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{{ClinPsy}}
  
{{ClinPsy}}
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'''This is a background article.''' For the psychological fear of vomiting See [[Emetophobia]]
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{{SignSymptom infobox |
  
{{SignSymptom infobox |
 
Name = Vomiting |
  
Name = Vomiting |
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ICD10 = R11 |
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ICD10 = {{ICD10|R|11||r|10}} |
 
ICD9 = {{ICD9|787}} |
  
ICD9 = {{ICD9|787}} |
 
}}
  
}}
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'''Vomiting ''' (also '''throwing up''' or '''emesis''') is the forceful expulsion of the contents of one's [[stomach]] through the [[mouth]]. '''Vomiting''' may result from many causes, ranging from [[gastritis]] or [[Poison|poisoning]] to [[brain tumor]]s, or elevated intracranial pressure (ICP). The feeling that one is about to vomit is called [[nausea]]. It usually precedes vomiting, but it does not always lead to vomiting. [[Antiemetic]]s are sometimes necessary to suppress nausea and vomiting, and in severe cases where [[dehydration]] develops, [[intravenous]] fluid may need to be administered.
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'''Vomiting ''' (also called '''throwing up''' or '''emesis''') is the forceful expulsion of the contents of one's [[stomach]] through the [[mouth]] and sometimes the [[nose]]. '''Vomiting''' may result from many causes, ranging from [[gastritis]] or [[poison]]ing to [[brain tumor]]s, or elevated [[intracranial pressure]] (ICP). The feeling that one is about to vomit is called [[nausea]]. It usually precedes, but does not always lead to vomiting. [[Antiemetic]]s are sometimes necessary to suppress nausea and vomiting, and, in severe cases where [[dehydration]] develops, [[intravenous]] fluid may need to be administered to replace fluid volume.
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[[Image:49-aspetti di vita quotidiana, vomito,Taccuino Sanitatis, Ca.jpg|thumb|300px|14th century illustration of vomiting from the Casanatense [[Tacuinum Sanitatis]]]]
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The medical branch investigating vomiting, emetics and antiemetics is called '''emetology'''.
  
The medical branch investigating vomiting, emetics and antiemetics is called '''emetology'''.
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Vomiting is different from regurgitation, although the two terms are often used interchangeably. Regurgitation is the return of undigested food (that has not yet reached the stomach) back up the [[esophagus]] to the [[mouth]]. The causes of vomiting and regurgitation are generally different.
   
 
==Mechanism==
  
==Mechanism==
 
=== Vomiting center ===
  
=== Vomiting center ===
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Vomiting is coordinated in the vomiting center in the lateral medullary reticular formation in the [[medulla oblongata|medulla]]. Receptors on the floor of the [[fourth ventricle]] of the brain represent a [[chemoreceptor trigger zone]], stimulation of which can lead to vomiting. The chemoreceptor zone lies outside the [[blood-brain barrier]], and can therefore be stimulated by blood-borne drugs that can [[Vomiting#Emetics|stimulate vomiting]], or [[Vomiting#Antiemetics|inhibit it]].
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Vomiting is coordinated in the vomiting center in the lateral medullary [[reticular formation]] in the [[pons]]. Receptors on the floor of the [[fourth ventricle]] of the brain represent a [[chemoreceptor trigger zone]], stimulation of which can lead to vomiting. The chemoreceptor zone lies outside the [[blood-brain barrier]], and can therefore be stimulated by blood-borne drugs that can [[Vomiting#Emetics|stimulate vomiting]], or [[Vomiting#Antiemetics|inhibit it]].
   
 
There are various sources of input to the vomiting center:
  
There are various sources of input to the vomiting center:
 
*The chemoreceptor trigger zone at the base of the fourth ventricle has numerous [[dopamine receptors|dopamine D<sub>2</sub> receptors]], [[5-HT receptor|serotonin 5-HT<sub>3</sub> receptors]], [[opioid receptor]]s, [[Acetylcholine receptor]]s, and receptors for [[substance P]]. Stimulation of different receptors are involved in different pathways leading to emesis, in the final common pathway substance P appears to be involved.<ref>Hornby PJ. Central neurocircuitry associated with emesis. Am J Med 2001;111:106S-12S. PMID 11749934.</ref>
 
*The chemoreceptor trigger zone at the base of the fourth ventricle has numerous [[dopamine receptors|dopamine D<sub>2</sub> receptors]], [[5-HT receptor|serotonin 5-HT<sub>3</sub> receptors]], [[opioid receptor]]s, [[Acetylcholine receptor]]s, and receptors for [[substance P]]. Stimulation of different receptors are involved in different pathways leading to emesis, in the final common pathway substance P appears to be involved.<ref>Hornby PJ. Central neurocircuitry associated with emesis. Am J Med 2001;111:106S-12S. PMID 11749934.</ref>
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*The vestibular system which sends information to the brain via [[cranial nerve VIII]] (vestibulocochlear nerve). It plays a major role in [[motion sickness]] and is rich in [[Muscarinic acetylcholine receptor|muscarinic receptors]] and [[histamine receptors|histamine H<sub>1</sub> receptors]].
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*The vestibular system which sends information to the brain via [[cranial nerve VIII]] (vestibulocochlear nerve). It plays a major role in [[motion sickness]] and is rich in [[Muscarinic acetylcholine receptor|muscarinic receptors]] and [[histamine receptor|histamine H<sub>1</sub> receptors]].
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*[[Vagus nerve|Cranial nerve X]] (vagus nerve), which is activated when the pharynx is irritated, leading to a gag reflex.
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*[[Vagus nerve|Cranial nerve X]] (vagus nerve), which is activated when the [[pharynx]] is irritated, leading to a gag reflex.
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*Vagal and [[enteric nervous system]] inputs that transmit information regarding the state of the [[gastrointestinal system]]. Irritation of the GI mucosa by chemotherapy, radiation, distention or acute infectious [[gastroenteritis]] activates the 5-HT<sub>3</sub> receptors of these inputs.
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*Vagal and [[enteric nervous system]] inputs that transmit information regarding the state of the [[gastrointestinal system]]. Irritation of the GI mucosa by chemotherapy, radiation, distention, or acute infectious [[gastroenteritis]] activates the 5-HT<sub>3</sub> receptors of these inputs.
 
