Constant Vomiting – Causes of the Condition. Doctor Komarovsky: what to do if a child is vomiting

Nausea and vomiting represent two similar, often accompanying protective phenomena, which are provided by nature as reflexes that are not amenable to conscious control. Nausea and vomiting are designed to cleanse the digestive tract of substances that are harmful, according to the body, despite the fact that these substances may not enter the bloodstream from the intestines. So, for example, there is medical practice examples of how a person feels sick and vomits from certain specific smells, tastes and even colors. Nausea and vomiting can be symptoms of a variety of diseases.

Externally, vomiting is an uncontrolled eruption of stomach contents through the mouth, and in some cases through the nose. Absolutely all reflexes, which also include vomiting, are pathways that carry the command-impulse to the organs that execute it, such as the muscles of the diaphragm, stomach, rib cage. Vomiting can be caused by irritation of any part of the reflex pathway. All components reflex path do not have to be involved. Understanding this fact necessary to find out the reason for the vomiting.

The frequency of vomiting depends on many factors, such as age, gender, and individual characteristics of a person. For example, women suffer from vomiting more often than men, and children (especially in adolescence) more often than adults. Also, more often than in others, vomiting occurs in people with a tendency to “sickness,” as well as with increased nervous excitability.

Causes of vomiting

The causes of vomiting may be the following:
1. Gastrointestinal diseases:
spicy surgical diseases: peritonitis, acute pancreatitis, acute intestinal obstruction, bleeding in the gastrointestinal tract, acute cholecystitis;
chronic diseases: gastritis, peptic ulcer of the stomach and duodenum, enterocolitis, duodenitis, cholelithiasis;
developmental anomalies of the gastrointestinal tract: narrowing of the pylorus (stenosis), fusion of a section of the gastrointestinal tract (atresia), defects in the development of the pancreas;
infections of the gastrointestinal tract: viral infections, food toxic infections, helminthiases,
foreign bodies of the stomach, esophagus, intestines,
functional disorders that are accompanied by impaired motor function of the intestines and stomach.
2. CNS diseases: brain tumors and injuries, brain infections (encephalitis, meningitis), increased intracranial pressure.
3. Diseases of cardio-vascular system: hypertonic disease, heart failure, myocardial infarction.
4. Diseases inner ear: Meniere's disease, labyrinthitis.
5. Diseases endocrine system: in diabetes mellitus – ketoacidosis, thyrotoxicosis, adrenal insufficiency, phenylketonuria.
6. Side effect medicines and penetration of toxic substances into the body.
7. Psychogenic reactions: fear and anxiety, hysteria, as an expression of some emotions - habitual vomiting.
8. Vomiting and nausea may be the result of motion sickness.
9. Vomiting often occurs in women in the first trimester of pregnancy, during toxicosis (gestosis).

Vomiting and nausea occur in many diseases. As a rule, nausea precedes vomiting, and vomiting gives the patient a feeling of relief. But this does not always occur, so the presence or absence of nausea is one of the main criteria for diagnosis.

Vomiting in children

IN childhood vomiting can be a reaction to many types of infections, nasopharyngeal diseases. This is due to the fact that the mechanisms of the occurrence and inhibition of gag reflexes in this age interval have not yet been fully formed. Vomiting in children can often be a consequence of negative emotional reactions. Vomiting in infants should not be confused with regurgitation of a small part of food after feeding, and vice versa: copious and frequent regurgitation after feeding must be distinguished from vomiting, which is associated with pathology of the intestines and stomach.

Vomiting in infectious diseases

In a group of diseases such as acute intestinal infections, vomiting in most cases is accompanied by symptoms of intoxication: weakness, fever, pain in joints and muscles. In many cases, vomiting precedes diarrhea or these symptoms occur at the same time. In such cases, vomiting brings a feeling of relief to the patient. TO similar diseases relate: food poisoning, salmonellosis, cholera, yersiniosis. In addition, vomiting may be present with helminthic infestations.

In the group of acute general infections, almost every acute infectious disease includes signs of intoxication, often - especially when it comes to young children - accompanied by vomiting (in most cases one-time) and diarrhea.

As for infectious diseases of the brain and its membranes, it should be noted that when the membranes of the brain are damaged, severe vomiting, severe headache are added to the signs of general intoxication, and subsequently confusion and convulsions may be observed. A distinctive feature of such vomiting is that it is not preceded by nausea, and after it the patient does not feel relief.

Vomiting blood

An important factor when establishing the causes of vomiting, it is contents of vomit. For example, if they constantly contain red blood, this indicates the presence of bleeding from the upper parts of the stomach (Malory-Weiss syndrome), esophagus or pharyngeal vessels. The blood that reacts with gastric juice will be colored brown (“ coffee grounds"). If there is an admixture of such blood in the vomit, this indicates the presence of bleeding from the stomach or, in more rare cases, from the duodenum.

Vomiting blood may indicate bleeding from a stomach or duodenal ulcer; in patients diagnosed with liver cirrhosis, bleeding from dilated veins of the esophagus. If there is foam in the vomit with blood, this is in most cases a sign of pulmonary hemorrhage.

With erosive gastritis, vomiting with a slight admixture of blood is also possible.

Vomiting with bile

If the vomit is colored in yellow or green color and have a bitter taste, we can say that it is bile. The presence of bile in the vomit may indicate two facts: 1) either it was simply thrown into the stomach, 2) or we are talking about duodenal obstruction. Only in a small percentage of cases, vomiting can be mixed with helminths, pus (stomach phlegmon), and foreign bodies.

