Vomiting

Description:

Vomiting — the complex-reflex act leading to eruption of contents of a stomach (sometimes together with intestines contents) through a mouth — arises at impact of peripheral or central irritants on the emetic center of a brainstem and quite often is one of the main symptoms of the serious illness demanding acute management. In most cases vomiting represents the defense reaction of an organism directed to removal from it the toxic or irritating substances.

Vomiting symptoms:

Vomiting is almost constantly observed at acute diseases of abdominal organs, at the same time vomiting is usually preceded by nausea, is frequent — an abdominal pain. Vomiting recently eaten food, bile — a characteristic symptom of acute gastritis. Usually one - and double vomiting gives to the patient relief. The repeated exhausting vomiting at acute gastritis leads to dehydration and loss of sodium, potassium and chlorine that in turn strengthens vomiting and considerably worsens a condition of patients. Persistent burdensome vomiting slime, sometimes with blood impurity, accompanies the acute erosive gastritises developing at hit in a stomach of strong acids and alkalis. Emergence of vomiting in combination with the pains in an anticardium which are usually prevailing in a clinical picture is characteristic of an aggravation of a peptic ulcer and quite often demands acute management. Observance of a bed rest, rigid diet and administration of atropine in most cases considerably reduce these symptoms.

The plentiful vomiting to acid contents of a stomach (the decayed remains long ago the eaten food) arising in 4 — 6 h after meal — the most important symptom of organic narrowing of an output part of a stomach (gatekeeper) in connection with scarring of an ulcer or with a malignant tumor. Carefully collected anamnesis and data of an objective research revealing exhaustion and the patient's obezvozhennost in the presence of "capotement" in a stomach on an empty stomach help diagnosis of an organic stricture of the gatekeeper. Patients with a pyloric stenosis are quite often so exhausted and dehydrated that even at the first address need parenteral administration of solution of glucose and isotonic solution of sodium chloride. Further they are subject to hospitalization in surgical department for operational treatment.

Extremely terrible symptom is the hematemesis testimonial of massive hemorrhage from vessels of a stomach or gullet.

Can be the cause of bleeding a vessel erosion at stomach ulcer or a duodenum, a rupture of a varicose vein of a gullet at cirrhosis with a portal hypertension, disintegration of a tumor of a stomach, at last, vascular diseases and hemorrhagic diathesis. If the hematemesis began after a heavy fit of coughing or after repeated attacks of vomiting, then the rupture of a mucous membrane of the lower third of a gullet can be the cause of bleeding (Mallori's syndrome — Weiss). If vomiting follows directly plentiful gastric bleeding, emetic masses consists of the scarlet or just turned blood. At less plentiful bleedings when blood some time remains in a stomach and hemoglobin under the influence of hydrochloric acid turns into muriatic hematin, emetic masses takes a characteristic form of a coffee thick.

Vomiting — the most important symptom of surgical diseases of abdominal organs. Usually it accompanies an attack of hepatic colic, acute cholecystitis and acute pancreatitis, being the main complaint of patients along with pain. At the same time vomiting is combined with morbidity at a palpation in an anticardium and the right hypochondrium, quite often local symptoms of irritation of a peritoneum, sometimes an ikterichnost of scleras. At an acute appendicitis vomiting during the first hours of a disease is also quite often observed. The plentiful vomiting with a fetor called for a stench fecal — one of the main symptoms of intestinal impassability. It is necessary to emphasize that vomiting at these diseases quite often develops to symptoms of irritation of a peritoneum and along with pain it has to be regarded as a precursory symptom of the medical emergency caused by acute surgical pathology of abdominal organs. At the same time vomiting is a characteristic symptom of diffuse peritonitis in its late stage when the diagnosis does not raise doubts, however the reason of peritonitis to establish quite difficult.

The attack of renal colic can be also followed by the vomiting which is combined quite often with swelling and abdominal pains. The similar symptomatology at right-hand colic leads sometimes to wrong diagnosis of acute cholecystitis or appendicitis.

Reflex vomiting is observed sometimes in an acute stage of a myocardial infarction (especially at its localization in a wall of a left ventricle) and quite often is the reason of diagnostic mistakes. The vomiting combination to pain in an anticardium at gastralgichesky option of a myocardial infarction even more complicates establishment of the correct diagnosis. However attentive inquiry about the nature of pain, existence to the real painful attack of the period of increase of attacks of stenocardia, identification, in addition to epigastric localization, retrosternal pains allow to suspect character of a basic disease, and at an electrocardiographic research — to verify the diagnosis.

At intoxications vomiting is usually preceded by nausea, persistent, repeated vomiting liquid and plentiful emetic masses is characteristic in the beginning. Emergence of vomiting is possible at various infectious diseases (flu, pneumonia, meningitis) at height of fever and intoxication. The plentiful vomiting food, and then liquid which is combined with intoxication, colicy pains in a stomach, high fever, usually repeated diarrhea (a fetid foamy chair of greenish coloring), sometimes vascular insufficiency is typical for food toxicoinfections.

From the medical emergencies which are shown except other symptoms, persistent vomiting, it is necessary to point to intoxications by opium drugs, nicotine and especially high doses of alcohol. Morning vomiting is characteristic; the alcohol smell is sometimes observed; in hard cases it is combined with consciousness disturbance, oppression of a respiratory center, vascular insufficiency. Patients need vigorous disintoxication therapy in combination with introduction of vascular means.

