Nausea & Vomiting

(Gastroenterology. 2001;120:261-62 & 263-86)

DEFINITION:

Vomiting: forceful expulsion of gastric contents associated with contraction of abdominal and chest wall musculature
Nausea: unpleasant sensation of the imminent need to vomit (above); a sensation that may or may not ultimately lead to the act of vomiting
Regurgitation: act by which food is brought back into the mouth without the abdominal and diaphragmatic muscular activity of vomiting
Anorexia: loss of desire to eat (true loss of appetite)
Sitophobia: fear of eating because of subsequent or associated discomfort
Retching: spasmodic respiratory movements against closed glottis with contraction of abdominal muscles without expulsion of gastric contents (dry heaves)
Rumination: chewing & swallowing of regurgitated food that came back into mouth within minutes of eating without an organic cause (See end of chapter)

PATHOPHYSIOLOGY: GM₃PIC₂ (mnemonic to help remember categories)

Medications & Toxic:

Infectious:

Gut Disorders:

Mechanical: gastric outlet obstruction, small bowel obstruction, pyloric stenosis, SMA syndrome, volvulus, Zenker’s diverticulum
Functional: gastroparesis, chronic intestinal pseudo-obstruction, nonulcer dyspepsia, IBS
Organic: pancreatic adenocarcinoma, intraperitoneal disease, PUD, cholecystitis, pancreatitis, hepatitis, CD, mesenteric ischemia, retroperitoneal fibrosis