Time of vomiting

The cause of vomiting can also be judged by knowing the time of its (vomiting) appearance. Vomiting that occurs in the morning occurs in pregnant women, with alcoholic gastritis and brain diseases. If vomiting occurs in the afternoon, it may be associated with diseases accompanied by impaired evacuation of gastric contents. With peptic ulcers and gastritis, vomiting occurs after eating.

Smell of vomit

The smell of vomit can be used to judge not only the processes occurring in the gastrointestinal tract. For example, sour smell vomiting may indicate a peptic ulcer or other processes with increased acid formation. If food stagnates in the stomach, there will be rotten smell of vomit. In case of intestinal obstruction, vomit is characterized by smell of feces. When consuming surrogates of alcohol or technical liquids, vomiting will have a characteristic smell of chemicals. At renal failure vomit smells like ammonia and for diabetes mellitus - acetone.

Examination of a patient with vomiting

If the diagnosis is based on the symptom of vomiting, it is necessary to use, in addition to the traditional detailed questioning of the patient, instrumental and laboratory methods research:
clinical blood test. It is needed in order to find out the nature of the disease (whether it is infectious or some other).
blood chemistry. It will help assess the function of almost any organ, find out the level of glucose in the body, as well as the level of metabolic products.
fibrogastroduodenoscopy necessary to exclude diseases of the stomach, esophagus and duodenum.
radiography of the gastrointestinal tract with the use of radiopaque agents. Using this procedure, it is possible to identify diseases throughout the gastrointestinal tract.
additional diagnostic methods: CT scan, ECG, ultrasound examinations.

Treatment of vomiting

To get rid of vomiting, you first need to identify the cause that caused it. For the symptomatic treatment of vomiting, various groups of drugs are used:
for mild vomiting: antipsychotics (etaperazine, haloperidol), tranquilizers (phenozepam, diazepam);
for vomiting caused by diseases of the inner ear, use antihistamines (dimenhydrinate, promethazine hydrochloride).

At symptomatic treatment Dopamine antagonists have the greatest effect (cerucal, metoclopramide). Similar to drugs in this group cisapride(stimulant of motor function of the gastrointestinal tract) has a large peripheral effect, in addition, it lacks some side effects metoclopramide.

For vomiting caused by chemotherapy during oncological diseases, serotonin receptor antagonist drugs are used (granisetron, ondansetron, tropisetron).

To avoid dehydration and impairment electrolyte balance for frequent vomiting, saline solutions are used: for internal use - rehydron, for intravenous administration – Ringer's solution.

Folk remedies for treating vomiting

Treat vomiting with remedies traditional medicine at home it is recommended using herbal decoctions:
calming effect: lemon balm, valerian, mint,
calming and antispasmodic effect on the gastric mucosa: dill, chamomile.

Until the cause of vomiting is determined, you should refrain from eating. If a child starts vomiting, do not self-medicate, seek help from a doctor.

Vomiting is a response to the process of excitation of a specific center of the medulla oblongata. This irritation of a part of the brain occurs due to the penetration of poisons, or reflexively from the organs. Nausea is usually a precursor to vomiting.

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Vomiting may accompany:

pathological processes of the gastrointestinal tract;
cerebrovascular accidents;
thrombosis of blood vessels of internal organs;
tumor neoplasms;
acute kidney diseases;
toxicosis (gestosis) of the first half of pregnancy;
infectious (most often intestinal) diseases;
diseases of the visual organs;
vestibular disorders;
acute forms of myocardial infarction;
drug overdose, drug incompatibility.

The patient initially experiences nausea, excessive salivation, and increased breathing. Then the diaphragm and the stomach section descend, passing into the 12 duodenum, begins to contract in the opposite direction (antiperistalsis), the upper “floor”, on the contrary, relaxes. Spasms of the diaphragm begin, pressure in the stomach cavity increases, and the glottis closes. After this, an eruption of gastric contents occurs through the esophagus into the oral cavity.

The patient turns pale, has a cold, sticky sweat, and often becomes dizzy and severe weakness, blood pressure may drop. - this is a sensation arising from irritation of the vagus and splanchnic nerves. Excitation from them is transmitted to the vomiting center and from it the impulse goes to the organs that are involved in vomiting.

In fact, vomiting is a specific symptom, but depending on the causes of its occurrence and a number of other factors, it has many varieties and characteristics of its course.

Features of vomiting:

vomiting not accompanied by nausea is characteristic of problems with the brain;
vomiting with severe headache is a sign of migraine;
Vomiting in the morning is typical for poisoning.

Signs of vomiting in pathological changes in the digestive tract

It begins with attacks of nausea, sometimes with accompanying pain.

Esophageal vomiting

Begins without nausea, in a lying position or when bending forward. Occurs due to retention and accumulation of food in the esophagus.

Food vomiting is typical for the following diseases:

narrowing of the esophagus (tumor, post-burn, ulcerative);
achalasia cardia (spasmodic tension of the lower esophagus);
diverticula of the esophagus (bag-like protrusions of the walls);
insufficiency of the sphincter (the muscle that compresses the passage from the esophagus to the stomach).

According to the timing of occurrence, the following are distinguished:

early vomiting that occurs while eating, with pain in the chest. It is provoked by eating solid foods due to problems in the esophagus;
late vomiting, which appears 3-4 hours after eating (a sign of severe dilation lower sections esophagus);
mixed. Occurs with ulcerative esophagitis (inflammation of the esophagus with ulcers).

Sometimes there is night vomiting. Complicated by getting into the respiratory tract.