*The CNS mediates vomiting arising from psychiatric disorders and stress.
  
*The CNS mediates vomiting arising from psychiatric disorders and stress.
   
 
=== Vomiting act ===
  
=== Vomiting act ===
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The vomiting act encompasses three types of outputs initiated by the medulla: Motor, [[parasympathetic]] nervous system (PNS) and [[sympathetic]] nervous system (SNS). Collectively, they are as follows:
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The vomiting act encompasses three types of outputs initiated by the chemoreceptor trigger zone: Motor, [[parasympathetic nervous system]] (PNS), and [[sympathetic nervous system]] (SNS). They are as follows:
   
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*Increased [[saliva]]tion to protect the [[tooth enamel|enamel]] of [[teeth]] from stomach acids (excessive vomiting leads to [[dental caries|caries]]). This is part of the PNS output.
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*Increased [[saliva]]tion to protect the [[tooth enamel|enamel]] of [[teeth]] from stomach acids (excessive vomiting leads to [[Erosion (dental)|dental erosion]]). This is part of the PNS output.
 
*[[Retroperistalsis]], starting from the middle of the [[small intestine]], sweeping up the contents of the digestive tract into the stomach, through the relaxed pyloric sphincter.
  
*[[Retroperistalsis]], starting from the middle of the [[small intestine]], sweeping up the contents of the digestive tract into the stomach, through the relaxed pyloric sphincter.
 
*A lowering of intrathoracic pressure (by inspiration against a closed [[glottis]]), coupled with an increase in abdominal pressure as the [[abdomen|abdominal muscles]] contract, propels stomach contents into the [[esophagus]] without involvement of retroperistalsis. The [[cardia|lower esophageal sphincter]] relaxes. This is part of the motor output, and it is also important to note that the stomach itself does not contract in the process of vomiting.
 
*A lowering of intrathoracic pressure (by inspiration against a closed [[glottis]]), coupled with an increase in abdominal pressure as the [[abdomen|abdominal muscles]] contract, propels stomach contents into the [[esophagus]] without involvement of retroperistalsis. The [[cardia|lower esophageal sphincter]] relaxes. This is part of the motor output, and it is also important to note that the stomach itself does not contract in the process of vomiting.
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*Vomiting is ordinarily preceded by retching.
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*Vomiting is ordinarily preceded by [[retching]].
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*Vomiting also initiates a SNS response causing both sweating and increased heart rate.
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*Vomiting also initiates an SNS response causing both sweating and increased heart rate.
   
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The [[neurotransmitter]]s that regulate vomiting are poorly understood, but inhibitors of [[dopamine]], [[histamine]] and [[serotonin]] are all used to suppress vomiting, suggesting that these play a role in the initiation or maintenance of a vomiting cycle. [[Vasopressin]] and [[neurokinin]] may also participate.
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The [[neurotransmitter]]s that regulate vomiting are poorly understood, but inhibitors of [[dopamine]], [[histamine]], and [[serotonin]] are all used to suppress vomiting, suggesting that these play a role in the initiation or maintenance of a vomiting cycle. [[Vasopressin]] and [[neurokinin]] may also participate.
   
 
==Content==
  
==Content==
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Since the stomach secretes acid, vomit contains a high concentration of [[hydronium|hydronium ion]]s and is thus strongly [[acidic]]. Recent food intake will be reflected in the gastric vomit.
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[[Gastric acid|Gastric secretions]] and likewise vomit are highly [[acidic]]. Recent food intake will be reflected in the gastric vomit. Irrespective of the content, vomit tends to be [[odor|malodorous]].
   
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The content of the ''vomitus'' (vomit) may be of medical interest. Fresh [[blood]] in the vomit is termed [[hematemesis]] ("blood vomiting"). Old blood bears resemblance to coffee grounds (as the [[iron]] in the blood is [[oxidation|oxidized]]), and when this matter is identified the term "coffee ground vomiting" is used. [[Bile]] can enter the vomit during subsequent heaves due to [[duodenum|duodenal]] contraction if the vomiting is severe. [[Fecal vomiting]] is often a consequence of [[intestinal obstruction]], and is treated as a warning sign of this potentially serious problem ("signum mali ominis"); such vomiting is sometimes called "miserere". If food has recently been consumed, then partly digested food may show up in the vomit.
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The content of the ''vomitus'' (vomit) may be of medical interest. Fresh [[blood]] in the vomit is termed [[hematemesis]] ("blood vomiting"). Altered blood bears resemblance to coffee grounds (as the [[iron]] in the blood is [[oxidation|oxidized]]), and, when this matter is identified, the term "[[coffee ground vomiting]]" is used. [[Bile]] can enter the vomit during subsequent heaves due to [[duodenum|duodenal]] contraction if the vomiting is severe. [[Fecal vomiting]] is often a consequence of [[intestinal obstruction]] or a gastro-colic fistula, and is treated as a warning sign of this potentially serious problem ("signum mali ominis"); such vomiting is sometimes called "miserere."
   
