Article by Dr Raghuram Y.S. MD (Ay)
Vomiting is a disturbing condition which all of us would have experienced at one or the other point of our life. It might be due to incompatible foods that we have consumed in terms of quality or quantity or as an effect of some chronic illness or toxins which are incompatible with our body or due to normal body behaviour as in pregnancy.
Vomiting might be a simple one, occurring once or twice, which often settles by itself. Some types of vomiting, especially those which are secondary to some systemic diseases are stubborn, recurring and are life threatening, since they too like diarrhoea cause severe dehydration and pressure on heart and brain.
Table of Contents
Vomiting is the forcible ‘voluntary’ or ‘involuntary’ emptying (throwing up) of stomach contents through the mouth and sometimes through nose. Many times, vomiting is preceded by nausea. Nausea is an uneasiness of the stomach that often comes before vomiting. This causes a feel to vomit and many times may cause vomiting or severe uneasiness in the form of chest and abdominal discomfort, headache, restlessness, nervousness etc.
Vomiting and Nausea are not diseases but are symptoms of many other pre-existing conditions.
Anti-emetics or medicines which check vomiting may be needed to suppress nausea and vomiting. In severe cases, intravenous fluids may be required, especially when dehydration develops.
‘Regurgitation’ – Vomiting is different from another condition called regurgitation. Regurgitation is the return of undigested food, back up the food pipe (oesophagus) to the mouth. This will not be associated with force, nausea or displeasure associated with vomiting. The causes also differ.
Other names – Vomit, Emesis, Heaving, Puke, Throwing up
Read related: 21 Lifestyle And Prevention Tips To Stop Vomiting And Nausea
Causes (Differential diagnosis of Vomiting) –
Vomiting can be caused by many conditions. It might occur as a response to gastritis or poisoning or as a sequel of disorders like brain tumours, raised intracranial pressure etc.
Below mentioned are the different conditions which cause vomiting or are associated with vomiting.
Causes in gastro-intestinal (digestive) tract –
Conditions related to Brain and sensory system
Metabolic disturbances (cause irritation both in the stomach and other parts of the brain and cause vomiting) –
Hyperemesis (excessive vomiting) and morning sickness are common in pregnancy
Drug reactions (vomiting may occur as an acute somatic response to)
Stomach flu (illness that refers to gastric inflammation caused by a range of viruses and bacteria) –
– Noro-virus (Norwalk virus or Norwalk agent)
– Swine influenza
Emetics are substances that induce vomiting when administered orally or by injection. It is used when any incompatible or harmful substance has been taken and must be expelled from the body immediately. This removes the substance before it is absorbed into the body.
Example, syrup of ipecac, salt water and mustard, copper sulphate, hydrogen peroxide (veterinary) etc.
Social cues –
Nausea or vomiting is caused when someone else vomits in our close proximity, due to the sight or smell of vomit. This has been commonly found among primates, in drinking parties, intense vomiting in ayahuasca ceremonies (considered as spiritual cleansing), mass hysteria (fears of vomiting or want to vomit by seeing someone do it) etc
Read related: 21 Lifestyle And Prevention Tips To Stop Vomiting And Nausea
Miscellaneous causes of vomiting –
Aspiration – when the gastric contents enter the respiratory tract, it really gets lethal. It is generally protected from gag or cough reflex, but not in those who consume alcohol or on anaesthesia. Aspiration causes choking and aspiration pneumonia
Dehydration and electrolyte imbalance – depletion of water stores occurs due to prolonged or excessive vomiting. This will alter the electrolyte status. Gastric vomiting leads to loss of acid (protons) and chloride, hypochloremic metabolic alkalosis and hypokalemia (potassium loss). Since the person is not able to take food, he may become cachectic. Metabolic acidosis occurs due to vomiting of intestinal contents including bile acids and HCO3.
Mallory Weiss tear – erosions or small tears occurring in the oesophageal mucosa caused by repeated or profuse vomiting are called Mallory-Weiss tear. It occurs if fresh red blood is mixed with vomit after several episodes.
