Vomiting, also known as emesis, puking ‘’’,barfing’’’,
throwing up, among other terms, is the involuntary, forceful expulsion
of the contents of one's stomach through the mouth and sometimes the
2.1 Phases 2.2 Contents
3 Differential diagnosis
3.1 Digestive tract
4 Treatment 5 Epidemiology 6 Social and cultural aspects 7 See also 8 References 9 External links
14th-century illustration of vomiting from the Casanatense Tacuinum Sanitatis
Receptors on the floor of the fourth ventricle of the brain represent a chemoreceptor trigger zone, known as the area postrema, stimulation of which can lead to vomiting. The area postrema is a circumventricular organ and as such lies outside the blood–brain barrier; it can therefore be stimulated by blood-borne drugs that can 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 receptors, acetylcholine receptors, and receptors for 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, which sends information to the brain via cranial nerve VIII (vestibulocochlear nerve), plays a major role in motion sickness, and is rich in muscarinic receptors and histamine H1 receptors. The cranial nerve X (vagus nerve) is activated when the pharynx is irritated, leading to a gag reflex. The vagal and enteric nervous system inputs transmit information regarding the state of the gastrointestinal system. Irritation of the GI mucosa by chemotherapy, radiation, distention, or acute infectious gastroenteritis activates the 5-HT3 receptors of these inputs. The CNS mediates vomiting that arises from psychiatric disorders and stress from higher brain centers.
The vomiting act encompasses three types of outputs initiated by the chemoreceptor trigger zone: Motor, parasympathetic nervous system (PNS), and sympathetic nervous system (SNS). They are as follows:
Increased salivation to protect tooth enamel from stomach acids.
(Excessive vomiting leads to dental erosion). This is part of the PNS
The body takes a deep breath to avoid aspirating vomit.
Retroperistalsis starts from the middle of the small intestine and
sweeps up digestive tract contents into the stomach, through the
relaxed pyloric sphincter.
Intrathoracic pressure lowers (by inspiration against a closed
glottis), coupled with an increase in abdominal pressure as the
abdominal muscles contract, propels stomach contents into the
esophagus as the 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.
The neurotransmitters that regulate vomiting are poorly understood,
but inhibitors of dopamine, histamine, and serotonin are all used to
suppress vomiting, suggesting that these play a role in the initiation
or maintenance of a vomiting cycle.
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 is open and bile is flowing into the stomach from the duodenum (this is more common in older people)
Movement: motion sickness (which is caused by overstimulation of the labyrinthine canals of the ear) Ménière's disease
Causes in the brain:
Brain tumors, which can cause the chemoreceptors to malfunction
Benign intracranial hypertension
Metabolic disturbances (these may irritate both the stomach and the parts of the brain that coordinate vomiting):
Hyperemesis, morning sickness
Drug reaction (vomiting may occur as an acute somatic response to):
alcohol (being sick while being drunk or being sick the next morning, suffering from the after-effects, i.e., the hangover) 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):
Bulimia Nervosa Purge disorder
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). Inducing
vomiting can remove the substance before it is absorbed into the body.
Ipecac abuse can cause detrimental health effects.
A drunk man vomiting, while a young slave is holding his forehead. Brygos Painter, 500–470 BC
It is quite common that, when one person vomits, others nearby become nauseated, particularly when smelling the vomit of others, often to the point of vomiting themselves. It is believed that this is an 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 Monty Python's The Meaning of Life (1983) and Stand By Me (1986). Intense vomiting in ayahuasca ceremonies is a common phenomenon. However, people who experience "la purga" after drinking ayahuasca, in general, regard the practice 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, 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, 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) 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 that "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. Miscellanea
After surgery (postoperative nausea and vomiting) Disagreeable sights or disgust, smells or thoughts (such as decayed matter, others' vomit, thinking of vomiting), etc. Extreme pain, such as intense headache or myocardial infarction (heart attack) Violent emotions Cyclic vomiting syndrome (a poorly understood condition with attacks of vomiting) High doses of ionizing radiation sometimes trigger a vomit reflex. Violent fits of coughing, hiccups, or asthma Anxiety Depression Overexertion (doing too much strenuous exercise can lead to vomiting shortly afterward). Rumination syndrome, an underdiagnosed and poorly understood disorder that causes sufferers to regurgitate food shortly after ingestion.
Projectile vomiting refers to 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 drug that is effective against vomiting and nausea. Antiemetics are typically used to treat motion sickness and the 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. Social and cultural aspects Herodotus, writing on the culture of the ancient Persians and highlighting the differences with those of the Greeks, notes that to vomit in the presence of others is prohibited among Persians. See also
Bulimia nervosa Emetophilia Cancer and nausea Emetophobia
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^ Li–gui, Huang; En–tong, Wang; Wei, Chen; Wei–xi, Gong (June
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Look up vomiting in Wiktionary, the free dictionary.
v t e
Symptoms and signs: digestive system and abdomen (R10–R19, 787,789)
Nausea Vomiting Heartburn Aerophagia Dysphagia
Odynophagia Halitosis Xerostomia Hypersalivation Burping
Flatulence Fecal incontinence
Blood: Fecal occult blood Rectal tenesmus Constipation Obstructed defecation Diarrhea Rectal discharge
Psoas sign Obturator sign Rovsing's sign Hamburger sign Heel tap sign Aure-Rozanova's sign Dunphy sign Alder's sign Lockwood's sign Rosenstein's sign
Acute abdomen Colic Baby colic Abdominal guarding Rebound tenderness
Bloating Ascites Tympanites Shifting dullness Bulging flanks Fluid wave test
Abdominal mass Hepatosplenomegaly
Jaundice Mallet-Guy sign Puddle sign
LCCN: sh85144382 GND: 4015109-8 SUDOC: 027256154 BNF: cb119338174 (data) NDL: 0056