Vomiting, vomiting with blood - Causes, symptoms and treatment. MF.

Vomiting is a kind of protective mechanism that protects our body from harmful substances entering it. Vomiting is essentially a reflex with a complex mechanism of formation and regulation. Vomiting externally is an uncontrolled eruption of the contents of the stomach through the mouth( sometimes through the nose).All reflexes, including vomiting, consist of ways that carry information to the center of the reflex( the brain), where a command is given to perform the reflex and the paths that carry the command-impulse to the organs of the performer: the stomach, the muscles of the diaphragm, the thorax. Irritation of any part of the reflex pathway can cause vomiting. Involvement of all components of the reflex path is not necessary;understanding this is necessary to determine the cause of vomiting.

The frequency of vomiting depends on the sex, age and individual characteristics of the person. So in women, vomiting occurs more often than in men, in children( especially adolescence) more often than in adults. In people with heightened emotional excitability, a tendency to "motion sickness," vomiting occurs more often.

Vomiting in children may occur as a response to many infections, nasopharyngeal diseases. This is due to the immaturity of the mechanisms of initiation-inhibition of emetic reflexes. Vomiting in children can often be associated with negative emotional reactions. In a nursing child, vomiting should not be confused with regurgitation of a small amount of food after feeding, and vice versa: frequent or profuse regurgitation after feeding should be distinguished from vomiting associated with the pathology of the stomach and intestines.

The causes of vomiting can be:

1. Diseases of the gastrointestinal tract:

• Acute surgical diseases: appendicitis, peritonitis, acute intestinal obstruction, acute pancreatitis, acute cholecystitis, bleeding in the gastrointestinal tract;
• Chronic diseases: peptic ulcer of stomach and duodenum, gastritis, duodenitis, enterocolitis, cholelithiasis;
• Anomalies in the development of the gastrointestinal tract: stenosis( constriction) of the pylorus, atresia( invasion of the GIT tract), defects in pancreatic development;
• Gastrointestinal tract infections: food toxic infections, viral lesions, helminthiases;
• Foreign bodies of esophagus, stomach, intestines;
• Functional disorders accompanied by impaired motor function of the stomach, intestines
• Oncological processes

2. Central nervous system diseases: trauma and brain tumors, increased intracranial pressure, brain infections( meningitis, encephalitis)

3. Cardiovascular diseases: heart failure, hypertensivedisease, myocardial infarction.

4. Diseases of the inner ear: labyrinthitis, Meniere's disease

5. Diseases of the endocrine system: thyrotoxicosis, ketoacidosis in diabetes mellitus, phenylketonuria, insufficiency of adrenal function.

6. Acute toxicity and side effects of

7. Psychogenic reactions: anxiety and fear, hysterics, habitual vomiting, as an expression of some emotions.

Nausea and vomiting can result from "motion sickness".Vomiting often occurs in the first trimester of pregnancy with toxicosis( gestosis).

Nausea and vomiting occur in many diseases. Most often, nausea precedes vomiting, and vomiting brings relief to the patient. However, this does not happen in all cases, and the presence or absence of nausea is an important diagnostic criterion.

Let's take a closer look at the diseases in which vomiting occurs.

Vomiting occurs in diseases associated with the term "acute abdomen," requiring urgent surgical intervention-acute appendicitis, cholecystitis, peritonitis, and intestinal obstruction.

Surgical diseases of the abdominal cavity often have a rapid onset, accompanied by severe pain, usually in places of localization of the process.

For appendicitis, this is the lower abdomen on the right. A symptom characteristic of appendicitis is the movement of pain in their middle upper abdomen( epigastrium) downwards. For acute pancreatitis is characterized by pain in the left hypochondrium or even surrounding, often pancreatitis is combined with acute cholecystitis( inflammation of the gallbladder), then the pain is localized in the upper abdomen. Vomiting with these states of relief, as a rule, does not bring.

Liver diseases , in which vomiting is possible, is accompanied by symptoms of impaired function: a feeling of bitterness in the mouth, darkening of the urine, icteric skin color, skin itching.

