Vomiting is a complex reflex act, which results in the involuntary throwing the contents of the stomach to the outside; due to the excitation of vomitoxin centre.
Vomiting consists of series of movements. First closes the porter and reduced pyloric stomach of. It overflows the fundus of the stomach and disclosure of cardiac his Department. The contents of the stomach gets into the esophagus and is pushed outwards under the effect of voltage abdominals and movements of the respiratory muscles.
Emetic center is located at the bottom of the fourth ventricle of the brain and is excited by the impulses emanating from the gastrointestinal tract and other areas of the body. In most cases precedes vomiting nausea (see).
There are vomiting Central and visceral origin and hematogenous-toxic and vomiting during pregnancy.
Vomiting Central origin due to organic diseases of the brain and its meninges (meningoencephalitis, tumors and brain injury), disorders of cerebral circulation; irritation or damage organs of equilibrium (cerebellum or ear labyrinth); emotional disorders. Vomiting also occurs when any cause disgust items (the conditioned reflex vomiting).
Vomiting visceral origin occurs when the irritation of the receptors of the stomach as a result of various chronic and acute diseases, and also at other organs: heart (myocardial infarction), gall bladder, uterus and its appendages, vermiform process, etc. in the reflex influences with these bodies on the stomach.
Hematogenous-toxic vomiting caused by irritation of the vomitoxin centre toxic substances circulating in the blood. They can get into the organism from outside (carbon monoxide, chlorine, emetics and other medicinal substances or to be formed in the body by the failure of the liver, kidneys, profound metabolic disorders in infectious diseases.
Vomiting of pregnancy may be an early symptom of toxicosis. Usually it is accompanied by nausea and salivation. In mild toxemia of pregnancy vomiting occurs periodically (in the morning) and is caused by ingestion of unpleasant odours. In severe toxemia of pregnancy vomiting becomes more or less constant (uncontrollable) and can occur even at night. Disorders of carbohydrate and fat metabolism until the appearance of acetone bodies (see) in the urine and blood.
Diagnostic value has the time of onset of vomiting. Vomiting fasting is observed in chronic gastritis, suffering from alcoholism, hypersecretion of gastric juice. Vomiting in 10-15 minutes after eating characteristic of acute gastritis and stomach ulcers, 4-6 hour. after eating for colorimetrique ulcers.
Of particular importance interviewing patients about the number and nature of vomit. The presence in vomitus food eaten the day before, and sometimes 2-3 days, typical for stenosis (narrowing) of the gatekeeper. The number of vomitus may be rather poor (when the morning vomiting suffering from alcoholism) or, on the contrary, a very rich (with pyloric stenosis).
The smell of vomit, as a rule, sour, when the food in the stomach putrid; intestinal obstruction and in the presence of a fistula between the stomach and colon vomit have the smell of feces.
The disappearance of pain after vomiting is typical for a gastric ulcer. During the attack liver cramps vomiting does not relieve pain.
Diagnostic value has admixture of blood to gag the masses (see Hematemesis), pus (phlegmonously gastritis).
Esophageal vomiting occurring when diverticula and narrowing of the esophagus is small portions of food and combined with spitting.
The treatment should be aimed at addressing the underlying disease. Measures should be taken to stop or at least reduce R. as if she is stubborn character. Oppressing emetic reflex drugs phenothiazine series (chlorpromazine 1 ml of 2.5% solution intramuscularly), pipolfen 2 ml of 2.5% solution intramuscularly. Abortion is shown only in severe toxemia.
The great value has the care of patients during vomiting, especially in critically ill and are in an unconscious state, as aspiration of vomitus in the respiratory tract may cause mechanical asphyxia (see), aspiration pneumonia. If the condition of the patient permits, should vomiting give it a sedentary or popularakie position on the side with tilt head down. It is very important to support the head of the patient. If the patient during vomiting should remain lying down, then you have his head turn sideways and hold it in this position to stop the vomiting. After vomiting give the patient to rinse the mouth with water, weak patients should clear the mouth moist tampon. Vomiting unconscious require an injection of a mouthpiece and down.
Vomiting (emesis, vomitus) - complex reflex act, caused by the excitation of vomitoxin centre, caused by changes in the external environment (cuddling, irritation visual or olfactory receptors) or irritation coming from the internal environment of the body (diseases of the gastrointestinal tract, liver, kidneys and other). In most cases precedes vomiting nausea (see).