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If the vomiting reflex continues for an extended period of time with no appreciable vomitus, the condition is known as '''non-productive emesis''' or '''dry heaves''', which can become both extremely painful and debilitating.
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If the vomiting reflex continues for an extended period of time with no appreciable vomitus, the condition is known as ''non-productive emesis'' or ''dry heaves'', which can be painful and debilitating.
   
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== Complications of vomiting ==
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==Complications==
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===Aspiration of vomitus ===
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===Aspiration of vomit ===
 
Vomiting can be very dangerous if the gastric content gets into the respiratory tract. Under normal circumstances the [[gag reflex]] and [[coughing]] will prevent this from occurring, however these protective reflexes are compromised in persons under narcotic influences such as [[ethanol|alcohol]] or [[anesthesia]]. The individual may choke and [[asphyxiation|asphyxiate]] or suffer an [[aspiration pneumonia]].
  
Vomiting can be very dangerous if the gastric content gets into the respiratory tract. Under normal circumstances the [[gag reflex]] and [[coughing]] will prevent this from occurring, however these protective reflexes are compromised in persons under narcotic influences such as [[ethanol|alcohol]] or [[anesthesia]]. The individual may choke and [[asphyxiation|asphyxiate]] or suffer an [[aspiration pneumonia]].
   
 
=== Dehydration and electrolyte imbalance ===
  
=== Dehydration and electrolyte imbalance ===
 
Prolonged and excessive vomiting will deplete the body of water (dehydration) and may alter the electrolyte status. The loss of acids leads to [[metabolic alkalosis]] (increased blood [[pH]]), and the electrolyte imbalance shows [[hypokalemia]] ([[potassium]] depletion) and [[hypochloremia]] ([[chlorine]] depletion). The hypokalemia is an indirect result of the [[kidney]] compensating for the loss of acid. With the loss of intake of food the individual will become [[cachexia|cachectic]].
  
Prolonged and excessive vomiting will deplete the body of water (dehydration) and may alter the electrolyte status. The loss of acids leads to [[metabolic alkalosis]] (increased blood [[pH]]), and the electrolyte imbalance shows [[hypokalemia]] ([[potassium]] depletion) and [[hypochloremia]] ([[chlorine]] depletion). The hypokalemia is an indirect result of the [[kidney]] compensating for the loss of acid. With the loss of intake of food the individual will become [[cachexia|cachectic]].
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===Mallory-Weiss tear===
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Repeated or profuse vomiting may cause erosions to the [[esophagus]] or small tears in the esophageal mucosa ([[Mallory-Weiss tear]]). This may become apparent if fresh blood is admixed with vomit after several episodes.
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===Dental===
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Recurrent vomiting, such as observed in [[bulimia nervosa]], may lead to destruction of the [[tooth enamel]] due to the acidity of the vomit.
   
 
==Causes==
  
==Causes==
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* [[Ileus]]
  
* [[Ileus]]
 
* [[Cholecystitis]], [[pancreatitis]], [[appendicitis]], [[hepatitis]]
  
* [[Cholecystitis]], [[pancreatitis]], [[appendicitis]], [[hepatitis]]
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* Food [[allergy|allergies]]
 
* In children, it can be caused by an allergic reaction to cow's milk proteins ([[milk allergy]])
  
* In children, it can be caused by an allergic reaction to cow's milk proteins ([[milk allergy]])
   
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* [[Cerebral hemorrhage]]
  
* [[Cerebral hemorrhage]]
 
* [[Migraine]]
  
* [[Migraine]]
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* [[Brain tumor]]s
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* [[Brain tumor]]s, which can cause the chemoreceptors to malfunction
 
* [[Benign intracranial hypertension]] and [[hydrocephalus]]
  
* [[Benign intracranial hypertension]] and [[hydrocephalus]]
   
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Drug reaction (vomiting may occur as an acute [[somatic]] response to):
  
Drug reaction (vomiting may occur as an acute [[somatic]] response to):
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* [[alcohol]] (being sick whilst being [[drunkenness|drunk]] or being sick the next morning suffering from the after-effects, i.e. the [[hangover]]).
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* [[Alcohol abuse]] (being sick while being [[drunkenness|drunk]] or being sick the next morning, suffering from the after-effects, i.e., the [[hangover]]).
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* [[opioid]]s
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* [[Inhalant abuse]]
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* [[Opioid]]s
 
* [[selective serotonin reuptake inhibitors]]
  
* [[selective serotonin reuptake inhibitors]]
 
* many [[chemotherapy]] drugs
  
* many [[chemotherapy]] drugs
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* some [[entheogen|entheogens]] (such as [[peyote]] or [[ayahuasca]])
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* some [[entheogen]]s (such as [[peyote]] or [[ayahuasca]])
   
 
===Other===
  
===Other===
 
* Self-induced
  
* Self-induced
 
** [[Eating disorder]]s ([[anorexia nervosa]] or [[bulimia nervosa]])
 
** [[Eating disorder]]s ([[anorexia nervosa]] or [[bulimia nervosa]])
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** One other way is when one is feeling nauseated actually thinking repeatedly and continuously of vomiting can cause a person to do so.
  