Chronic diseases of the gastrointestinal tract are also accompanied by pain, depending on the localization of the process. The onset of pain is associated with the ingestion of irritating, hot, or cold dishes. The presence of chronic diseases of the stomach and intestines is usually known to the patient.

Acute infectious diseases of the stomach and intestines are accompanied by diarrhea, fever, intoxication.

Vomiting, as a symptom of the diseases and brain injuries of , does not bring relief, it can occur for no apparent reason. These diseases are also characterized by headache, impaired consciousness. Tumors of the brain in the initial stages may not cause serious disorders, but manifest themselves with various symptoms of "unclear" origin: dizziness, decreased or increased blood pressure, a violation of the sensitivity of various parts of the body, dizziness, changes in speech, gait, including vomiting. Vomiting can be the first sign of infectious lesions of the brain and its membranes( encephalitis, meningitis).

Periodically occurring severe headache, accompanied by vomiting of , may be a migraine attack - a frequent illness, especially in women. Migraine is characterized by intolerance to noise, bright light, the appearance of pain can be provoked by smells, the use of certain products.

Headache, decreasing or passing after vomiting, may be a sign of high blood pressure.

Vomiting that occurs with internal ear diseases , is accompanied by noise in the ears, dizziness, impaired coordination of movements.

Vomiting in diabetes mellitus speaks of improper treatment and the occurrence of a complication - ketoacidosis. Toxic components of improper glucose metabolism, act on virtually all parts of the emetic reflex.

Vomiting in poisoning with other toxic substances, or as a side effect of the action of drugs, occurs due to exposure to the receptors of the stomach and intestines or directly to the center of vomiting after absorption into the blood. Usually enough leading questions are enough for the patient to point out an episode of using or contacting various substances from building materials and technical fluids to suspicious foods.

Vomiting in infectious diseases.

Acute intestinal infections. In this group of diseases, vomiting is most often accompanied by symptoms of intoxication: fever, weakness, pain in the muscles and joints. Vomiting often precedes diarrhea, or these symptoms appear simultaneously. In this case, vomiting brings relief to the patient. These diseases include: salmonellosis, food poisoning, dysentery, yersiniosis, cholera. In addition, vomiting occurs in helminthic invasions.

Acute common infections. Almost any acute infectious disease occurs with signs of intoxication, which in some patients, especially in young children, is often accompanied by vomiting - more often single - and diarrhea.

Infectious diseases of the brain and its membranes. When the membranes of the brain are affected, symptoms of general intoxication are accompanied by a severe headache, marked vomiting;then there may be confusion, convulsions. A characteristic feature of such vomiting is often the absence of previous nausea and the subsequent relief of well-being.

Vomiting with blood

When searching for the cause of vomiting, you must pay attention to the contents of the vomit. So the presence of unchanged( red) blood will speak of bleeding from the vessels of the pharynx, esophagus or upper stomach( Melori-Weiss syndrome).Blood, which reacts with gastric juice, will have a brown color of the "coffee grounds", an admixture of such altered blood will speak of bleeding from the stomach or( more rarely) of the duodenum.

Vomiting with blood can indicate bleeding from stomach or duodenal ulcers, bleeding from the enlarged esophagus veins in people with cirrhosis. Vomiting of blood with an admixture of foam indicates most often on pulmonary hemorrhage.

Vomiting with a small amount of blood can be with erosive gastritis.

Vomiting with bile

The presence of bile in the vomit will say either a simple cast in the stomach, or a violation of the patency of the duodenum. In very rare cases, impurities in the vomit masses can be: pus( phlegmon of the stomach), foreign bodies, helminths.

Time of occurrence of vomiting

You can assume the cause of vomiting by evaluating the time of its occurrence. Morning vomiting is typical for pregnant women, brain diseases, alcoholic gastritis. Vomiting at the end of the day is typical for diseases accompanied by a violation of the evacuation of gastric contents. Vomiting that occurs after ingestion occurs with gastritis or peptic ulcer.