Emetic center, located, as the majority of physiologists, at the bottom of the bottom IV heart, directly activates afferent impulses generated in the gastrointestinal tract and other areas of the body. Afferent fibers gag reflex arc are mainly composed nn. vagus, splanchnicus (abdominal) and n. glossopharyngeus (from the root of the tongue and throat), as well as nn. phrenicus, opticus, olfactorius, vestibulares. Efferent fibres pass through n. phrenicus (the diaphragm), and nn. spinales (to the muscles of the abdominal wall). Emetic center is also under the influence of the cerebral cortex.
Depending on the reason gag reflex, there are vomiting nervous and visceral origin and hematogenous-toxic vomiting.
The first group includes R. associated with organic brain disease or its meninges, brain diseases; vomiting caused by irritation or defeat organ of balance - of the cerebellum or ear labyrinth; psychogenic vomiting, coming in acute emotional disorders, conditioned reflex R. arising from or even when you view any cause disgust items.
The second group includes R., caused by irritation of the mucous membrane of the stomach, lesions of the intestine, gall bladder and liver, inflammation of the peritoneum, the interior of the reproductive organs in women, kidney damage, irritation of the tongue, throat, pharynx.
Hematogenous-toxic vomiting occurs under the influence of toxic substances circulating in the blood. They can get into the organism from outside (carbon monoxide, chlorine, emetics and other medicinal substances or to be formed in the body by the failure of the liver, kidneys, deep metabolism disorders, infectious diseases.
Diagnostic significance of the timing R., connecting it with eating, pain in R., the number and nature of vomit.
Vomiting fasting is observed in chronic gastritis in alcoholics and hypersecretion. R. in 10-15 minutes after eating characteristic of acute gastritis, ulcers and stomach cancer under certain tumor localization. R. after 4-6 hours after eating occurs when colorimetrically the plague.
The smell of vomit sour, when the food in the stomach putrid, intestinal obstruction and when fistula between the stomach and colon - feces. In the latter case vomit contain admixtures Kala, whereas in intussusception fecal odor associated with decomposition of the content of thin intestines and his reflux into the stomach. From impurities found in vomitus, the diagnostic value of the blood (see Gematemezis), pus (phlegmonously gastritis), fecal masses. The defeat of the digestive organs are the most common cause R.
Esophageal vomiting (vomitus oesophagealis) occurs when diverticula and narrowing of the esophagus. Often R. accompanied by diseases of kidneys, urinary tract, sexual organs. Diseases of the pleura, pericardium, disorders of cardiac activity are also often accompanied R.
Vomiting is a very common symptom in some diseases of the nervous system (encephalitis, meningitis, tumors, brain concussion, hemorrhages and other disorders of cerebral circulation). Functional disorders of nervous system can occur R. - nervous (vomitus nervosus) and hysterical (vomitus hystericus).
Often accompanied by vomiting many infectious diseases. However, it can be single, only at the beginning diseases (typhoid fever, erysipelas, scarlet fever). In severe forms of many infectious diseases (smallpox, typhoid fever, sepsis, cerebrospinal meningitis), in case of poisoning, anuria, migraine and especially when toxicosis of pregnancy R. sometimes takes very hard protracted nature of the so - called indomitable R. (gravidarum).
R. may occur during an acute attack of glaucoma one or both eyes, crises in endocrine diseases (Addison's disease, diffuse toxic goiter), as well as with extensive burns, traumatic and operating shocks.
Special treatment vomiting does not exist. It should be aimed at the underlying disease. Measures should be taken to stop or at least reduce vomiting in that case, if she is stubborn character and detrimental to the General condition of the patient.
When food poisoning washed stomach 2% solution of sodium bicarbonate or 1% solution of potassium permanganate, injected under the skin isotonic solution of sodium chloride. To suppress reflexogenic impulses that can come from a stomach, appoint benzocaine inside of 0.25-0.5 g 3 times a day or candles (Papaverini hydrochlorici 0,04, Anaesthesini 0,2, Butyri Cacao 2,0; 1 candle 2-3 times a day), 0.25, or novocaine 0.5% solution inside of 20 ml several times a day. In addition, when persistent vomiting appoint cold on the stomach and anti-emetics, in particular chlorpromazine 2.5% solution (25-50 mg intramuscularly 2 times a day), subcutaneous infusion izotoniceski solution of sodium chloride.
At uremia washed stomach 2% solution of sodium bicarbonate, produce duodenal intubation for pumping perhaps more bile, appoint alkaline water, drip enema with 2% solution of sodium bicarbonate, subcutaneous infusion izotoniceski solution of sodium chloride and 5% glucose solution. With increasing intracranial pressure injected 20 ml 40% glucose solution, intramuscularly 5 ml of 25% solution of magnesium sulfate, sometimes produce a lumbar puncture.