Vomiting is an early symptom at some prskomatozny states. The accruing renal failure with the developing uraemia usually is followed by the persistent painful vomiting which is combined with other symptoms of uraemia: disturbances from the central nervous system, an oliguria, a skin itch, an ammonia smell from a mouth, a diarrhea, anemia. The hepatic prekoma also quite often is followed by vomiting. Existence and strengthening of jaundice, emergence or increase in ascites, reduction of the sizes of a liver, development of encephalopathy, a characteristic hepatic smell from a mouth help to establish the correct diagnosis.

It is especially important to know that the diabetes mellitus decompensation, the increasing insulyarny insufficiency with development of acidosis usually is followed by vomiting. Importance of the correct assessment of vomiting as symptom of a diabetic prekoma consists that vigorous rational therapy by insulin, administration of liquids, sodium chloride liquidate acidosis, prevent development of a coma and bring the patient out of a prekomatozny state. Vomiting at a diabetic prekoma is usually combined with pains in an anticardium, slackness and the patient's adynamia; a polyuria, thirst, dryness of an integument and mucous membranes, an acetone smell from a mouth. Anamnestic instructions on a diabetes mellitus and identification of traces of injections of insulin on hands, a stomach, hips significantly simplify the diagnosis.

Patients with the increasing insufficiency have functions of adrenal glands at a gipokortshdizm, an addisonovy disease vomiting which is combined with abdominal pains, frequent is usually observed by a diarrhea, sharp weakness, arterial hypotension and that is especially characteristic of an addisonovy disease, the xanthopathy which is the most expressed on open parts of a body — a face, a neck, hands, palmar folds and places of friction by clothes. Timely introduction by the patient with the increasing adrenal insufficiency of adrenal hormones, sodium chloride, liquid leads to improvement of a state and the termination of vomiting.

The vomiting which is combined with a diarrhea, abdominal pains, excitement, tachycardia — one of the main symptoms of the thyrocardiac crisis which is also demanding rendering acute management, administration parenterally of liquids, saline solutions, glucose with insulin, cardiacs, steroid hormones, purpose of thyreostatic drugs.

Vomiting without the previous nausea and abdominal pains — a frequent symptom of acute vascular and inflammatory diseases of a brain. At a brain distsirkulyation it appears at headache height without the previous nausea, is combined with vestibular frustration, amplifies at turns of the head, does not give relief. A vomiting combination to headaches, fluctuations of the ABP and furthermore identification of focal neurologic symptomatology help to establish the correct diagnosis. Vomiting in combination with a hemicrany allows to assume migraine, at a combination to the expressed dizziness, decrease in hearing it is possible to suspect Menyer's disease. In case of high fever, a headache, accession of meningeal symptoms the inflammation of a meninx can be diagnosed. The skull injury, concussion also usually are followed by vomiting.

Thus, vomiting is not a specific symptom of any certain disease, however in all cases vomiting as a symptom demands specification of circumstances of its emergence, features of emetic masses, the accounting of other displays of a disease for the purpose of clarification of character of a basic disease for timely assistance. In need of conditions of a hospital conduct a laboratory research of emetic masses: bacteriological (at food toxicoinfections), judicial and chemical (at suspicion of poisonings with poisons).

It is important to emphasize that vomiting, being one of symptoms of various diseases, quite often considerably worsens a condition of patients, strengthens dehydration and loss of electrolytes, leads to development of a metabolic alkalosis, deepening thereby organism intoxication. At disturbances of consciousness the aspiration of emetic masses leading to development of aspiration pneumonia is possible, and at plentiful aspiration — to asphyxia. Persistent wearisome vomiting can provoke anguishes of a mucous membrane with development of massive gastric bleedings.

Vomiting reasons:

It arises:

1. As a result of reflex excitement of the emetic center medicines, for example, at strong local irritation of a peritoneum or mesentery, at impassability of tubular structures with muscular walls (a bilious channel, a gut, an ureter, etc.).

2. At irritation of the emetic center toxins or medicines. Infections, exogenous intoxications — poisonings with carbon monoxide, poisonous mushrooms, alcohol, some drugs (for example, cardiac glycosides, narcotic analgetics), etc., toxicosis of pregnant women, prekomatozny states (can be the cause of vomiting at diseases of kidneys, a liver), endocrine diseases (a diabetes mellitus, adrenal insufficiency, a thyrotoxicosis).

3. "Brain" vomiting is a consequence of direct irritation of the emetic center at diseases of TsNS and arises at hypertensive crisis, disturbances of cerebral circulation, wet brain, migraine, meningitis, tumors, abscesses, brain injuries.

Treatment of Vomiting:

Symptomatic medicamentous therapy for stopping of vomiting includes use of spasmolysants (Nospanum of 2 ml of 2% of solution), m-holinoblokatorov (atropine of 0,5 — 1 ml of 0,1% of solution) or Metoclopramidum digestive tract normalizing motility (a raglan, cerucal, 2 ml). The specified drugs are administered intravenously or intramusculary. At pernicious vomiting and inefficiency of the above described treatment, appoint neuroleptics (for example, этаперазин 4 — 8 mg in 3 — 4 times a day). At emergence of symptoms of intoxication disintoxication therapy is shown, at the expressed hypovolemia — intravenous administration of liquids and electrolytes, at fluctuations of the ABP — the therapy directed to his normalization. Need of hospitalization is defined by character of a basic disease: The patient with a hematemesis is subject to immediate hospitalization in surgical department where the ezofagogastroduodenoskopiya with diagnostic, and sometimes and the medical purpose is urgently carried out. To the direction in hospital the high bed rest, hunger, holding available haemo static actions are necessary.