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Vomiting

Vomiting is a complex reflex act in which involuntary ejection of the contents of the stomach out; due to the excitement of the emetic center.

Vomiting consists of a series of sequential movements. First, the pylorus closes and the pyloric part of the stomach contracts. This causes an overflow of the bottom of the stomach and the opening of its cardial part. The contents of the stomach enters the esophagus and is pushed out under the influence of tension in the abdominal muscles and movements of the respiratory muscles.

The emetic center is located in the bottom of the fourth ventricle of the brain and is excited by impulses emanating from the gastrointestinal tract and other areas of the body. In most cases, vomiting is preceded by nausea (see).

There are vomiting of central and visceral origin, as well as hematogenous-toxic and vomiting of pregnant women.

Vomiting of central origin is caused by organic diseases of the brain and its membranes (meningoencephalitis, tumors and brain injuries), disorders of cerebral circulation; irritation or damage to the organs of balance (the cerebellum or the labyrinth); emotional disorders. Vomiting also occurs when seeing any objects that cause aversion (conditioned reflex vomiting).

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Vomiting of visceral origin occurs when stomach receptors are irritated as a result of various chronic and acute diseases, as well as damage to other organs: the heart (myocardial infarction), gall bladder, uterus and its appendages, appendix, etc., as a result of reflex effects with these organs on the stomach.

Hematogenous toxic vomiting is caused by irritation of the vomiting center by toxic substances circulating in the blood. They can enter the body from the outside (carbon monoxide, chlorine , vomiting and other medicinal substances) or form in the body itself with functional insufficiency of the liver, kidneys, deep metabolic disorders in infectious diseases.

Pregnant vomiting can be an early symptom of toxemia. It is usually accompanied by nausea and drooling. With a slight toxicosis of pregnancy, vomiting occurs periodically (in the morning) and is caused by food intake or unpleasant odors. With severe toxicosis of pregnancy, vomiting becomes more or less constant (indomitable) and can occur even at night. There is a violation of carbohydrate-fat metabolism until the appearance of acetone bodies (see) in the urine and blood.

Diagnostic value is the time of the onset of vomiting. Vomiting on an empty stomach is observed in chronic gastritis , in people suffering from alcoholism, in hypersecretion of gastric juice. Vomiting 10-15 minutes after eating is characteristic of acute gastritis and gastric ulcer , after 4-6 hours. after eating - for paravokal ulcers.

Of particular importance is the questioning of patients about the number and nature of vomitus. The presence of food eaten in the vomit, eaten the day before, and sometimes in 2–3 days, is characteristic of the pyloric stenosis (narrowing). The number of vomit can be very scarce (in the morning vomiting suffering from alcoholism) or, on the contrary, very abundant (in case of pyloric stenosis).

The smell of emetic masses, as a rule, is sour; during the processes of decay in the stomach, it is putrid; in case of intestinal obstruction and in the presence of a fistula between the stomach and the large intestine, vomit smells of feces .

The disappearance of pain after vomiting is characteristic of gastric ulcer. During an attack of liver colic vomiting does not relieve pain.

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The diagnostic value is the admixture of blood to the vomit masses (see Hematemesis ), pus (phlegmonous gastritis ).

Esophageal vomiting, occurring with diverticula and narrowing of the esophagus, is in small portions of food and is combined with regurgitation .

Treatment should be aimed at eliminating the underlying disease. Measures should be taken to stop or at least reduce vomiting if it is persistent in nature. The gag reflex is inhibited by the phenothiazine series (chlorpromazine 1 ml of a 2.5% solution intramuscularly), pipolfen 2 ml of a 2.5% solution intramuscularly. Abortion is indicated only in severe toxemia.

Of great importance is the care of patients during vomiting, especially in seriously ill and unconscious patients, since aspiration of vomit into the respiratory tract can cause mechanical asphyxiation (see), aspiration pneumonia . If the condition of the patient allows, it should be given vomiting to give him a sitting or reclining position on the side with the head tilted down. It is very important to support the head of the patient. If the patient during vomiting should remain in the supine position, then it is necessary to turn his head to the side and hold it in this position until the vomiting stops. At the end of vomiting, the patient is allowed to rinse the mouth with water, for weak patients, the oral cavity should be cleaned with a wet swab. When vomiting in an unconscious state requires the introduction of a mouthpiece expander.

Vomiting (emesis, vomitus) is a complex reflex act caused by stimulation of the vomiting center caused by changes in the external environment (motion sickness, irritation of the visual or olfactory receptors) or irritations coming from the internal environment of the body (diseases of the gastrointestinal tract, liver, kidneys, etc. ). In most cases, vomiting is preceded by nausea (see).