Signs of vomiting in diseases of the stomach and duodenum

Gastric vomiting makes itself felt almost immediately after a heavy meal, in case of pathology of the duodenum - after 2-3 hours.

Note:A distinctive feature is relief immediately after vomiting and a decrease in pain.

A narrowed opening of the outlet (pyloric) section of the stomach (with cicatricial changes) causes frequent, voluminous vomiting with undigested food that has been in the stomach for several days, with a putrid odor.

If vomiting is repeated frequently and contains remnants of recently eaten food, then a spasm of the lower part of the stomach should be suspected. Occurs in case of poisoning with toxins, acute ulcerative process in the stomach, diseases and dyskinesia of the bile ducts, neuroses.

In cases of acute gastritis, patients often complain of vomiting - repeated, with pain in the epigastric region, which brings relief. Chronic gastritis very rarely accompanied by vomiting.

Signs of vomiting when

Vomiting begins with the occurrence of severe, spasmodic and paroxysmal pain in the abdominal area of a diffuse nature. Intestinal obstruction in the upper sections - the cause of vomiting bile. Obstruction localized in parts of the large intestine is manifested by fecal vomiting. The patient has a similar complaint when there is a passage (fistula) between the adjacent stomach and a loop of the large intestine.

Acute can also cause vomiting, especially if there is severe pain and elevated temperature.

The peritoneal arteries are accompanied by vomiting of blood.

With peritonitis (inflammation of the peritoneum), repeated vomiting and fever are observed, bringing relief each time.

Vomiting, which can be caused by diseases of the liver, pancreas, gallbladder and ducts

With these diseases, vomiting is often repeated and is accompanied by pain in the area of the right hypochondrium. Patients experience yellowness of the skin and sclera of the eyes, especially after breaking the diet and eating fatty foods. Diseases with focal changes gallbladder, ducts, cause bile vomiting.

Acute pancreatitis is manifested by simultaneous vomiting and paroxysmal pain in the upper abdomen. During an attack, vomiting of blood may begin, often of an indomitable nature.

The infection often occurs with vomiting and fever, accompanied by pain in the right hypochondrium, enlarged liver, and the development of yellowness of the skin in patients.

Vomiting in endocrine diseases

In severe forms there may be diabetic comas. These are serious complications of this disease that require immediate help. Vomiting is a frequent accompaniment of this pathology.

Chronic adrenal insufficiency and hyperparathyroidism are also characterized by the presence of vomiting.

Poisoning

Intoxications arising from various reasons in humans (infectious diseases, poisoning by industrial and household poisons) can cause vomiting and diarrhea without fever or with various types of fevers.

Important:In any case of intoxication, vomit is subject to mandatory laboratory testing.

Phenomena indicating cerebral vomiting

Occurs as a result of injuries and diseases of the brain, blood vessels and surrounding tissues. An increase in pressure in the diploic veins of the skull (intracranial pressure) gives characteristic vomiting with intense headaches that occur in the morning, when trying to get up or simply turning the head while lying down. These signs may be accompanied by disturbances in the functioning of the heart and breathing. Possible loss of consciousness (Bruns syndrome).

Vomiting and fever are characteristic of inflammatory diseases of the brain and membranes - and. In these cases, intense pain in the head also occurs, specific neurological symptoms, which are determined by a neurologist. The development of paresis and paralysis is possible.

Meniere's disease is accompanied by damage to the vestibular apparatus with attacks of dizziness, hearing loss and periodic vomiting.

Many people suffering periodically experience a sharp increase in blood pressure and a deterioration in their condition, accompanied by nausea and vomiting.

How to artificially induce vomiting

For some diseases and conditions, it is necessary to be able to induce vomiting yourself. In case of overeating, poisoning, or consumption of poor quality food or water, it may be necessary to empty the contents of the stomach by inducing forced vomiting.

Most often used traditional way– pressure on the root of the tongue with two fingers or a spoon. To make the procedure easier, it is better to drink a solution of manganese. It is prepared from a small amount of crystals potassium permanganate and a liter of warm, boiled water. The solution must be stirred until a pink, uniform color is obtained. Then drink it and stimulate vomiting. The solution helps to rinse the stomach well and cleanse it. It also relieves discomfort during vomiting.

For the same purpose, you can use a solution of salt and soda in water (1 teaspoon per liter). Drink in one gulp and empty your stomach. In most cases there is relief.

Vomiting in children

Vomiting in a child is a common symptom that accompanies many childhood diseases.

As in adults, it happens:

psychogenic;
organic (caused by diseases).

In newborns in the first months of life, vomiting may occur due to excess food intake. It is often accompanied by swallowing air.

Note:sometimes “chewing gum” occurs - regurgitation with repeated swallowing (rumination). Regurgitation differs from vomiting in the absence of muscle tension.

Vomiting in children is accompanied by:

diseases of the gastrointestinal tract;
infectious diseases;
poisoning;
heart and vascular diseases;
pathology nervous system.

A child may have cases of vomiting and diarrhea without fever of unknown etiology or as the first (single) symptoms of an incipient disease.

Important:requires a mandatory determination of the cause - vomiting of bile. In children it is a sign of serious illness.

What to do about vomiting in children? The answer is in the video review:

Emergency measures and treatment methods for vomiting

The volume and nature of assistance must be taken into account depending on the reasons that caused vomiting.

Most cases require immediate gastric lavage by inducing artificial vomiting. It is strictly contraindicated to administer antiemetic drugs to the patient.

If there is blood in the vomit, then lavage of the stomach is prohibited. The patient can be given small pieces of ice for oral administration; it is better to place an ice bubble on the epigastric region. Urgent hospitalization in a supine position is required.