Dentistry – destruction of tooth enamel occurs due to recurrent vomiting (due to acidity of the vomit), in cases like bulimia nervosa. Digestive enzymes degrade the tissue of the gums.
Read related: 25 Easy, Effective Home Remedies for Vomiting And Nausea
Patho-physiology of Vomiting –
Receptors represeinting a ‘chemoreceptor trigger zone’ known as ‘area postrema’ are located on the floor of the 4th ventricle of the brain. The stimulation of this area can lead to vomiting.
Various pathways of vomiting –
The act of vomiting encompasses 3 outputs initiated by the ‘chemoreceptor trigger zone’, They are –
– Parasympathetic nervous system (PNS)
– Sympathetic nervous system (SNS)
They are as follows:
Retching phase – In this, few coordinated contractions take place in the abdominal muscles along with diaphragm and muscles of respiratory inspiration. Nothing is expelled.
Expulsive phase – follows the retching phase. Enormous shifts in both diaphragm and abdomen brings about intense pressure in the stomach. These shifts are nothing but vigorous contractions of these muscles that last for a prolonged time. When the upper oesophageal sphincter relaxes, the pressure is suddenly released, resulting in expulsion of gastric contents. The relief of pressure and release of endorphins into the bloodstream after the expulsion causes relief from vomiting.
Read related: Chardi Roga – Vomiting: Ayurveda Explanation, Types, Symptoms
Vomiting generally consists of contents of stomach. Gastric secretions and vomit are highly acidic. In gastric vomiting, we can see the recently taken food.
Fresh blood in vomit is called haematemesis (blood vomiting). The blood has a coffee ground appearance. In severe vomiting, bile can enter the vomit due to duodenal contractions. Fecal vomiting is associated with intestinal obstruction or a gastro-colic fistula.
Dry heaves (non-productive emesis) – vomiting reflex continuing for an extended period with no appreciable vomitus
Bright red vomit – suggests bleeding from food pipe (oesophagus)
Dark red vomit with liver like clots – points towards profuse bleeding in the stomach (perforated ulcer)
Coffee ground like vomit – suggests less severe bleeding in the stomach
Yellow vomit – suggests bile
Nausea and / or vomiting are the main complaints in 1.6% of visits to family physicians in Australia
Is vomiting harmful?
Usually vomiting is harmless, but can be a sign of a more serious illness. Serious conditions that may result in nausea or vomiting are concussions, meningitis, intestinal obstruction, appendicitis, brain tumours etc.
Dehydration caused by vomiting is a serious point of concern. Adults can detect symptoms of dehydration but children have a greater risk of becoming dehydrated, especially if they have diarrhoea, because they are often unable to communicate and express symptoms of dehydration. Signs of dehydration are dry lips and mouth, sunken eyes, rapid breathing or pulse, decreased urination (infants) and sunken fontanelle (infants).
Hyper-emesis gravidarum – recurrent vomiting in the pregnancy, mother feels fluid and mineral imbalances which can endanger her life or that of her unborn child.
Rarely, excessive vomiting can tear the lining of the oesophagus also known as a Mallory-Weiss tear. If the oesophagus gets ruptured, it is called Boerhaave’s syndrome and is a medical emergency.
Read related: Chardi Roga Chikitsa: Ayurvedic Treatment For Vomiting, Limitations
When to call for a doctor in case of vomiting?
Seek immediate medical attention if the below said conditions are seen with vomiting –
Antiemetic (drug effective against vomiting and nausea) – anticholinergics, antihistamines, dopamine antagonists, serotonin antagonists and cannabinoids are used as antiemetics
Drink gradually larger amounts of clear liquids, water, restore fluid balance in the body
Avoid solid food until the vomiting episodes have passed away
Oral rehydrating solution – to prevent and treat dehydration (if vomiting or diarrhoea last more than 24 hours)
Eating some crackers before getting out of bed or high protein snack before going to bed (less meat or cheese) – for pregnant women experiencing morning sickness.
Click to consult Dr Raghuram Y.S. MD(Ayu) – email / skype