics. Care must be taken with salt, as excessive intake can potentially be harmful. Copper(II) sulfate, Copper sulfate was also used in the past as an emetic. It is now considered too toxic for this use. Hydrogen peroxide is used as an emetic in veterinary practice.


Self-induced

* Eating disorders (anorexia nervosa or
bulimia nervosa Bulimia nervosa, also known as simply bulimia, is an eating disorder An eating disorder is a mental disorder defined by abnormal eating behaviors that negatively affect a person's health, physical or mental health, mental health. Only one eat ...
) * To eliminate an ingested poison (some poisons should not be vomited as they may be more toxic when inhaled or aspirated; it is better to ask for help before inducing vomiting) * Some people who engage in binge drinking induce vomiting to make room in their stomachs for more alcohol consumption. * Participants of the Milk challenge typically end up vomiting most of the milk they consume, as proteins in the ingested milk (such as casein) rapidly denature and unravel on contact with gastric acid and protease enzymes, rapidly filling the stomach. Once the stomach becomes full, stretch receptors in the stomach wall trigger signals to vomit to expel any further liquid the participant ingests. * People suffering from
nausea Nausea is a diffuse sensation of unease and discomfort, often perceived as an urge to vomiting, vomit. While not painful, it can be a debilitating symptom if prolonged and has been described as placing discomfort on the chest, upper abdomen, or ...

nausea
may induce vomiting in hopes of feeling better.


Miscellanea

* After surgery (postoperative nausea and vomiting) * Disagreeable sights or disgust, smells, sounds or thoughts (such as decayed matter, others' vomit, thinking of vomiting), etc. * Extreme pain, such as an intense headache or myocardial infarction (heart attack) * Extreme emotions * Cyclic vomiting syndrome (a poorly understood condition with attacks of vomiting) * Cannabinoid hyperemesis syndrome (similar to cyclic vomiting syndrome, but has cannabis use as its underlying cause). * High doses of
ionizing radiation Ionizing radiation (or ionising radiation), including nuclear radiation, consists of s or s that have sufficient to s or s by detaching s from them. The particles generally travel at a speed that is greater than 1% of , and the electromagnetic w ...
sometimes trigger a vomit reflex. * Violent fits of
coughing A cough is a sudden expulsion of air through the large breathing passages that can help clear them of fluids, irritants, foreign particles and Microorganism, microbes. As a protective reflex, coughing can be repetitive with the cough reflex follow ...
,
hiccups A hiccup (scientific name ''singultus'', from a Latin word meaning "to catch one's breath while sobbing"; also spelled wikt:hiccough, hiccough) is an involuntary contraction (myoclonic jerk) of the diaphragm (anatomy), diaphragm that may repeat ...

hiccups
, or asthma * Anxiety * Depression (mood), Depression * Overexertion (doing too much strenuous exercise can lead to vomiting shortly afterwards). * Rumination syndrome, an underdiagnosed and poorly understood disorder that causes sufferers to regurgitate food shortly after ingestion.


Other types

* ''Projectile vomiting'' is vomiting that ejects the gastric contents with great force. It is a classic symptom of infantile hypertrophic pyloric stenosis, in which it typically follows feeding and can be so forceful that some material exits through the nose.


Treatment

An antiemetic is a medication, drug that is effective against vomiting and
nausea Nausea is a diffuse sensation of unease and discomfort, often perceived as an urge to vomiting, vomit. While not painful, it can be a debilitating symptom if prolonged and has been described as placing discomfort on the chest, upper abdomen, or ...

nausea
. Antiemetics are typically used to treat
motion sickness Motion sickness occurs due to a difference between actual and expected motion. Symptoms commonly include nausea Nausea is a diffuse sensation of unease and discomfort, often perceived as an urge to vomit. While not painful, it can be a debilit ...
and the Adverse effect (medicine), side effects of medications such as opioids and chemotherapy. Antiemetics act by inhibiting the receptor sites associated with emesis. Hence, anticholinergics, antihistamines, dopamine antagonists, serotonin antagonists, and cannabinoids are used as antiemetics. Evidence to support the use of antiemetics for nausea and vomiting among adults in the emergency department is poor. It is unclear if any medication is better than another or better than no active treatment.


Epidemiology

Nausea and/or vomiting are the main complaints in 1.6% of visits to family physicians in Australia.


Society and culture

Herodotus, writing on the culture of the Achaemenid Empire, ancient Persians and highlighting the differences with those of the Ancient Greece, Greeks, notes that to vomit in the presence of others is prohibited among Persians.


Social cues

It is quite common that, when one person vomits, others nearby become nauseated, particularly when smelling the vomit of others, and often to the point of vomiting themselves. It is believed that this is an evolution, evolved trait among primates. Many primates in the wild tend to browse for food in small groups. Should one member of the party react adversely to some ingested food, it may be advantageous (in a survival sense) for other members of the party to also vomit. This tendency in human populations has been observed at drinking parties, where excessive consumption of alcoholic beverages may cause a number of party members to vomit nearly simultaneously, this being triggered by the initial vomiting of a single member of the party. This phenomenon has been touched on in popular culture: notorious instances appear in the films ''Mr Creosote, Monty Python's The Meaning of Life'' (1983) and ''Stand by Me (film), Stand By Me'' (1986). Intense vomiting in ayahuasca ceremony, ceremonies is a common phenomenon. However, people who experience "la purga" after drinking ayahuasca, in general, regard the practise as both a physical and spiritual cleanse and often come to welcome it. It has been suggested that the consistent emetic effects of ayahuasca—in addition to its many other therapeutic properties—was of medicinal benefit to indigenous peoples of the Amazon Basin, Amazon, in helping to clear parasites from the gastrointestinal system. There have also been documented cases of a single ill and vomiting individual inadvertently causing others to vomit, when they are especially fearful of also becoming ill, through a form of mass hysteria. Most people try to contain their vomit by vomiting into a sink, toilet, or trash can, as vomit is difficult and unpleasant to clean. On airplanes and boats, Sickness bag, special bags are supplied for sick passengers to vomit into. A special disposable bag (leakproof, puncture-resistant, odorless) containing absorbent material that solidifies the vomit quickly is also available, making it convenient and safe to store until there is an opportunity to dispose of it conveniently. People who vomit chronically (e.g., as part of an eating disorder such as
bulimia nervosa Bulimia nervosa, also known as simply bulimia, is an eating disorder An eating disorder is a mental disorder defined by abnormal eating behaviors that negatively affect a person's health, physical or mental health, mental health. Only one eat ...
) may devise various ways to hide this disorder. An online study of people's responses to "horrible sounds" found vomiting "the most disgusting". Professor Trevor Cox of the University of Salford's Acoustic Research Centre said, "We are pre-programmed to be repulsed by horrible things such as vomiting, as it is fundamental to staying alive to avoid nasty stuff." It is thought that disgust is triggered by the sound of vomiting to protect those nearby from possibly diseased food.


Psychology

Emetophilia is sexual arousal from vomiting, or watching others vomit. Emetophobia is a phobia that causes overwhelming, intense anxiety pertaining to vomiting.


See also

* Bulimia nervosa * Emetophilia * Cancer and nausea * Emetophobia * Vasodilation *Diarrhea *Nose-blowing *Belching


Notes


References


External links


Cyclical Vomiting Syndrome
* {{Authority control Vomiting, Reflexes Symptoms and signs: Digestive system and abdomen Body fluids Emetics