Subcutaneous atropine or metaclopramide can be used to stop vomiting. For indomitable vomiting, antipsychotics (etaperazine, meterazine, haloperidol) are prescribed.

Treatment of repeated vomiting with severe dehydration is supplemented with intravenous drip isotonic solution, glucose, other drugs.

Such patients are subject to hospitalization.

Lotin Alexander, radiologist

Quite often, adults and children experience such unpleasant phenomena as nausea and vomiting. Babies especially suffer from this - any change in diet, stress or injury can cause them to regurgitate everything they eat. In most cases, vomiting goes away after a while if you follow a certain diet. But if it happens more often than every hour, lasts more than a day, or children suffer from it, then a doctor must be called. And since most often his visit may be delayed, it is necessary to provide first aid to the patient. Especially parents of small children should know what to do if they vomit before the doctor arrives. After all, it is very important that the child does not suffer and complications do not arise.

Why does vomiting occur?

A condition where the stomach suddenly empties through the mouth can occur for various reasons. Vomiting is complicated physiological process, associated with the work of the stomach, liver, vestibular apparatus and brain. That's why various disorders in the work of these organs it can be caused by:

the most common cause of vomiting is poisoning from poor-quality food, unusual foods or medications;
infectious diseases of the gastrointestinal tract almost always cause gastric emptying through the mouth;
ARVI, otitis, pneumonia and even a simple cough can also;
emptying of the stomach through the mouth can occur with gastritis, ulcers, or problems with the liver or intestines;
brain injuries and concussions are also often accompanied by vomiting;
Some particularly sensitive people and children react this way to severe stress.

Why is vomiting dangerous?

You don't always need to try to stop this condition. In most cases, vomiting is associated with toxins, poisons, or infections entering the gastrointestinal tract. In this way, the body tries to get rid of them. If vomiting is stopped artificially with the help of any drugs, general intoxication may develop. But it is necessary to help the patient, since such a condition can cause severe dehydration of a person. With vomit, the patient loses a lot of fluid, which is especially dangerous for children. Therefore, it is important to know what to do when vomiting in order to alleviate the patient’s condition and prevent dehydration. Such gastric emptying can also be dangerous in small children and unconscious patients, as they may choke.

Vomiting without fever or diarrhea

What to do if indigestion is not accompanied by fever and dyspepsia? The most possible explanation for this condition is poisoning from poor-quality food, chemicals, overeating or reaction to medications. Most often in this case, vomiting occurs without fever and diarrhea. What to do if this happens?

The main thing is to remove toxins and prevent dehydration. To do this, you need to rinse your stomach as quickly as possible by drinking at least two liters of water. It should be boiled and lukewarm. To prevent dehydration, drink as much as possible more water. This is especially important for children. To restore the water and mineral balance of the body, you need to drink a solution of "Regidron".

What to do if vomiting occurs frequently, causes noticeable inconvenience, but is not caused by poisoning? This can be understood by the absence of abdominal pain and symptoms of intoxication. Before the doctor arrives, you should take a Cerucal tablet, which suppresses the gag reflex.

What to do when vomiting

If gastric emptying occurs more often than every hour, it is advisable to call a doctor. Before his arrival, first aid must be provided to the patient. The easiest case is when there is vomiting without fever. What to do about this?

put the patient in bed, preferably on his side;
Drink small portions of water, tea or unsweetened compote as often as possible;
Powders containing potassium and magnesium salts “Regidron” or “Oralin” will help alleviate the patient’s condition; if it is not possible to purchase them, then you need to dilute a teaspoon of salt and sugar in a liter of boiled water;

It is recommended to drink activated carbon - 1 tablet per 10 kilograms of weight;
You can put ice on your stomach;
for nausea, if there is no strong urge to vomit, it is recommended to sniff mint essential oil or ammonia.

At intestinal infections diarrhea, vomiting and fever are observed. What to do in this case? Before the doctor arrives, you can drink enterosorbent - activated carbon or Polysorb. It is permissible to start taking antiseptics that do not irritate the gastrointestinal tract, for example, Enterol or Ersefuril.

What not to do

If vomiting is frequent, accompanied by pain, diarrhea or fever, and if there is a suspicion of an infectious disease or head injury, then you should definitely call a doctor. Before he arrives you cannot:

There is;
take antibiotics and other chemotherapy drugs;
take painkillers or anti-inflammatory medications;
apply a heating pad to your stomach.

Vomiting in a child

If this happens once and is not accompanied by other symptoms, there is nothing to worry about. This can happen if a child is teething, tried unfamiliar food, tried to swallow a large piece, was very frightened of something, or was injured. But most often, such gastric emptying occurs during acute intestinal infections and other diseases. In this case, the child appears. What should you do if this happens?

you must call a doctor immediately;
the child needs to be put to bed, but immediately when vomiting, he should be sat down or turned over on his side;

do not leave the baby alone;
after vomiting, wipe your lips and face, preferably rinse your mouth;
It is very important for the child to drink a lot: give 2-3 sips every 10 minutes;
if the baby is an infant, then you need to put him to the breast as often as possible;
It is better to feed the child with glucose-salt solutions, which can be purchased at the pharmacy or made independently.

Some surgical diseases, for example appendicitis, lead to the following: What to do in this case? You need to call immediately ambulance. Before she arrives, you should put the child to bed, give him a little something to drink, and you can put a heating pad with ice on his stomach.