 
** [[Sexual fetish]] ([[emetophilia]])
  
** [[Sexual fetish]] ([[emetophilia]])
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** To remove a poison in case such has been ingested (some poisons should not be vomited as they may be more toxic when inhaled or aspirated; it is generally considered better to ask for help before inducing vomiting)
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** To remove a poison in case such has been ingested (some poisons should not be vomited as they may be more toxic when inhaled or aspirated; it is, in general, considered better to ask for help before inducing vomiting)
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** Some people who are engaged in [[binge drinking]] will induce vomiting in order to make room in their stomachs for further alcohol consumption. In the United Kingdom, this practice is known as ''tactical chundering,'' and as ''boot and rally'' or ''pulling the trigger'' in the United States.
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** Some people who are engaged in [[binge drinking]] will induce vomiting in order to make room in their stomachs for further alcohol consumption. In the United Kingdom, this practice is known as ''tactical chundering,'' or ''hitting the reset button'' and as ''boot and rally'' or ''pulling the trigger'' in the United States.
 
* After [[surgery]] ([[postoperative nausea and vomiting]])
  
* After [[surgery]] ([[postoperative nausea and vomiting]])
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* Disagreeable sights or smells, such as decayed matter, others' vomit, etc.
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* Disagreeable sights, smells or thoughts (such as decayed matter, others' vomit, thinking of vomiting), etc.
 
* Extreme pain, such as intense [[headache]] or [[myocardial infarction]] (heart attack)
  
* Extreme pain, such as intense [[headache]] or [[myocardial infarction]] (heart attack)
 
* Violent emotions (including laughing)
  
* Violent emotions (including laughing)
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* [[Cyclic vomiting syndrome]] (a poorly understood condition with attacks of vomiting)
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* [[Cyclic vomiting syndrome]] (a poorly-understood condition with attacks of vomiting)
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* High doses of [[ionizing radiation]] will sometimes trigger a vomit reflex in the victim.
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* High doses of [[ionizing radiation]] will sometimes trigger a vomit reflex in the victim
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* Violent fits of [[coughing]]
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* Violent fits of [[coughing]] or [[hiccups]]
 
* [[Nervousness]]
  
* [[Nervousness]]
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==Neurobiology of vomiting==
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*[[Area postrema]]
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*[[Chemoreceptor trigger zone]]
   
 
==Related medication==
  
==Related medication==
 
===Emetics===
  
===Emetics===
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An ''emetic'', such as [[Syrup of Ipecac]], is a substance that induces vomiting when administered orally or by injection. An emetic is used medically where a substance has been ingested and must be expelled from the body immediately. Inducing vomiting can remove the substance before it is absorbed into the body. Ipecac abuse can lead to detrimental health effects.
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An ''[[emetic]]'', such as [[Syrup of Ipecac]], is a substance that induces vomiting when administered orally or by injection. An emetic is used medically where a substance has been ingested and must be expelled from the body immediately. Inducing vomiting can remove the substance before it is absorbed into the body. Ipecac abuse can lead to detrimental health effects.
   
 
===Antiemetics===
  
===Antiemetics===
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An [[antiemetic]] is a [[medication|drug]] that is effective against vomiting and [[nausea]]. Antiemetics are typically used to treat [[motion sickness]] and the [[Adverse effect (medicine)|side effects]] of some [[opioid]] [[analgesic]]s and [[chemotherapy]] directed against [[cancer]].
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An [[antiemetic]] is a [[medication|drug]] that is effective against vomiting and [[nausea]]. Antiemetics are typically used to treat [[motion sickness]] and the [[Adverse effect (medicine)|side-effects]] of some [[opioid]] [[analgesic]]s and [[chemotherapy]] directed against [[cancer]].
   
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Antiemetics act by inhibiting the receptor sites associated with emesis. Hence, anticholinergics, antihistamines, dopamine antagonists, serotonin antagonists and cannabinoids are used as anti-emetics.
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Antiemetics act by inhibiting the receptor sites associated with emesis. Hence, anticholinergics, antihistamines, dopamine antagonists, serotonin antagonists, and cannabinoids are used as anti-emetics.
   
 
==Social implications==
  
==Social implications==
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[[Image:Vomit.jpg|thumb|Vomit found on [[pavement]], suggesting unexpected vomiting occurred. Vomiting resulting from social drinking is often sudden and uncontrollable.]]
  
 
===Nausea inducement in groups===
  
===Nausea inducement in groups===
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It is quite common that when one person vomits, others nearby will become nauseated, particularly when smelling the vomit of others, often to the point of vomiting themselves. It is believed that this is an [[evolution|evolved]] trait among [[primates]]. Many primates in the wild will tend to browse for food in small groups. Should one member of the party react adversely to some ingested food it may be advantageous (in a survival sense) for other members of the party also to vomit. This tendency in human populations has been observed at drinking parties, where excessive consumption of [[alcohol]]ic beverages may result in a number of party members vomiting nearly simultaneously, this being triggered by the initial vomiting of a single member of the party. This phenomenon has been touched on in popular culture: notorious instances appear in the films ''[[The Meaning of Life]]'' (1983) and ''[[Stand by Me (film)|Stand By Me]]'' (1986), while in the computer game [[Theme Hospital]], it is referred to as a 'vomit wave' and can spread through the hospital quickly.
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It is quite common that, when one person vomits, others nearby will become nauseated, particularly when smelling the vomit of others, often to the point of vomiting themselves. It is believed that this is an [[evolution|evolved]] trait among [[primates]]. Many primates in the wild will tend to browse for food in small groups. Should one member of the party react adversely to some ingested food, it may be advantageous (in a survival sense) for other members of the party also to vomit. This tendency in human populations has been observed at drinking parties, where excessive consumption of [[alcohol]]ic beverages may result in a number of party members vomiting nearly simultaneously, this being triggered by the initial vomiting of a single member of the party.
   
