Nausea & Vomiting

Nausea & Vomiting
NAUSEA is the sensation that precedes vomiting.VOMITING is the involuntary forced expulsion of stomach contents through the mouth. In most cases, the explanation is simple like irritation of the stomach by food or overindulgence in food and alcohol. Both are common complaints and are usually self-limiting. However, attention has to be paid to fluid balance and referral to hospital should be considered in case of dehydration and weight loss. If symptoms persist, a full examination of the patient is mandatory to look for serious underlying pathologies.Stimulation of the vomiting centre causes hypo-motility and reverse- motility of the digestive tract. The diaphragm presses down on the stomach and the abdominal walls move inwards, forcing the stomach contents out through the oesophagus. As this happens, the epiglottis clamps down upon the voice-box, thus preventing vomit from entering the wind-pipe. 

What causes Nausea and Vomiting?

Both nausea and vomiting result from stimulation of the vomiting centre located in the brain stem. This centre can be activated in two ways – chemically and neutrally. Chemical activation is mediated via the chemoreceptor trigger zone (CTZ) that is sensitive to the presence of toxins and poisons in the blood stream. Neural activation occurs as a result of information coming directly from the frontal lobes of the brain, the digestive tract and balancing mechanism of the inner ear.

Stimulation of the vomiting centre causes hypo-motility and reverse- motility of the digestive tract. The diaphragm presses down on the stomach and the abdominal walls move inwards, forcing the stomach contents out through the oesophagus. As this happens, the epiglottis clamps down upon the voice-box, thus preventing vomit from entering the wind-pipe.

Identification of Cause

The seriousness of vomiting depends upon its cause. It may be caused by overeating or drinking too much or by a viral infection. Alternatively, it may follow head injury or poisoning. Careful attention has to be paid in the following situations:

  • Head injury
  • Blood in the vomit
  • Temperature is more than 38degreeCelcius
  • Diarrhoea and continuous stomach pain
  • Stomach pain not relieved by vomiting
  • Chronic and unresponsive

Situation & Conditions to be suspected

  • Overindulgence in food, drinks or intake of drugs — Gastric Irritation
  • Consumption of bad food, similar symptoms seen in those who shared the food — Food Poisoning
  • Diarrhoea with or without rise in temperature – Gastoentiritis
  • Vomit contains blood or brown-black material resembling coffee grounds — Bleeding in the Gastroentestinal tract.
  • Abdominal pain not relieved by vomiting — Appendicitis, Perforation of duodenal ulcer, Pancreatitis.
  • Colicky pain — Gall Stones.
  • Jaundice – Hepatitis
  • Headache, drowsiness, difficulty in looking towards light; pain when bending the neck – Meningitis
  • Pain in and around one eye with blurred vision — Glaucoma.
  • Young woman who has missed her period – Pregnancy
  • While travelling — Motion Sickness
  • Accident, trauma — Head Injury, hematoma in the stomach
  • Vomiting during pregnancy: usually begins in the sixth week and peaks during the tenth week. Drug therapy should be avoided as far as possible. In severe cases  promethazine and doxylamine can be used as they are apparently free from teratogenic effects.

Drugs that commonly cause nausea and vomiting

  • Allopurinol
  • Antibiotics
  • Bromocriptine
  • Cytotoxics
  • Digoxin
  • Gold
  • Iron
  • Levopa
  • NSAIDS( Nonsteroid anti inflamatory drugs)
  • Oestrogens
  • Opiates
  • Penicillamine
  • Quinidine
  • Sulphasalazine
  • Theophyline
  • Thiazides

Management

The patient must be asked not to eat any solid food until nausea and vomiting subsides. He must be encouraged to take small sips of water to prevent dehydration. When the stomach settles, he should be advised to eat dry food like biscuits and toast before resuming normal diet. Attention has to be paid to fluid and electrolyte balance. Signs of dehydration include severe thirst, dry lips and tongue, sunken eyes, loss of skin elasticity, increased heart and respiratory rate, muscle cramps, lethargy, confusion and headache. If patient cannot take anything by mouth, intravenous fluids should be considered and the water salt balance should be carefully monitored by blood tests.