Diet for vomiting

Whatever the reasons for this condition, it is advisable to refuse to eat on the first day. This is especially important in case of poisoning. You just need to drink a lot: water, tea, rosehip decoction, dried fruit compote, or To restore the loss of minerals, prepare a glucose-saline solution.

What is needed for this?

boil 100 grams of raisins in a liter of water for at least half an hour, rub through a sieve and strain;
add a teaspoon of salt, half a spoon of soda and 3-4 tablespoons of sugar to the broth;
Boil the mixture for 2-3 minutes and cool.

When vomiting becomes less frequent, you can gradually start eating. It's best to eat mashed potatoes, dried bread, oatmeal or rice porridge with water or boiled lean meat. You can eat bananas and applesauce. Meals should be fractional, that is, small portions, but frequent. It's not advisable to eat if you don't feel like it.

What medications can be given?

The most important thing is to prevent dehydration and mineral loss. To do this, you need to drink water-salt solutions: "Regidron", "Citroglucosolan" or "Oralin".
To make it easier for the body to cope with possibly ingested toxins, enterosorbents are needed. For these purposes, activated carbon, "Polysorb", "Polyphepan", "Filtrum Sti", "Smecta" or "Lignosorb" are used.

With intestinal infections, frequent diarrhea and vomiting are observed. What to do in this case? Before testing, you can start taking intestinal antiseptics or antimicrobial biologicals. They are active against most bacteria and do not suppress the immune system. It is best to use Ersefuril, Biosporin, Baktisubtil or Enterol.
Probiotics help with infections and poisoning from vomiting. It is best to use "Linex", "Hilak Forte", "Primadofilus" or "Bifidumbacterin".
In case of stress, motion sickness or allergies, you can take depressant drugs - "Cerucal" or "Motilium". But they are contraindicated for intestinal infections and poisoning.

Vomiting is a complex reflex act necessary to remove toxic substances from the stomach, but it can occur due to various functional, organic disorders. It is often preceded by nausea. These symptoms accompany all kinds of pathologies gastrointestinal tract, endocrine and nervous systems and even infectious diseases (especially in children). To get rid of these unpleasant manifestations, it is necessary to determine the type of nausea and vomiting (this will help determine the cause), and then the doctor will prescribe the appropriate treatment.

Why does vomiting and nausea occur?

Sometimes nausea occurs due to irritation of the vestibular apparatus. So, it is this process that underlies seasickness.

Most often, nausea precedes vomiting, but it happens that vomiting occurs without unpleasant sensation lump rolling up to the throat. Sometimes after nausea there is no vomiting. These painful symptoms arise due to the activation of the vomiting center, and the stimulus is not only pathological processes, but also:

disgusting sensations (gustatory, visual, olfactory);
irritation of the vestibular apparatus and interoreceptors (motion sickness).

Also, a special chemoreceptor zone, the trigger zone, is interconnected with the vomiting center. Toxins that enter the stomach stimulate chemoreceptors, the signal from which enters the trigger zone. It releases mediators and stimulates the vomiting center, from which impulses are sent to the abdominal muscles. They contract and push the contents of the stomach out. The stomach itself does not take part in the reflex act.

This is far from full list all those functional disorders and pathologies accompanied by vomiting and nausea. These unpleasant symptoms can even be psychogenic, arising due to strong emotional experiences, nervous overstrain. That is why, in order to accurately determine the cause, it is necessary to undergo an examination.

What are vomiting and nausea?

With pathology of the digestive tract, vomiting occurs, as a rule, as a result of eating heavy, fried, fatty foods, and the patient usually feels relief after vomiting.

Nausea and vomiting most often occur due to pathologies of the gastrointestinal tract, dysfunction of the autonomic nervous system and the appearance of toxins in the blood. There are different types of these painful manifestations:

visceral;
central origin;
hematogenous-toxic.

The clinical manifestations of these types of vomiting are different. For differential diagnosis You need to pay attention to the following signs:

When vomiting occurs. Its appearance is provoked by certain foods (for example, fatty foods); it appears in the morning or at any time of the day, regardless of meals, or immediately after meals. For example, with damage to the subcardial part of the stomach, vomiting begins soon after eating, and with pyloric pathology - after 2–2.5 hours.
Nausea can be an independent symptom or precede vomiting. Sometimes, to alleviate the condition, patients themselves induce vomiting. In some diseases, vomiting is not preceded by nausea. For example, severe vomiting that occurs without the feeling of its approach indicates an increase in intracranial pressure.
Does the patient's condition improve after vomiting?
Character of vomit. It is necessary to determine their acidity, whether they contain impurities of bile, blood or undigested food.
Clinical, laboratory and instrumental signs of the underlying disease. The patient is sent to take a blood and urine test. If gastrointestinal pathology is suspected, it is recommended. For vomiting of central origin, a study of the nervous system (nystagmus, fundus examination) is necessary.

A thorough examination and questioning of the patient helps the clinician most accurately determine the type and cause of vomiting and nausea:

Esophageal vomiting that occurs during a stricture is not preceded by nausea. It appears after eating and is not abundant. The vomit contains undigested pieces of food; it has an alkaline or neutral environment.
Gastric. It is usually preceded by nausea. Appears 1-1.5 hours after eating, at the height of digestion. Vomit is acidic and contains partially digested pieces of food. The presence of blood in them, as a rule, indicates. After vomiting, the patient feels relief. In case of tumors of the stomach and esophagus, the vomit is putrid in nature.
With pyloric stenosis, vomit is neutral or alkaline. They contain a large number of undigested and partially digested food eaten the day before (food leftovers can even be from food eaten the day before the attack). In this case, vomiting is profuse.
Due to impaired patency of the duodenum, bile is detected in the vomit. Especially if the pathology arose distal to the nipple of Vater.
Visceral vomiting caused by liver pathology bile ducts, renal colic, does not alleviate the patient's condition.
Vomiting of central origin occurs at altitude due to increased intracranial pressure. It often occurs without preceding nausea and does not alleviate the patient’s condition.
Hematogenous-toxic vomiting, especially in children under one year of age, is one of the main symptoms infectious disease. It is accompanied by an increase in temperature and the presence of other signs (for example, cough, runny nose or acute respiratory infections).

