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Monday, October 3, 2011

Vomiting- Clinical presentation and question to ask to find out the cause of vomiting

Clinical presentation of a case of vomiting:

The clinical presentation of vomiting varies with the cause. This is because the receptors that lead to vomiting vary with the cause, eg dopamine receptors in the chemoreceptor trigger zone are stimulated by metabolic and drug causes of nausea and vomiting, whereas gastric irritation stimulates histamine receptors in the vomiting centre via the vagus nerve.

So based on the receptors activated, the different types of antiemetic drugs are prescribed.



 So let’s take a look at the various clinical pictures associated with vomiting:

1. Nausea and vomiting, particularly with abdominal pain and discomfort suggest gastrointestinal disorders.

2. Dyspepsia, metabolic abnormalities, drugs may cause nausea without little or no vomiting.

3. Large volume vomiting with little nausea may occur in intestinal obstruction.

4. Raised intracranial pressure may cause vomiting without nausea.

5. Peptic ulcer disease seldom cause painless vomiting unless complicated by pyloric stenosis (obstruction of the gastric outlet- see the next point).

6. Gastric outlet (the passage through which food goes from the stomach to the intestine/duodenum) obstruction cause large volume, projectile vomiting with that is not bile stained (green).

7.  Obstruction distal to the pylorus (the lower end of the stomach where the small intestine begins) / intestinal obstruction produce bile-stained vomiting without any nausea. The more distal the level of intestinal obstruction the more marked the symptoms of abdominal distension and abdominal colic (pain lasts for a short period {seconds or minutes}, eases off and then returns).

8.  Anxiety may cause vomiting on wakening or immediately after breakfast and only rarely later in the day. This anxiety could be due to the different worries of everyday life or in case of children due to school phobia.

9. Pregnancy, alcohol misuse, depression also cause early morning vomiting.

10. Anorexia nervosa and Bulimia: Eating disorders characterized by undisclosed, self-induced vomiting.
The difference between them is that in bulimia, weight is maintained or increased, but in anorexia nervosa the weight loss is obvious.

11. Rumination: Rumination is the habitual, involuntary, subconscious regurgitation of gastric contents which are then chewed and swallowed is uncommon.



 

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Questions to ask to find out the probable cause of vomiting:


The clinical presentation of vomiting varies with its cause. The following questions help to find out the probable cause of vomiting:

1. What medication has the patient been taking?

2. Does vomiting occur after nausea or without any nausea at all?

3. Is vomiting associated with dyspepsia or abdominal pain?

4. Is dyspepsia or abdominal pain relieved by vomiting?

5. Is vomiting related to meal times, early morning or late evening?

6. Is the vomitus bile-stained (green), bloodstained or feculent?

7. Is the patient sad or depressed for some reason?


Reference: The following books were used in the making of the above article:







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