Vomiting – is a complex reflex involving autonomic and somatic neural pathways.

Vomiting
can be acute or chronic. There’s synchronous contraction of diaphragm, intercostal and
abdominal muscles which increase intra-abdominal pressure + relaxation of LES 🡪 ejection of
gastric content.

Regurgitation – the return of usually undigested food back up to the esophagus and
pharynx, without the force and displeasure associated with vomiting.
● First you must differentiate between vomiting and regurgitation.

Symptoms - nausea, hyper-salivation, stretching, and then vomiting. ask the patient if these
symptoms are present or not, if not probably regurgitation.
● Increase in Intra-cranial hypertension - explosive vomitus.
● Understand if there are other symptoms like abdominal pain, fever...
● How often it happens.

Content of Vomit - food, blood, bile, the color of the vomit.

1. If the patient is vomiting food 🡪 understand the relationship with the meals 🡪 5 minutes
after eating or one hour after.
2. Bile in the vomit – coming from the duodenum.
3. Blood – think about neoplasm.
4. Feces – in case of intestinal obstruction or fistula.

The main causes are:

1. CNS – Migraine, Meningitis, Increased ICP.
2. Gastroduodenal – peptic ulcer, gastric cancer, gastroparesis.
3. Acute abdomen – acute appendicitis, acute pancreatitis, intestinal obstruction,
cholecystitis.
4. Alcohol, drugs (e.g. NSAIDs, Antibiotics, Opiates).
5. Infections – gastroenteritis, hepatitis, UTI.
6. Metabolic Diseases – Diabetic ketoacidosis, Addison disease.
7. Acute coronary syndrome.

Functional Causes:
1. Anxiety – phobias might elicit it,
2. Pregnancy.

Gastroparesis – delayed gastric emptying without a mechanical obstruction of stomach or

duodenum due to inherited to acquired disorders of gastric pacemaker or secondary to
autonomic nervous systems (e.g. diabetic neuropathy), musculature problems (systemic
sclerosis, amyloidosis) or drugs like opiates, CCB. The main symptoms are recurrent vomiting
and early satiety.