It should be remembered that vomiting is not only a painful symptom of the disease. It can lead to serious consequences:

Prolonged vomiting causes dehydration, alkalosis, and cardiac dysfunction.
Intense – causes rupture of the esophagus and other serious consequences.
In children of the first year of life, vomiting can cause death.

That's why there are many different pills for nausea and vomiting. But the doctor will prescribe them after he determines the type of these unpleasant symptoms and the reason why they arose.

Conclusion

Vomiting and nausea are a reflex act necessary to protect the body from poisoning, because it is not without reason that it is caused by unpleasant taste and olfactory sensations. It occurs when there is a disorder of the vestibular apparatus, but most often indicates the presence pathological process. A specialist will determine which one. If these unpleasant and painful symptoms appear, consultation with a therapist or gastroenterologist is necessary.

In case of vomiting of central origin, you need to be examined by a neurologist, or less often by a psychiatrist. If there is a suspicion of acute myocardial infarction, the help of a cardiologist will be required. And these specialists will determine why nausea and vomiting occurred and how to get rid of them.

Minor ailments are not uncommon during pregnancy. Some of them are caused by a change in your condition, others may be caused by negative environmental influences.
Nausea and vomiting, which are caused by early toxicosis, accompany most pregnancies to one degree or another. These phenomena are unpleasant, but if they do not lead to malnutrition expectant mother, she is not losing weight, her body is not in danger of dehydration due to frequent vomiting, this condition does not require medical intervention.

Most experts consider morning sickness to be completely normal occurrence, accompanying the onset of pregnancy, since it is quite explainable by the restructuring that has begun in the woman’s body. Active production of hormones, increased load on the liver of the expectant mother - all this is the cause of morning sickness. As a rule, the condition of the expectant mother improves significantly by the 10-12th week of pregnancy, when the placenta begins to function.

Complications. Severe vomiting can lead to the development of dehydration and disturbances in electrolyte metabolism (usually hypokalemia and metabolic alkalosis), and is relatively rarely accompanied by ruptures of the esophagus - partial (Mallory-Weiss syndrome) or complete (Boerhaave syndrome). Long-term vomiting can lead to malnutrition, weight loss, and metabolic disorders.

Causes of nausea and vomiting

Nausea and vomiting occur when the vomiting center is irritated. Direct causes can affect the gastrointestinal tract or central nervous system or be observed as part of systemic diseases.

The most common reasons:

Gastroenteritis.
Impact of drugs.
Exposure to toxins.

Cyclic vomiting syndrome (CVS) is a relatively rare disorder characterized by severe, repeated attacks of vomiting or nausea alone that occur at varying intervals; however, during the period between attacks it is not possible to detect any structural changes. This disorder is most often observed in children ( average age onset - 5 years), with a tendency to develop remission as they grow older. SCR in adults is often associated with long-term use of marijuana (hemp extract).

Nausea (nausea) and vomiting (vomitus) most often occur by a neuroreflex pathway with irritation of the stomach, especially the pyloric region, and the nearest organs - the beginning of the duodenum and jejunum, lower segment of the esophagus, pharynx in acute gastritis, esophagitis and pharyngitis (morning mucous vomiting of alcoholics), etc. Impaired movement of food and chyme, stagnation and reverse peristalsis especially often lead to nausea and, to a certain extent, appropriate vomiting. Vomiting of pure gastric juice is characteristic of peptic ulcer disease, especially of duodenal ulcer, which brings relief and is often artificially induced by the patient himself; further vomiting occurs when the pylorus narrows, occurring rarely (as opposed to irritable vomiting with acute gastritis), usually once a day, and emptying the stomach of stagnant masses. Reflex vomiting is observed in diseases of various organs, primarily the intestines and peritoneum with appendicitis, helminthic infestation, with colic - hepatic, renal, uterine, tubo-ovarian. Vomiting can also be of central nervous, including cortical, origin, with toxic irritation of the vomiting center (uremia, poisoning with alcohol, carbon monoxide, digitalis, sulfonamides, apomorphine, ipecac; however, with uremia, alcoholism, the effect of sulfonamides, the local stomach irritation), with increased intracranial pressure (tumors, meningitis, acute blood supply to the meninges), with damage to the semicircular canals. Cerebral vomiting is characterized by the absence of nausea, which is probably more closely associated with antiperistalsis of the stomach and intestines. Habitual nervous vomiting without anatomical changes can reach an indomitable degree and lead to death from exhaustion and self-poisoning. Vomiting in pregnant women probably occurs with the participation of endocrine changes (the effect of the pituitary gland on the stomach) and nervous factors. Reflex and central nervous vomiting is more easily caused in women and children, especially with frequent repetition of vomiting. The practical diagnostic meaning of nausea and vomiting, as well as treatment methods, can be very different in each individual case.