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Intense vomiting in [[ayahuasca]] [[ceremony|ceremonies]] is a common phenomenon. However, people who experience "la purga" after drinking ayahuasca generally regard it as both a physical and spiritual cleanse and often come to welcome it. <ref>Shanon, B. (2002). The antipodes of the mind: Charting the phenomenology of the ayahuasca experience. (2002). Oxford: Oxford University Press.</ref> It has been suggested that the consistent emetic effects of ayahuasca — in addition to its many other therapeutic properties — was of medicinal benefit to [[indigenous people|indigenous peoples]] of the [[Amazon]], in helping to clear [[parasite|parasites]] from the gastrointestinal system. <ref>Andritzky, W. (1989). Sociopsychotherapeutic functions of ayahuasca healing in Amazonia. Journal of Psychoactive Drugs. 21(1), 77-89.</ref>
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Intense vomiting in [[ayahuasca]] [[ceremony|ceremonies]] is a common phenomenon. However, people who experience "la purga" after drinking ayahuasca, in general, regard the practice as both a physical and spiritual cleanse and often come to welcome it. <ref>Shanon, B. (2002). The antipodes of the mind: Charting the phenomenology of the ayahuasca experience. (2002). Oxford: Oxford University Press.</ref> It has been suggested that the consistent emetic effects of ayahuasca — in addition to its many other therapeutic properties — was of medicinal benefit to [[indigenous people]]s of the Amazon, in helping to clear [[parasite]]s from the gastrointestinal system. <ref>Andritzky, W. (1989). Sociopsychotherapeutic functions of ayahuasca healing in Amazonia. Journal of Psychoactive Drugs. 21(1), 77-89.</ref>
   
  ⚫
There have also been documented cases of a single ill and vomiting individual inadvertently causing others to vomit, when they are especially fearful of also becoming ill, through a form of [[mass hysteria]].
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There have also been documented cases of a single ill and vomiting individual inadvertently causing others to do so, when they are especially fearful of also becoming ill, through a form of [[mass hysteria]].
  
   
 
===Context===
  
===Context===
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Most people try to contain their vomit by vomiting into a sink, toilet, or trash can, as both the act and the vomit itself are widely considered embarrassing; vomit is also difficult to clean. On airplanes and boats, special bags are supplied for sick passengers to vomit into. Alternatively, a special disposable bag is available containing absorbent material that solidifies the vomit quickly, making it convenient and safe to keep (leakproof, puncture resistant, odorless) until there is an opportunity to dispose of it conveniently.
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Most people try to contain their vomit by vomiting into a sink, toilet, or trash can, as both the act and the vomit itself are widely considered embarrassing; vomit is also difficult to clean. On airplanes and boats, special bags are supplied for sick passengers to vomit into. A special disposable bag containing absorbent material that solidifies the vomit quickly is available, also, making it convenient and safe to keep (leakproof, puncture-resistant, odorless) until there is an opportunity to dispose of it conveniently.
   
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People who vomit chronically (e.g. as part of an [[eating disorder]] such as [[bulimia nervosa]]) may devise various ways to hide this disorder.
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People that vomit chronically (e.g., as part of an [[eating disorder]] such as [[bulimia nervosa]]) may devise various ways to hide this disorder.
   
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===In language===
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===Sound===
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According to an online study of 30 traditionally bad sounds, the sound of vomiting is the worst sound in the world.<ref>[http://www.acoustics.salford.ac.uk/news/news2.htm Acoustics audio video, University of Salford<!-- Bot generated title -->]</ref> Professor Cox of the [[University of Salford]]'s Acoustic Research Centre said that "We are pre-programmed to be repulsed by horrible things such as vomiting, as it is fundamental to staying alive to avoid nasty stuff". It is thought that the thought of disgust is triggered by the sound of vomiting to protect food from those possibly diseased nearby<ref>{{cite web | work= | title=Sound101.org |url=http://www.sound101.org/horriblesound.php?factoid=disgust}}</ref>.
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As with other physiological processes involving body wastes, vomiting has [[taboo]] aspects. This is shown by the large number of colourful [[euphemism]]s and [[dysphemism]]s for vomiting. (see: [[toilet humour]]). Reference to vomiting is often made in speech (e.g. "it makes me sick", "I need a bucket") or by gesturing to signify being disgusted by someone or something.
  
