Vomiting

Overview

Vomiting is forcing the contents of the stomach up throughout the mouth. To remove the either non-toxic or harmless substance from the body after ingestion is called emesis. In detail, Vomiting is a violent act in which the stomach has to overcome the pressure that in place to keep food and secretion within the stomach.

The stomach almost reflexes itself inside out –forcing into the lower portion of the oesophagus during emesis episodes.

Vomiting is a cause is food poisoning and gastritis head injury, brain cancer.

Nausea is the discomfort felt before emesis but not all nausea results in emesis.[5]

Vomiting Accomplished By- 

Emesis is accomplished by a fierce, downward contraction of the diaphragm muscles. At the same time, the abdomen muscles tighten against a relaxed stomach with an open gastro-esophageal sphincter. The content of the stomach is propelled up and out.

Vomiting Reflex-

As a part of the body reflex person may produce excessive saliva just before the emesis. It is a complex, coordinated reflex orchestrated by the emesis center of the brain.

That response to brain signals coming from; –

• The mouth, stomach, also intestine.
• The bloodstream, which may contain medicine or infections.
• The balancing system in the ear (morning sickness).
• The brain itself, including unsettling sights, smells or thought.[5]

Indian epidemiology then other

Causes of Vomiting:

Alcoholism

Drugs i.e.:

• NSAIDs
• Antibiotics
• Digoxin
• Cytotoxins

Infections i.e.:

• Hepatitis
• Gastroenteritis
• Urinary tract infection

Metabolic i.e.:

• Diabetic ketoacidosis
• Addison’s disease
• Cyclical vomiting syndrome

Psychological

CNS disorders i.e.:

• Vestibular neuronitis
• Migraine
• Raised intracranial pressure
• Meningitis

Gastroduodenal i.e.:

• Peptic ulcer disease
• Gastric cancer
• Gastroparesis

Uraemia

The acute abdomen i.e.:

• Appendicitis
• Cholecystitis
• Pancreatitis
• Intestinal obstruction [1]

Mechanism:

• Vomiting is usually three phases of reflex mechanism, which everyone reading this has to experience. Nausea, Retching, or emesis.

NAUSEA i.e.- 

• The first steps of nausea in most cases. However, in some cases, nausea may be absent.
• An unpleasant sensation and difficult to psychic experience that immediately pre-cedes emesis.
• Associated with decreased gastric motility and increase tone in the small intestine.

RETCHING i.e.-

• The second stage call dry heaves or reaching. There is follow nausea.
• Without any expulsion of gastric content can occurs without any vomiting but usually generating the negative pressure that leads to emesis.

VOMITING i.e.-

• The final stage is vomiting when the gastric and often small intestine content propel up to and out of the mouth.
• It results from a highly coordinated serious event that could describe as the following series of steps.
• A deep breath take the glottis is closed and the larynx raise to open the upper esophageal sphincter.
• Also, the soft palate elevate to close off the posterior nares. Additionally, The diaphragm is contracted downward and opening of the gastric cardiac.[5]

Risk factors are things that make you more likely to develop a disease in the first place.

Pathogenesis refers to the development of a disease. It’s the story of how a disease gets started and progresses.

This is the entire journey of a disease, encompassing the cause but going beyond it.

Pathophysiology of Vomiting:

Vomiting is so many sources of having to vomit centre:

1. The chemoreceptor trigger is the base of the fourth ventricle has numerous dopamineD2 receptors,serotonin5-HT receptors, opioid receptors, acetylcholine receptors, and receptors for substance p.stimulation of the different receptor are involved in the different pathway leading to emesis, in the final common pathway substance appears involved.
2. The vestibular system, which sends information to the brain via control nerve-VIII (Vestibulocochlear nerve), plays a major role in motion sickness and is rich in muscarinic receptorand histamine H1 receptors.
3. The cranial nerve X (vagus nerve) is activated when the pharynx is irritated, leading to a gag reflex.
4. The vagal and enteric nervous system inputs transmit information regarding the state of the gastrointestinal system irritation of the GI mucosa by chemotherapy, radiation, distention, or acute infections gastroenteritis activates the 5HT receptors of these inputs.
5. The CNS mediates vomiting that arises from psychiatric disorders and stress from higher brain centres.