The emetic center, located, according to most physiologists, in the lower part of the IV ventricle, is directly activated by afferent impulses that occur in the gastrointestinal tract and other areas of the body. Afferent fibers of the gag reflex arc are mainly composed of nn. vagus, splanchnicus (from the abdominal organs) and n. glossopharyngeus (from the root of the tongue and throat), as well as nn. phrenicus, opticus, olfactorius, vestibulares. Efferent fibers pass through n. phrenicus (to the diaphragm) and through nn. spinales (to the muscles of the abdominal wall). The emetic center is also under the influence of the cerebral cortex.

Depending on the reasons that caused the gag reflex, distinguish vomiting of nervous and visceral origin, as well as hematogenous-toxic vomiting.

The first group includes vomiting associated with an organic disease of the brain or its membranes, disorders of cerebral circulation; vomiting caused by irritation or damage to the organs of balance - the cerebellum or ear labyrinth; psychogenic vomiting, occurring in acute emotional disorders, conditioned reflex vomiting, which occurs at the sight or even at the presentation of any objects of disgust.

The second group includes vomiting caused by irritation of the mucous membrane of the stomach, intestinal lesions, gallbladder and liver, inflammation of the peritoneum, internal genital organs of a woman, kidney damage, irritation of the root of the tongue, pharynx, pharynx.

Hematogenous toxic vomiting occurs under the influence of toxic substances circulating in the blood. They can enter the body from the outside (carbon monoxide, chlorine, emetic and other medicinal substances) or form in the body itself with functional insufficiency of the liver, kidneys, deep metabolic disorders, infectious diseases.

The time of onset of vomiting, its connection with food intake, pain during vomiting, the number and nature of vomiting masses have a diagnostic value.

Fasting vomiting is observed in chronic gastritis in alcoholics and hypersecretion. Vomiting 10–15 minutes after a meal is characteristic of acute gastritis, ulcers, and stomach cancer at certain sites of the tumor. Vomiting after 4-6 hours after eating occurs with peri-ulcer ulcer.

The smell of vomit sour, with the processes of decay in the stomach - putrid, with intestinal obstruction and with a fistula between the stomach and large intestine - fecal. In the latter case, the vomit contains an admixture of feces, whereas in case of intestinal obstruction, the fecal odor is associated with the decomposition of the contents of the small intestines and its reflux into the stomach. Of the impurities that are found in vomitus, blood is of diagnostic importance (see Hematemesis), pus (phlegmonous gastritis), fecal masses. Damage to the digestive organs is the most common cause of vomiting.

Esophageal vomiting (vomitus oesophagealis) occurs in diverticula and narrowing of the esophagus. Often vomiting accompanies kidney, urinary tract, and genital organs. Diseases of the pleura, pericardium, and cardiac abnormalities are also often accompanied by vomiting.

Vomiting is a very common symptom in a number of diseases of the nervous system (encephalitis, meningitis, tumors, concussion, hemorrhage and other disorders of the cerebral circulation). In functional disorders of the nervous system, vomiting can also be observed - nervous (vomitus nervosus) and hysterical (vomitus hystericus).

Often vomiting accompanies many infectious diseases. However, it can be a single, only at the beginning of the disease (typhus, erysipelas, scarlet fever). In severe forms of many infectious diseases (smallpox, typhoid fever, sepsis, cerebrospinal meningitis), in cases of poisoning, anuria, migraine, and especially vomiting in toxicosis of pregnancy sometimes takes a very persistent protracted nature - the so-called indomitable vomiting (hyperemesis).

Vomiting can be observed during an acute attack of glaucoma in one or both eyes, crises in endocrine diseases (Addison's disease, diffuse toxic goiter), as well as in extensive burns, traumatic and surgical shock.

There is no specific treatment for vomiting. It should be directed to the underlying disease. Measures should be taken to stop or at least reduce vomiting if it is persistent in nature and adversely affects the general condition of the patient.

In case of food poisoning, the stomach is washed with a 2% solution of sodium bicarbonate or a 1% solution of potassium permanganate; an isotonic solution of sodium chloride is poured under the skin. To suppress the reflexogenic impulses that can come from the stomach, anesthesin is administered orally at 0.25–0.5 g 3 times a day or candles (Papaverini hydrochlorici 0.04, Anesthesini 0.2, Butyri Cacao 2.0; 1 candle 2-3 times a day), Novocain 0.25 or 0.5% solution by mouth in 20 ml several times a day. In addition, with persistent vomiting, a cold is prescribed to the stomach and antiemetics, in particular aminazin 2.5% solution (25–50 mg intramuscularly 2 times a day), subcutaneous infusions of isotonic sodium chloride solution.

With uremia, the stomach is washed with 2% sodium bicarbonate solution, duodenal intubation is performed to pump out as much bile as possible, alkaline drinking is prescribed, drip enemas with 2% sodium bicarbonate solution, subcutaneous infusions of isotonic sodium chloride solution and 5% glucose solution. With an increase in intracranial pressure, 20 ml of 40% glucose solution is injected intravenously, 5 ml of 25% solution of magnesium sulfate is injected intramuscularly, sometimes lumbar puncture is performed.