   
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===Vomit phobia===
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<!--Please only insert commonly used slang terms here; neologisms or your friends' new invention will be removed-->
  
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Vomit phobia, or [[emetophobia]], as it is also known, is the sixth-most-common phobia in the world, according to the International Emetophobia Society. In addition to the actual phobia, there are many other disorders and phobias that sufferers may be afflicted with, such as [[irritable bowel syndrome]] and [[agoraphobia]]. People with emetophobia tend to avoid eating in public, socialising, and going to parties. They may hardly eat at all, and for this reason may be diagnosed as [[anorexic]]. Emetophobes will go to extraordinary lengths to avoid vomiting or seeing someone vomit. Some emetophobics have the distinct ability to actually prevent themselves from vomiting, called "vomit continence." They are able to fight the feeling of nausea before the feeling eventually subsides.
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[[Slang]] terms for the act of vomiting include: "hurling", "throwing up", "upchucking", "booting", "puking", "ralphing", "barfing", "keeling", "chucking up", "sicking up", "tossing your cookies", "shouting groceries", "spewing", "spewing chunks", "chundering" and "boking".
  
   
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*[[Antiemetic drugs]]
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"[[Wallace and Gromit]]" has recently become [[rhyming slang]] for vomit.[http://books.guardian.co.uk/news/articles/0,,1940494,00.html]
  
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*[[Emetic drugs]]
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*[[Nausea]]
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*[[Rumination (eating)]]
   
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"Puke" and "puking" date from at least the 16th century.<ref>Concise Oxford Dictionary</ref> In ''As You Like It'', Shakespeare talks of the infant 'Mewling and puking in the nurse's arms'.
  
   
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==In other animals==
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==See also==
  +
*[[Chemoreceptor trigger zone]]
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*[[Whale]]s vomit regularly (every 7 to 10 days) as a means of the ordinary digestive process, to expel indigestible items they have swallowed.
  
  +
*[[Emetophilia]]- a paraphilia in which an individual is sexually aroused by vomiting or observing others vomit
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*The domestic [[cat]] is well known for its tendency to vomit, particularly when attempting to dislodge hairballs from its throat or upper [[gastrointestinal]] tract. Chronic vomiting in cats may indicate underlying thyroid, liver or kidney dysfunction and should be investigated by a veterinarian. [[Dog]]s also vomit often (frequently after eating grass) and are also known for eating their own vomit, a fact even cited in the Bible: [[King James Version of the Bible|KJV]] [[Book of Proverbs|Proverbs]] 26:11 "As a dog returneth to his vomit, so a fool returneth to his folly."
  
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*[[Owl]]s will expel the undigestible bones and fur of their meals as a [[Pellet (ornithology)|pellet]] after partial digestion of the nutritious parts rather than passing them through the digestive tract.
  
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*Some adult [[bird]]s regurgitate food to feed their young, triggered by a [[feather]] or a [[beak]] of their young. The food can be either incompletely digested or partially predigested, depending on the species. Some bird species may also use regurgitation as a form of defense, [[defensive vomiting|vomiting]] when wounded or molested. When an intruder or a [[predator]] comes near a [[fulmar]] on its nest, the bird vomits oil up to 3 [[foot (unit of length)|feet]] at the enemy. Larger animals, such as [[wolf|wolves]], may also regurgitate partially or undigested food to feed their young.
  
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*When in danger, the [[sea cucumber]] may eject its entire digestive tract. The animal is able to re-grow another one.
 
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*Some large mammals, including horses, cannot or rarely vomit.
  
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*Many rodents are readily killed by commercial poisons because they lack the ability to vomit, which can be problematic for some pet owners.
  
   
 
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*[http://faq.emetophobia.net/emetophobia.html Emetophobia FAQ]
  
 
*[http://www.cvsa.org.uk Cyclical Vomiting Syndrome]
  
*[http://www.cvsa.org.uk Cyclical Vomiting Syndrome]
   
 
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This is a background article. For the psychological fear of vomiting See Emetophobia


Name of Symptom/Sign:
Vomiting
[[Image:{{{Image}}}|190px|center|]]
ICD-10 R11
ICD-O: {{{ICDO}}}
ICD-9 787
OMIM {{{OMIM}}}
MedlinePlus {{{MedlinePlus}}}
eMedicine {{{eMedicineSubj}}}/{{{eMedicineTopic}}}
DiseasesDB {{{DiseasesDB}}}

Vomiting (also called throwing up or emesis) is the forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose. Vomiting may result from many causes, ranging from gastritis or poisoning to brain tumors, or elevated intracranial pressure (ICP). The feeling that one is about to vomit is called nausea. It usually precedes, but does not always lead to vomiting. Antiemetics are sometimes necessary to suppress nausea and vomiting, and, in severe cases where dehydration develops, intravenous fluid may need to be administered to replace fluid volume.

File:49-aspetti di vita quotidiana, vomito,Taccuino Sanitatis, Ca.jpg

14th century illustration of vomiting from the Casanatense Tacuinum Sanitatis

The medical branch investigating vomiting, emetics and antiemetics is called emetology.

Vomiting is different from regurgitation, although the two terms are often used interchangeably. Regurgitation is the return of undigested food (that has not yet reached the stomach) back up the esophagus to the mouth. The causes of vomiting and regurgitation are generally different.

Mechanism

Vomiting center

Vomiting is coordinated in the vomiting center in the lateral medullary reticular formation in the pons. Receptors on the floor of the fourth ventricle of the brain represent a chemoreceptor trigger zone, stimulation of which can lead to vomiting. The chemoreceptor zone lies outside the blood-brain barrier, and can therefore be stimulated by blood-borne drugs that can stimulate vomiting, or inhibit it.

