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DAVID MACK/SPL
Computer artwork of the vomiting reflex
N
ausea is the word used to a result, the stomach expels the vomitus with aspiration of the stomach contents into the
describe the sensation of discom- great force into the mouth and out of the lung, potentially leading to aspiration pneu-
fort and unease in the stomach body. monitis and pneumonia.
and is derived from the Greek This sequence may be repeated in co-
word for sea-sickness (naus means ship). ordination with respiratory cycles, and The vomiting process
Nausea itself is not an illness but a symptom retrograde peristalsis from the small intestine
associated with a variety of conditions. Nau- to the stomach may refill the stomach sever- The act of vomiting is a complex physiolog-
sea and vomiting are produced by the same al times. Retching is a similar process to ically co-ordinated sequence. It is said to be
stimuli and can be viewed as a progressive vomiting, where the movements involved controlled by the vomiting centre in the
response to increased stimulus. are less severe and do not result in ejection brain. Generally, this is no longer considered
The act of vomiting (emesis) is caused by a of vomitus. to be a distinct anatomical structure, but is
series of changes within the gastrointestinal believed to involve a central pattern genera-
tract, in co-ordination with respiratory Complications If vomiting is left untreat- tor, similar to that which co-ordinates
movements. Generally, salivation precedes ed, in addition to causing distress, ventilation. The vomiting process is closely
the ejection of vomitus and there is a simul- hypokalaemic hypo-chloraemic alkalosis associated with the salivary, vagal and respi-
taneous increased volume of inspiration into (volume depletion, loss of gastric hydrogen ratory centres of the brain, and has several
the lungs, which increases abdominal pres- ions and alterations in the renin- excitatory inputs (see Panel 1, p186).
sure.The epiglottis closes and the soft palate angiotensin-aldosterone system) can result. Among these is the chemoreceptor trigger
of the mouth rises to prevent vomitus enter- Vomiting can also cause mucosal damage zone, as described in Panel 2 (p186).
ing the lungs. The pyloric region of the such as Mallory-Weiss tears, or rupture the The remainder of this article explains
stomach undergoes a strong contraction, oesophagus (eg, Boerhaave syndrome).A fall common causes of nausea and vomiting
while the fundus, cardiac sphincter and in haemocrit and subsequent endoscopy likely to be encountered in hospital practice.
oesophagus remain relaxed and the external should identify any bleed and associated
muscles of the anus and urethra contract. As physical damage. Gastrointestinal rupture as Treatment-induced
a result of vomiting is particularly dangerous
in alcoholics who have developed Chemotherapy-induced nausea and
Alan Worsley and Andrew Husband are senior
oesophageal varices. vomiting Chemotherapy-induced nausea
lecturers in pharmacy practice at the University of
Another complication associated with and vomiting (CINV) can be classified as
Sunderland
uncontrolled vomiting is the possible acute, delayed or anticipatory. Two further
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