Nausea and vomiting

Introduction Nausea and vomiting are common clinical symptoms. Nausea is often a precursor to vomiting and can also appear alone. It shows the special discomfort of the upper abdomen, often accompanied by dizziness, runny, pulsation, blood pressure and other symptoms of exacerbation. Vomiting refers to a complex reflex action of the contents of the stomach or a portion of the contents of the small intestine that flow out of the mouth through the esophagus. Vomiting can remove harmful substances from the stomach, and people can play a protective role, but persistent and severe vomiting can cause technical water, electrolyte imbalance, metabolic alkalosis and malnutrition, and even esophageal and gastric mucosal tears (MallmpWiess) Syndrome) complications.

Cause

First, reflective vomiting

(1) Digestive diseases

l, pharyngeal stimulation

2, stomach, duodenal diseases

3. Other digestive diseases

(2) Acute poisoning

(3) Respiratory diseases

(four) urinary system diseases

(5) Circulatory diseases

(6) Gynecological diseases

(7) Glaucoma

Second, central vomiting

(1) Central nervous system diseases

(two) drug toxicity 1

(3) metabolic disorders, stimulation of toxins in the body, radioactivity

1, hyponatremia

2, diabetic ketoacidosis

3, thyroid crisis

4, adrenal crisis

5, pregnancy vomiting

6, acute systemic infection

7. Radioactive damage

Third, the vestibular barrier

(a) labyrinthitis

(B) Meniere's disease

(three) motion sickness

Fourth, neurological vomiting

(a) stomach nerve function card

(two) rickets

The vomiting center is located in the medulla oblongata and can cause vomiting when stimulated. Vomiting is caused by a series of complex and coordinated reflexes. The first is pyloric contraction and closure, the stomach reverses peristalsis, the fundus is filled, and the cardia is open, while the abdominal muscles contract, the diaphragm drops, and the abdominal pressure increases, so that the stomach contents pass through the esophagus. Swallow and vent outside the exit. If the stomach reverse creep is weak, or the cardia does not open, the stomach contents are not from the thermal power plant, and the feeling of the leaves is called nausea. The mechanism of career heart is basically the same as vomiting. The difference between the two is that the motility of the vomiting center is different, resulting in different clinical manifestations. When vomiting is accompanied by intestinal peristalsis, bile and intestinal contents can be mixed in the vomit.

The medulla has two different functions of vomiting: one is the nerve reflex center - the vomiting center, located at the bottom of the fourth ventricle; the other is the chemosensory angle band, which receives various chemical stimuli that cause vomiting. The actual action of vomiting in vomiting, which accepts excitement from drugs and chemicals such as apomorphine, morphine, digitalis, phyllophylline, and uranium sulfate from digestive and other body parts, cerebral cortex, vestibular organs, and chemoreceptors. , produces an impulse to the vomiting center and causes vomiting.

an examination

Related inspection

Duodenal juice and bile parasite examination Hepatitis A antibody parasite excretions and secretions Examination of hydatid skin test

First, physical examination

Pay attention to blood pressure, respiratory odor, abdominal tenderness, rebound tenderness, gastrointestinal peristalsis and intestinal type, abdominal mass, bowel sounds, and water sounds. Perform nervous system, vestibular nerve function and ophthalmologic examination when necessary.

Second, laboratory and other inspections

According to the patient's condition, blood routine, urine routine, urine ketone body, blood sugar, electrolyte series, blood gas analysis, urea nitrogen, blood and urine powder enzymes, cerebrospinal fluid routine, toxicological analysis of vomiting liquid can be selected.

When there are indications, do abdominal X-ray or plain film, gastrointestinal barium meal imaging, fiber gastroduodenaloscopy, electrocardiogram, abdominal or brain B-mode ultrasound, CT or magnetic resonance, cerebral angiography.

Differential diagnosis

1. Abdominal pain with nausea and vomiting is one of the clinical manifestations of acute pancreatitis. It occurs at the onset of the disease and is characterized by the inability to relieve abdominal pain after vomiting. The frequency of vomiting is also consistent with the severity of the lesion. In edematous pancreatitis, not only nausea, but also vomiting often 1 to 3 times, in hemorrhagic pancreatitis, vomiting is severe or persistent retching frequently.

2, fever accompanied by abdominal pain, diarrhea, nausea, vomiting refers to the body's abdominal pain, diarrhea, nausea, vomiting due to digestive diseases.

3, nausea (nausea) is a kind of stomach discomfort that can cause vomiting impulse, often a vomiting pre-driver's feeling, but it can also appear alone, mainly for the special discomfort of the upper abdomen, often accompanied by dizziness, salivation, pulse Slow, low blood pressure and other symptoms of vagus nerve excitement.

4. Vomiting is a kind of reflex action that the contents of the stomach are reversed into the esophagus and spit out through the mouth. It can be divided into three stages, nausea, retching and vomiting, but some vomiting can be a precursor to nausea or retching. Vomiting can spit out harmful substances that are swallowed into the stomach. It is a kind of defensive reflex of the body and has certain protective effects, but most of them are not caused by it, and frequent and severe vomiting can cause complications such as dehydration and electrolyte imbalance.

5, nausea and vomiting after burns is one of the early symptoms of burn shock. A common cause is also cerebral hypoxia. Vomiting is generally the contents of the stomach. In severe shock, there may be brown or bloody vomit, suggesting severe congestion, edema or erosion of the digestive tract mucosa. When the amount of vomiting is too large, acute gastric dilatation or paralytic ileus should be considered.

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