Nausea and Vomiting

Vomiting
• Highly integrated and complex reflex involving
both autonomic and somatic neural pathways
• Ejection of gastric contents due to synchronous
ontraction of the diaphtagm, intercostal muscles
and abdominal muscles which raises intra-
abdominal pressure in combination with
relaxation of the LES
• Generally associated with nausea, retching,
salivation, anorexia. .
• IMPORTANT: distinguish true vomiting from
regurgitation
Main Causes of Vomiting
Mechanism of Vomiting
Clinical Characteristics of Vomiting
• Nausea and vomiting in the morning with
ejection of mucoid material or GI secretions
due to direct activation of CRTZ: pregnancy,
drugs, toxins, metabolic disorders
• Vomiting of partially digested food: gastric
outlet obstruction or gastroparesis
• Pseudovomiting: ejection of undigested food:
achalasia, Zenker’s diverticulum
• Biliary vomiting: following multiple,
recurrent epysodes of vomiting
• Fecaloid vomiting: intestinal obstruction,
• Vomiting without nausea or retching:
endocranial hypertension
Anti-emetic drugs
• Metoclopramide and Clebopride: central anti-
D2 + agonistic of peripheral 5-HT4 receptors
• Aloperidol: anti-D2 and anti-M1 central
• Ondansetron, Dolasetron: anti 5-HT3 at
CRTZ + prokinetic gastric effect
• Cannabinoids (Nabilone): CB1 receptor
• Cisapride, Tegaserod: agonistc effect on
peripheral 5-HT4 receptors
• Eritromycin: antagonist of motilin receptors