Medication

Drugs to manage nausea and vomiting are of two types: those that act directly on the digestive tract and those that act centrally. Drugs that act on the digestive tract increase intestinal contraction and accelerate transit. Centrally acting agents act at the vomiting centre or chemoreceptor trigger zone (CTZ) located in the brainstem and block impulses that induce nausea and Vomiting.

DOPAMINE ANTAGONISTS (prochlorperazinemetoclopramidedomperidone) act against D2 receptors in the brain stem (CTZ).

Prochlorperazine is a phenothazine possessing powerful antiernetic activity. In addition to CTZ, it also acts at the vomiting centre. It is used for nausea and vomiting due to various causes including migraine. Metoclopramide has a peripheral action on the gut and enhances gastric hurrying in addition to its effect on CTZ. Domperidone, unlike metoclopramide, does not cross the blood-brain barrier and may cause fewer extrapyramidal side-effects at high doses, eg. dystonia in children and parkinsonism in elderly.

ANTIHISTAMINES (promethazinediphenhydraminecyclizinecinnarizine) act on the vestibular apparatus of the inner ear and are useful in motion sickness and vomiting due to vestibular disease.

ANTISEROTONIN agents like ondansetron act on peripheral and central serotonin Acceptors and are valuable in the management of nausea and vomiting not relieved by conventional, less expensive agents.

ANTICHOLINERGICS act on the vomiting centre and digestive tract and reduce gastrointestinal hyperactivity. They help in the management of motion sickness but can cause dry mouth, drowsiness and blurred vision. All motion sickness drugs are effective if given before the journey. Once the sickness has started, the symptoms are more difficult to control.

 

 

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About Manbir & Gurpreet

Gurpreet Kaur’s journey in this world .... Gurpreet Kaur was a Musician. She was a singer and a composer of music. Her interest was composing and singing Gurbani Shabads in Indian Classical style. She sang Shabads in All the Raags mentioned in Sri Guru Granth Sahib Ji. She also taught Gurmat Sangeet at Gurmat Gian Missionary College, Jawadi, Ludhiana. Elder child to Pushpinder Kaur and Dr. Brig. Harminder Singh, was born in Amritsar on 13th Jan 1962. She attended various convent schools as a child because her father would get frequent Army postings as a dental surgeon. She graduated with Music Honors from Govt. College for Women, Chandigarh. Music was her hobby and she composed and sang Raag based Gurbani Shabads. Doing Kirtan was part of growing up nurtured by her parents. She learned music from her father Dr. Brigadier Harminder Singh who was a dental surgeon in Indian Army and a very good singer himself. Gurpreet’s Bhua (father’s sister), Ajit Kaur retied as a Head of Department of Music from Govt. College for Women Ludhiana, and was a renounced Punjabi singer of her time. Gurpreet Kaur also learned nuances of Indian Classical Music from Pandita Sharma. She was a mother of three children, and a grandmother. Her daughter Keerat Kaur is a Computer Engineer. Her two sons Gurkeerat Singh and Jaskeerat Singh are doctors in USA. Her daughter Keerat Kaur too was part of her group ~ Gurmat Gian Group. Gurpreet Kaur left this world at the age of 54yrs on 12th Sept 2016 in Baltimore USA. She had recorded around 25 cds of Gurbani Keertan. 'Raag Ratan' Album (6 CDs) is a Compilation of Shabads in All the 31 Sudh Raags of Sri Guru Granth Sahib Ji. 'Gauri Sagar' Album (3 CDs) is a Compilation of All forms of Raag Gauri in Sri Guru Granth Sahib Ji. 'Nanak Ki Malhaar' ~ ((3 CDs) is an album of Raag Malhar Shabads in various forms of Malhar. 'Gur Parsaad Basant Bana' ~ (3 CDs) is an album of Shabads in Raag Basant sung in various forms of Raag Basant. Har Ki Vadeyai Sarni Aayea Sewa Priya Kee Preet Piyaree Mohan Ghar Aavho Karo Jodariya Mo Kao Taar Le Raama Taar Le Tere Kavan Kavan Gun Keh Keh Gawan Mera Baid Guru Govinda Saajanrraa Mera Saajanrraa

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