Other factors

• The vomiting act encompasses three types of output initiated by the chemoreceptors trigger zone, motor parasympathetic nervous system, and sympathetic nervous system they are follows
• Increased salivation to protect tooth enamel from stomach acids. Excessive emesis leads to dental erosions. This is part of PNS.
• The body takes a deep breath to avoid aspirating vomit.
• Retro peristalsis starts from the middle of the small intestine and sweeps up digestive tract contents into the stomach, through the relaxed pyloric sphincter.
• Intracranial pressure lower (by inspiration against a closed glottis) coupled with an increase in abdominal pressure as the abdominal muscles contract, propels stomach contents into the oesophagus as the lower oesophageal sphincter relaxes. the stomach itself does not contract in the process of vomiting except for at the angular notch nor is there any retro peristalsis in the oesophagus.
• It ordinarily preced by retching

SNS response

• Emesis also initiates an SNS response causing both sweating and increase heart rate.
• The neurotransmitter that regular vomiting poorly understand but inhibitors of dopamine, histamine, e, and serotonin all use to suppress Emesis, suggesting that these play a role in the initiation or maintenance of a vomiting cycle. vasopressin and neurokinin may also participate.[5]

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• Increase saliva production
• Involuntary expulsion of food from the mouth and nose
• Uneasy feeling
• Nausea
• Stomach upset
• Dizziness
• Anxiety [5]

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If you need to see a doctor for vomiting, they will take your medical history and perform a physical exam to try to find the underlying cause. A history of your medication will be taken to see if vomiting is a side effect.[3]

Lab tests

Your doctor may use the following lab tests:

• Blood tests– show signs of anemia, dehydration, inflammation, infection, and liver
• Urine tests show signs of dehydration, infection, and kidney[6]

Upper GI endoscopy:

Your doctor may perform an upper GI endoscopy to look for problems in your upper digestive tract that may be causing nausea and vomiting.[6]

Imaging tests:

A doctor may perform one of more of the following imaging tests:

• Ultrasound of the abdomen.
• Gastric emptying test, also called gastric emptying scintigraphy.
• A radiologistcan then measure how quickly the stomach empties after the meal. Additionally, Health care professionals perform gastric emptying tests only between episodes.
• Upper GI series.
• MRI scanor CT scan of the brain.[6]

Complications are what happen after you have a disease. They are the negative consequences of the disease process.

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Centrally Anti-Emetics-

1. Dopamine D2receptor Antagonist-: Haloperidol
2. Sedative Hypnotics-: Barbiturates, Benzodiazepines

Central and Peripheral Anti-Emetics-

• Anticholinergics-: e.g. Atropine, Hyoscine, Dicyclomine.
• Antihistamine -: e.g. Cyclizine, Meclizine, Promethazine
• 5-HT3 Receptor Antagonist-: e.g. Ondansetron, Granisetron.
• Tranquilizers -: e.g. Domperidone, Phenothiazines, Chlorpromazine, Prochlorperazine, Haloperidol.
• Accelerators of gastric emptying-: e.g. Metoclopramide, Domperidone, Cisapride.
• Neurokinin Receptors antagonists – e.g. Aprepitant, Fosaprepitant.

Peripheral Anti- Emetics-                   

1. Demulcents-: e.g. Gum Acacia, Gum Tragacanths.
2. Adsorbent and Astringent-:  e.g. Aluminium Hydroxide, kaolin, Bismuth Carbonate.
3. Gastric Mucosal Anesthetics-: e.g. Chlorobutane, Oxethazaine

Drug Acting by Removing Spasm-

1. Relieving Myogenic Spasm-: e.g. Volatile oils, spirits, camphor menthol.
2. Relieving Neurogenic Spasm-: e.g. Atropine, Hyoscine, propantheline.[5]

Non-Pharmacologic:

The nonpharmacologic method is used to manage nausea and vomiting they are following types i.e.

1. Acupressure
2. Hypnosis
3. Acupuncture
4. Muscles relaxation Technique
5. Distraction
6. Behaviour Therapy [5]

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Homeopathic Treatment

Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines are selected after a full individualizing examination and case-analysis, which includes the medical history of the patient, physical and mental constitution, family history, presenting symptoms, underlying pathology, possible causative factors etc.

What Homeopathic Doctors Do?

A miasmatic tendency (predisposition/susceptibility) is also often taken into account for the treatment of chronic conditions. A homeopathy doctor tries to treat more than just the presenting symptoms. The focus is usually on what caused the disease condition? Why ‘this patient’ is sick ‘this way’.

The disease diagnosis is important but in homeopathy, the cause of disease is not just probed to the level of bacteria and viruses. Other factors like mental, emotional and physical stress that could predispose a person to illness are also looked for.

No a days, even modern medicine also considers a large number of diseases as psychosomatic. The correct homeopathy remedy tries to correct this disease predisposition. The focus is not on curing the disease but to cure the person who is sick, to restore the health.