Odor of vomiting

The smell of vomiting can give an idea of ​​the processes occurring not only in the gastrointestinal tract. So sour smell can talk about processes with increased acidity, for example, peptic ulcer, with stagnation of food in the stomach, the smell of vomiting will be rotten, and with intestinal obstruction - caloric. In addition, the specific smell of chemicals will indicate the use of surrogates of alcohol or technical liquids. The smell of ammonia occurs in patients with renal insufficiency, and acetone - in patients with diabetes mellitus.

Examination of the patient with vomiting

Using diagnostics for the symptom of vomiting, in addition to a detailed questioning of the patient, use laboratory and instrumental research methods:

, a clinical blood test will help clarify the nature( infectious or other) of the disease, biochemical blood tests will reveal the level of metabolic products, glucose,evaluate the function of almost any organ. Fibrogastroduodenoscopy will eliminate diseases of the esophagus, stomach and duodenum. Radiography of the gastrointestinal tract, carried out using radiopaque substances, will help to identify diseases throughout the gastrointestinal tract. As additional methods of research use ECG, ultrasound, computer tomography.

Vomiting treatment

Vomiting treatment should be directed primarily at eliminating the cause that caused it. As a symptomatic treatment for vomiting, drugs of various groups are used: tranquilizers( diazepam, fenozepam) and neuroleptics( haloperidol, etaperazine) are used for mild vomiting, antihistamines( promethazine hydrochloride, dimenhydrinate) are used for vomiting caused by diseases of the inner ear. More effective in symptomatic treatment of dopamine antagonists( metoclopramide, cerucal), similar to this group, the stimulant of the motor function of the gastrointestinal tract "cisapride" has a more peripheral effect and is devoid of some side effects of metoclopramide. Drugs - antagonists of serotonin receptors( ondansetron, granisetron, troposetron) are used for vomiting associated with cancer chemotherapy.

With frequent vomiting, saline solutions( rehydron) inside and in the form of intravenous infusions( Ringer's solution) are used to correct dehydration and electrolyte imbalance.

Traditional remedies for vomiting

Traditional methods of treating vomiting at home include the use of decoctions of herbs that have a calming effect( valerian, lemon balm, mint), spasmolytic and soothing effect on the gastric mucosa( chamomile, dill).For drinking when vomiting recommend green tea, lemon water. Often there is a popular way: vodka with salt and orange juice is not suitable for everyone, this method should not be experienced first.

Do not eat when vomiting until the cause of vomiting is established. If you vomit the child immediately call a doctor and do not treat at home.

Complications of vomiting

Vomiting can not only be a sign of formidable diseases, but also itself cause complications such as: dehydration, ruptures of the mucosa of the esophagus, stomach, pharynx. Vomit, getting into the respiratory tract, cause the so-called aspiration pneumonia. With frequent vomiting, the gastric juice that enters the oral cavity destroys the teeth - caries develop.

When and to which doctor to contact when vomiting

If you experience vomiting, call a doctor( usually an ambulance or district therapist) should be accelerated if:

1. You do not know the cause of vomiting;
2. Vomiting is repeated many times;
3. In vomit there is an admixture of scarlet or altered brown blood
4. Vomiting is accompanied by signs of damage to the central nervous system: a violation of consciousness, severe headache, tension of the occipital muscles with an inability to bend the neck;
5. Vomiting is accompanied by obvious signs of an infectious bowel disease( frequent loose stools, high fever, impaired consciousness);
6. Assume that the cause of vomiting can be the use of a poisonous substance;
7. You do not know what to do or how to help the patient.

Which doctors can be needed if there is vomiting:

- Gastroenterologist
- Cardiologist
- Dermatologist
- Psychotherapist
- Neurologist
- Pulmonologist
- Gynecologist
- Urologist
- Endocrinologist
- Otorhinolaryngologist

What kind of doctors can I need if I havevomiting with blood:

- Gastroenterologist
- Hepatologist