Causes of vomiting without nausea:

Intracranial tumors.
The patient is asked if he suffers from headaches or double vision; check whether the gait is impaired.
Increased intracranial pressure.
Important signs: nystagmus, nipple swelling optic nerve, pathology of the cranial nerves.
Encephalitis.
Meningitis.
Migraine.
Periodic vomiting.
Vomiting usually recurs at intervals of 2-3 months and occurs in children, adolescents or young adults. It is often accompanied by migraine. With such vomiting, beta blockers sometimes help.

The vomiting center is located in medulla oblongata close to the centers that control breathing and salivation (for this reason, vomiting is combined with hyperventilation and increased salivation). The center receives signals from the chemoreceptors of the trigger zone located in the bottom of the fourth ventricle, in the area postrema. The area postrema is supplied with blood from the posterior inferior cerebellar artery, and there is no blood-brain barrier here.

The trigger zone is the site of action of some medicines, vomiting In addition, it receives information from the stomach, intestines, gall bladder, peritoneum and heart via afferent fibers:

The feeling of nausea appears to be formed by the passage of impulses along the same pathways responsible for the feeling of satiety, so nausea is usually accompanied by anorexia.
It is necessary to distinguish vomiting from belching (the latter occurs without effort, i.e. without the participation of muscles that provide gagging movements; it usually gives a sour or bitter sensation in the mouth and is not accompanied by nausea).

Medicines that cause nausea and vomiting

Opiates, digoxin, levodopa, ipecac, cytotoxic agents (act on the chemoreceptor trigger zone).
Antibiotics (tetracyclines, metronidazole, erythromycin). Sulfonamides (including mesalazine).
Acetylsalicylic acid, NSAIDs (damage the gastric mucosa and can stimulate the vomiting center through ascending afferent influences).
Alcohol (acts directly through the chemoreceptor trigger zone and due to its damaging effect on the gastric mucosa).

Symptoms and signs of nausea and vomiting

The following signs are especially important:

signs of hypovolemia;
headache;
signs of peritoneal irritation;
bloating, severe tympanitis. Interpretation of results. Many signs are characteristic of certain causes of vomiting.

If vomiting occurs through a short time After taking a drug or toxic substance or sudden changes in body position, in the absence of significant changes according to neurological examination and abdominal assessment, vomiting can most likely be explained by these factors. The same applies to cases of pregnancy - in the absence of pathology according to the examination. With the acute development of vomiting and diarrhea in an initially practically healthy patient and the absence of significant changes according to examination data, the likelihood of infectious gastroenteritis is high; further examination can be delayed.

Vomiting that occurs when thinking about food or is not associated in time with eating suggests psychogenic cause, the same is indicated by the presence of a history of functional nausea and vomiting in the patient himself or his family members. You should ask the patient in more detail, because... he himself may not be aware of this connection or may not even admit that he was experiencing a state of stress.

Examination. All women of childbearing age should have a urinary pregnancy test. In case of severe vomiting, vomiting lasting more than 1 day, or signs of dehydration according to the examination data, a laboratory research(in particular, assess the content of electrolytes, urea nitrogen, creatinine, serum glucose, perform a urine test, and in some cases, liver tests). If there are signs of alarm, the examination plan is based on the corresponding clinical manifestations.

Chronic vomiting usually requires the following laboratory tests, as well as upper gastrointestinal endoscopy, x-ray examination small intestine, studies of gastric emptying and anthro-duodenal motility.

Examination for nausea and vomiting

Deciding on the list of blood tests is usually simple; their set is based on the medical history, as well as on the results of the examination carried out before:

IN general analysis blood tests sometimes reveal anemia. The development of iron deficiency is possible with peptic ulcer disease or malignant tumors with ulceration, as well as with pathology of the small intestine, an increase in MCV is typical for situations with alcohol abuse, deficiency of vitamin B 12 or folic acid.
The concentration of urea and electrolytes can change both due to vomiting (at the same time the content of K +, Na + decreases, hyperchloremic metabolic alkalosis develops), and due to the underlying primary kidney dysfunction - it is advisable to check the calcium concentration, as well as determine biochemical indicators of liver function. To rule out acute pancreatitis, blood is immediately sent to determine amylase activity.
Upper gastrointestinal endoscopic examination may aid in diagnosis, especially if performed to rule out peptic ulcer or other changes in the mucous membrane, bile reflux. Endoscopy provides little information for diagnosing functional disorders. In this regard, X-ray contrast examination is much more effective; it helps to detect stasis in the upper gastrointestinal tract and narrowing.

Anamnesis. History of present illness helps clarify the frequency of vomiting episodes and their duration; association with possible precipitating factors, such as exposure to drugs or toxins, traumatic brain injury, body movements (traveling by car, plane, ship, riding a merry-go-round); the presence in the vomit of bile (bitter taste, yellow-green color) or blood (red color, “coffee grounds”). To the important associated symptoms include abdominal pain, diarrhea. It is necessary to evaluate the time of the last bowel movement and passing of gas, the presence of headache and/or systemic dizziness (vertigo).

Assessment of the state of various systems is aimed at identifying signs of conditions that may be accompanied by vomiting, for example, amenorrhea and swelling of the mammary glands (during pregnancy), polyuria and polydipsia (with diabetes), hematuria and pain in the lateral abdomen (with urolithiasis).

A medical history can help identify conditions that may be accompanied by vomiting, such as pregnancy, diabetes, migraines, liver or kidney disease, cancer (the timing of chemotherapy or radiation therapy should be established), and previous abdominal surgery (which may cause of adhesive obstruction). It is necessary to clarify what medications and substances the patient took during Lately; certain substances may not show toxic effect for several days (eg, acetaminophen, mushroom poisons).

Indications of recurrent vomiting in other family members should be taken into account.