Homeopathic medicines

If a disease pathology is not very advanced, homeopathy remedies do give a hope for cure but even in incurable cases, the quality of life can be greatly improved with homeopathic medicines.

The homeopathic remedies (medicines) given below indicate the therapeutic affinity but this is not a complete and definite guide to the homeopathy treatment of this condition.

The symptoms listed against each homeopathic remedy may not be directly related to this disease because in homeopathy general symptoms and constitutional indications are also taken into account for selecting a remedy.

Homoeopathic Medicines:

Ipecacuanha:

• For prolonged vomiting, this homeopathy medicine is a good cure.
• Especially in pregnancy associated with belching and excessive saliva.
• This is also useful when watching moving objects for prolonged periods of induces vomiting.
• There may be associated with abdominal painafter a meal.

Carbo Vegetalis:

• If the vomiting is associated with indigestion, heartburn, flatulence, also a bloated feeling, carbo vegetables can be the ideal remedy.
• Either Food regurgitation or GERD with a sour taste in the mouth is a good indicator of using this remedy.
• There is gas in the stomach which causes distention and burping, especially in children, also this remedy is very useful in such cases.

Arsenicum Album:

• If food poisoning is the cause, then this is the best homeopathic remedy especially for vomiting.
• There is a burning sensation in the stomach along with thirst, and small frequent sips of water are beneficial.
• The stools are dark, small in amount, and have a foul smell. The person is chilly, exhausted, also anxious.

Ignatia:

• Vomiting is brought on by emotional stressors, associated with depression, and trying to curb this feeling.
• The person may be crying also have mood swings and sleeplessness.
• This homeopathic remedy Ignatia can use in children who may complain of a lump in the throat.
• In children especially, everything that is said will be taken very personally.

Nux Vomica:

• In the case of vomiting and diarrhea homeopathic remedies Nux Vomica helps relieve nausea associated with gas and bloating
• It is especially useful in pregnancy where the person can be irritable and impatient and have vomiting after eating and in the morning.
• There is a constant sense of retching. Children who have eaten too much food can treat with this remedy.
• The child could also have stomach pain, headache, and irritability.

Antimonium crudum:

• The tongue coat with a white layer and vomiting occurs soon after eating or drinking.
• There could be a history of eating indigestible foods or an overloaded stomach.

Aethusa: 

• If a child is vomiting curd-like material followed by exhaustion, the solution of Aethusa homeopathic is good in this condition.
• The hungry child eats and goes through the bout of nausea, also the cycle repeats.[2]

• Drink plenty of liquids to avoid dehydration.
• Adhere to a clear liquid diet to rest the stomach.
• Avoid strong odours, including food and cooking smells, perfume, and smoke, that could possibly trigger vomiting.
• When you begin eating solid food again, stick to bland foods that are easily digestible, like cereal, rice, and crackers.
• Avoid spicy and fatty foods.[3]

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1]Book of Davidsons Medicine 21th

2] https://www.lybrate.com/topic/homeopathic-remediesforvomiting/b18c375cc64d237c53c0ad2b41d49c50

3]https://www.everydayhealth.com/vomiting/guide/

4]Chamberlain_s_Symptoms_and_Signs_in_Clinical_Medicine_13th_medibos_blogspot_com_(1)_(1)

5] https://medicoiq.com/what-is-vomiting-and-their-causes-symptoms/

6] https://www.niddk.nih.gov/health-information/digestive-diseases/cyclic-vomiting-syndrome/diagnosis#:~:text=Doctors%20use%20lab%20tests%2C%20upper,pattern%20or%20cycle%20of%20symptoms.

Frequently Asked Questions

What is Vomiting?

Vomiting in contrast, is a highly specific physical event that results in the rapid, forceful evacuation of gastric contents in retrograde fashion from the stomach up to and out of the mouth.

Homeopathic Medicines used by Homeopathic Doctors in treatment of Vomiting?

• Ipecacuanha
• Carbo Vegetalis
• Arsenicum Album
• Ignatia
• Nux Vomica
• Antimonium crudum

What are reasons of Vomiting?

• Alcoholism
• Drugs
• Infections
• Metabolic
• Psychological
• Vestibular neuronitis
• Migraine
• Peptic ulcer disease
• Gastric cancer
• Gastroparesis
• Uraemia

What are the symptoms of Vomiting?

• Increase saliva production
• Involuntary expulsion of food from the mouth and nose
• Uneasy feeling
• Nausea
• Stomach upset
• Dizziness
• Anxiety