There are various sources of input to the vomiting center:

Vomiting act

The vomiting act encompasses three types of outputs initiated by the chemoreceptor trigger zone: Motor, parasympathetic nervous system (PNS), and sympathetic nervous system (SNS). They are as follows:

  • Increased salivation to protect the enamel of teeth from stomach acids (excessive vomiting leads to dental erosion). This is part of the PNS output.
  • Retroperistalsis, starting from the middle of the small intestine, sweeping up the contents of the digestive tract into the stomach, through the relaxed pyloric sphincter.
  • A lowering of intrathoracic pressure (by inspiration against a closed glottis), coupled with an increase in abdominal pressure as the abdominal muscles contract, propels stomach contents into the esophagus without involvement of retroperistalsis. The lower esophageal sphincter relaxes. This is part of the motor output, and it is also important to note that the stomach itself does not contract in the process of vomiting.
  • Vomiting is ordinarily preceded by retching.
  • Vomiting also initiates an SNS response causing both sweating and increased heart rate.

The neurotransmitters that regulate vomiting are poorly understood, but inhibitors of dopamine, histamine, and serotonin are all used to suppress vomiting, suggesting that these play a role in the initiation or maintenance of a vomiting cycle. Vasopressin and neurokinin may also participate.

Content

Gastric secretions and likewise vomit are highly acidic. Recent food intake will be reflected in the gastric vomit. Irrespective of the content, vomit tends to be malodorous.

The content of the vomitus (vomit) may be of medical interest. Fresh blood in the vomit is termed hematemesis ("blood vomiting"). Altered blood bears resemblance to coffee grounds (as the iron in the blood is oxidized), and, when this matter is identified, the term "coffee ground vomiting" is used. Bile can enter the vomit during subsequent heaves due to duodenal contraction if the vomiting is severe. Fecal vomiting is often a consequence of intestinal obstruction or a gastro-colic fistula, and is treated as a warning sign of this potentially serious problem ("signum mali ominis"); such vomiting is sometimes called "miserere."

If the vomiting reflex continues for an extended period of time with no appreciable vomitus, the condition is known as non-productive emesis or dry heaves, which can be painful and debilitating.

Complications

Aspiration of vomit

Vomiting can be very dangerous if the gastric content gets into the respiratory tract. Under normal circumstances the gag reflex and coughing will prevent this from occurring, however these protective reflexes are compromised in persons under narcotic influences such as alcohol or anesthesia. The individual may choke and asphyxiate or suffer an aspiration pneumonia.

Dehydration and electrolyte imbalance

Prolonged and excessive vomiting will deplete the body of water (dehydration) and may alter the electrolyte status. The loss of acids leads to metabolic alkalosis (increased blood pH), and the electrolyte imbalance shows hypokalemia (potassium depletion) and hypochloremia (chlorine depletion). The hypokalemia is an indirect result of the kidney compensating for the loss of acid. With the loss of intake of food the individual will become cachectic.

Mallory-Weiss tear

Repeated or profuse vomiting may cause erosions to the esophagus or small tears in the esophageal mucosa (Mallory-Weiss tear). This may become apparent if fresh blood is admixed with vomit after several episodes.

Dental

Recurrent vomiting, such as observed in bulimia nervosa, may lead to destruction of the tooth enamel due to the acidity of the vomit.

Causes

Vomiting may be due to a large number of causes, and protracted vomiting has a long differential diagnosis.

Digestive tract

Causes in the digestive tract:

  • Gastritis (inflammation of the gastric wall, usually by viruses)
  • Pyloric stenosis (in babies - this typically causes a very forceful "projectile vomiting" and is an indication for urgent surgery)
  • Bowel obstruction
  • Acute abdomen and/or peritonitis
  • Ileus
  • Cholecystitis, pancreatitis, appendicitis, hepatitis
  • Food allergies
  • In children, it can be caused by an allergic reaction to cow's milk proteins (milk allergy)

Sensory system and brain

Causes in the sensory system:

Causes in the brain:

Metabolic disturbances (these may irritate both the stomach and the parts of the brain that coordinate vomiting):

Pregnancy:

  • Hyperemesis, Morning sickness

Drug reaction (vomiting may occur as an acute somatic response to):

Other

  • Self-induced
    • Eating disorders (anorexia nervosa or bulimia nervosa)
    • Sexual fetish (emetophilia)
    • To remove a poison in case such has been ingested (some poisons should not be vomited as they may be more toxic when inhaled or aspirated; it is, in general, considered better to ask for help before inducing vomiting)
    • Some people who are engaged in binge drinking will induce vomiting in order to make room in their stomachs for further alcohol consumption. In the United Kingdom, this practice is known as tactical chundering, or hitting the reset button and as boot and rally or pulling the trigger in the United States.
  • After surgery (postoperative nausea and vomiting)
  • Disagreeable sights, smells or thoughts (such as decayed matter, others' vomit, thinking of vomiting), etc.
  • Extreme pain, such as intense headache or myocardial infarction (heart attack)
  • Violent emotions (including laughing)
  • Cyclic vomiting syndrome (a poorly-understood condition with attacks of vomiting)
  • High doses of ionizing radiation will sometimes trigger a vomit reflex in the victim
  • Violent fits of coughing or hiccups
  • Nervousness

Neurobiology of vomiting

Related medication

Emetics

An emetic, such as Syrup of Ipecac, is a substance that induces vomiting when administered orally or by injection. An emetic is used medically where a substance has been ingested and must be expelled from the body immediately. Inducing vomiting can remove the substance before it is absorbed into the body. Ipecac abuse can lead to detrimental health effects.