Physical examination. When assessing vital signs, note the presence of fever and signs of hypovolemia (tachycardia and/or hypotension).

On general examination, the presence of jaundice and skin rash should be noted.

When examining the abdomen, you need to pay attention to bloating and scars after previous operations; assess the nature of peristaltic noises (normal, increased); perform percussion to assess tympanitis; upon palpation, evaluate pain, signs of irritation of the peritoneum (symptom of muscle protection, rigidity, the phenomenon of “rebound pain” (Shchetkin-Blumberg symptom)), the presence of space-occupying formations, an increase in the size of organs, hernias. Rectal examination and transvaginal examination (in women) reveal local tenderness, mass formations and bleeding.

A neurological examination evaluates consciousness, the presence of nystagmus, signs of meningism (Kernig and Brudzinski's symptoms), ophthalmological symptoms characteristic of increased intracranial pressure or subarachnidal hemorrhage (retinal hemorrhage).

Make your life easier

First of all, find out what taste sensations and smells cause the most violent reaction in your body. Most expectant mothers react negatively to the smell of gasoline, cigarette smoke, various perfumes and detergent flavors, as well as the smell of fried food and the aroma of freshly brewed coffee. Avoid “meetings” with them, spend time in a well-ventilated area, and perhaps nausea will not bother you during the day.

In order to make the morning less gloomy - and, as you know, attacks of nausea most often occur in the morning, on an empty stomach - follow a certain ritual of getting up. The best remedy to alleviate your condition now it will be light breakfast in bed. Ask someone from your family to look after you or take care of yourself - in the evening, put a plate of crackers or corn flakes, put an apple. These foods are usually well accepted by the stomach and do not cause nausea. Choose those foods that are pleasant to you: it could be a light fruit salad, yogurt or boiled eggs.

Throughout the day you should eat small meals 5 to 6 times. Drink more fluids - many women benefit from sour fruit juices diluted half and half with water, although you may prefer slightly salted tomato juice. It helps to relieve nausea by rinsing your mouth with mint infusion or water with a small amount of lemon juice.

Look for your remedy - a small mint candy, a slice of lemon or a crust rye bread can be a real salvation.

The increased load on the liver requires special attention to this body. Nowadays, animal proteins must be present in your diet. Eat lean meat, cottage cheese and mild cheese. Avoid broths, fried, fatty and spicy foods, and canned foods.

To alleviate your condition, your doctor may recommend that you take vitamin B6. Antioxidants such as vitamin E, ascorbic acid and beta-carotene (take only as prescribed by a doctor!). And here additional dose You don’t need iron yet; moreover, iron-containing drugs can increase the manifestations of toxicosis.

At home, you can prepare infusions of herbs that have a beneficial effect on the mucous membrane of the digestive system and the functioning of the stomach, liver and bile ducts: valerian root, peppermint, calendula and chamomile flowers will help.

Aromatherapy can also help, for example, the beneficial effects of the smell of ginger on women have been proven.

Treatment for nausea and vomiting

Identified diseases and dehydration are treated. Even in the absence of severe dehydration, intravenous infusion(1 l 0.9% saline solution; in children - at a dose of 20 ml/kg body weight), which often helps to reduce symptoms. In adults, various antiemetic drugs are effective (Table 7-6). The choice of one or another remedy depends on the underlying cause and severity of vomiting.

Typically used:

for seasickness (motion sickness): antihistamines and/or scopolamine in the form of a patch;
with light and moderate severe symptoms: prochlorperazine or metoclopramide;
for severe, refractory vomiting and vomiting during chemotherapy: 5-HT3 receptor antagonists.

If vomiting continues, it is necessary to prescribe drugs parenterally.

With psychogenic vomiting, establishing a trusting relationship with the patient involves understanding the discomfort that he experiences and joint efforts to relieve symptoms, whatever their cause. Remarks like “you’re fine” or “it’s an emotional problem” should be avoided. A short trial of symptomatic therapy with antiemetics may be given. During long-term follow-up of the patient, regular follow-up visits to the doctor help resolve the underlying problem.

Causes of vomiting not related to pain

Infectious:

Viral gastroenteritis.
Food poisoning; Possibly HP related infection. Infections of other localizations, including inflammatory diseases urinary tract and pneumonia in the elderly.
Viral labyrinthitis.

Mechanical obstruction:

Pyloric stenosis, duodenal obstruction due to stomach or pancreatic cancer. Esophageal carcinoma.
Biliary reflux, especially if you have had previous gastric surgery or gastroenterostomy.

Alcoholic gastritis:

A common cause of belching in the early morning hours. The belching is usually not profuse, often mixed with blood.

Acute liver failure:

For example, with an overdose of paracetamol (paracetamol poisoning), acute fatty liver in pregnant women

Metabolic reasons:

Addison's disease (if such a suspicion arises, efforts are directed to the search for postural hypotension, pigmentation of the mucous membranes).
An increased or normal K content is especially important, since vomiting typically reduces the concentration of potassium in the blood.
The possibility of hypercalcemia, uremia and hyperthyroidism must be considered.
Up to 30% of patients diabetes mellitus From time to time, episodes of nausea and vomiting are noted.

Many medications are prescribed for nausea and vomiting. They must be used with caution, keeping in mind that they all have side effects.

Basic provisions

In many cases, the causes of vomiting are obvious; examination of the patient does not reveal significant abnormalities; Only symptomatic treatment is sufficient.
There is a need to be alert to the possibility of the syndrome acute abdomen and dangerous craniocerebral pathology.
Patients of childbearing potential should be assessed for possible pregnancy.