Antiemetics

An antiemetic is a drug that is effective against vomiting and nausea. Antiemetics are typically used to treat motion sickness and the side-effects of some opioid analgesics and chemotherapy directed against cancer.

Antiemetics act by inhibiting the receptor sites associated with emesis. Hence, anticholinergics, antihistamines, dopamine antagonists, serotonin antagonists, and cannabinoids are used as anti-emetics.

Social implications

Nausea inducement in groups

It is quite common that, when one person vomits, others nearby will become nauseated, particularly when smelling the vomit of others, often to the point of vomiting themselves. It is believed that this is an evolved trait among primates. Many primates in the wild will tend to browse for food in small groups. Should one member of the party react adversely to some ingested food, it may be advantageous (in a survival sense) for other members of the party also to vomit. This tendency in human populations has been observed at drinking parties, where excessive consumption of alcoholic beverages may result in a number of party members vomiting nearly simultaneously, this being triggered by the initial vomiting of a single member of the party.

Intense vomiting in ayahuasca ceremonies is a common phenomenon. However, people who experience "la purga" after drinking ayahuasca, in general, regard the practice as both a physical and spiritual cleanse and often come to welcome it. [2] It has been suggested that the consistent emetic effects of ayahuasca — in addition to its many other therapeutic properties — was of medicinal benefit to indigenous peoples of the Amazon, in helping to clear parasites from the gastrointestinal system. [3]

There have also been documented cases of a single ill and vomiting individual inadvertently causing others to vomit, when they are especially fearful of also becoming ill, through a form of mass hysteria.

Context

Most people try to contain their vomit by vomiting into a sink, toilet, or trash can, as both the act and the vomit itself are widely considered embarrassing; vomit is also difficult to clean. On airplanes and boats, special bags are supplied for sick passengers to vomit into. A special disposable bag containing absorbent material that solidifies the vomit quickly is available, also, making it convenient and safe to keep (leakproof, puncture-resistant, odorless) until there is an opportunity to dispose of it conveniently.

People that vomit chronically (e.g., as part of an eating disorder such as bulimia nervosa) may devise various ways to hide this disorder.

Sound

According to an online study of 30 traditionally bad sounds, the sound of vomiting is the worst sound in the world.[4] Professor Cox of the University of Salford's Acoustic Research Centre said that "We are pre-programmed to be repulsed by horrible things such as vomiting, as it is fundamental to staying alive to avoid nasty stuff". It is thought that the thought of disgust is triggered by the sound of vomiting to protect food from those possibly diseased nearby[5].

Vomit phobia

Vomit phobia, or emetophobia, as it is also known, is the sixth-most-common phobia in the world, according to the International Emetophobia Society. In addition to the actual phobia, there are many other disorders and phobias that sufferers may be afflicted with, such as irritable bowel syndrome and agoraphobia. People with emetophobia tend to avoid eating in public, socialising, and going to parties. They may hardly eat at all, and for this reason may be diagnosed as anorexic. Emetophobes will go to extraordinary lengths to avoid vomiting or seeing someone vomit. Some emetophobics have the distinct ability to actually prevent themselves from vomiting, called "vomit continence." They are able to fight the feeling of nausea before the feeling eventually subsides.


See also

References

  1. ↑ Hornby PJ. Central neurocircuitry associated with emesis. Am J Med 2001;111:106S-12S. PMID 11749934.
  2. ↑ Shanon, B. (2002). The antipodes of the mind: Charting the phenomenology of the ayahuasca experience. (2002). Oxford: Oxford University Press.
  3. ↑ Andritzky, W. (1989). Sociopsychotherapeutic functions of ayahuasca healing in Amazonia. Journal of Psychoactive Drugs. 21(1), 77-89.
  4. ↑ Acoustics audio video, University of Salford
  5. ↑ Sound101.org.

External links


v·d·e
Digestive system - Gastroenterology (primarily K20-K93, 530-579)
Esophagus

GERD - Achalasia - Boerhaave syndrome - Zenker's diverticulum - Mallory-Weiss syndrome - Barrett's esophagus

Stomach

Gastric ulcer - Gastritis - Dyspepsia - Pyloric stenosis - Achlorhydria - Gastroptosis - Gastroparesis

Small intestine

Duodenal ulcer - Intussusception - Abdominal angina

Colon

Diarrhea - Appendicitis - Bowel obstruction - Diverticulitis - Diverticulosis - IBD (Crohn's, Ulcerative colitis) - IBS - Constipation - Megacolon (Toxic megacolon) - Anal fissure - Anal fistula - Anal abscess - Rectal prolapse

Hernia

Inguinal (Indirect, Direct) - Femoral - Umbilical - Incisional - Diaphragmatic - Hiatus

Liver

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Accessory digestive

Gallbladder/Biliary tree (Gallstones, Choledocholithiasis, Cholecystitis, Cholesterolosis, Cholangitis, PSC, Biliary fistula, Ascending cholangitis)
Pancreas (Acute pancreatitis, Chronic pancreatitis, Pancreatic pseudocyst, Hereditary pancreatitis)

Other/general

Malabsorption (e.g. celiac, Whipple's) - Tropical sprue - Hematemesis - Melena - Gastrointestinal bleeding (Upper, Lower) - Peritonitis

See also congenital

Template:Digestive system and abdomen symptoms and signs


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