Disease: Nausea and Vomiting

    Nausea and vomiting facts

    • Nausea and vomiting are symptoms of a disease or condition. The underlying cause of the illness causing nausea and vomiting should be identified and treated.
    • Nausea and vomiting symptom control is important both for comfort's sake and to prevent dehydration.
    • Dehydration can worsen nausea and vomiting.
    • Medication may be available to control symptoms of nausea and vomiting.

    Introduction to nausea and vomiting

    Nausea and vomiting are symptoms of an underlying illness and not a specific disease. Nausea is the sensation that the stomach wants to empty itself, while vomiting (emesis) or throwing up, is the act of forcible emptying of the stomach. The term "dry heaves" refers to an episode of vomiting where there is no food in the stomach to vomit, and only clear secretions are vomited.

    Vomiting is a violent act in which the stomach almost turns itself inside out - forcing itself into the lower portion of the esophagus (the tube that connects the mouth to the stomach) during a vomiting episode, expelling food and secretions.

    What causes nausea or vomiting?

    There are numerous causes of nausea and vomiting. These symptoms may be due to the following:

    • Acute gastritis (direct irritation of the stomach lining)
    • Central causes in which signals from the brain cause nausea and vomiting
    • Other illnesses not due to stomach problems
    • Medications and medical treatments
    • Mechanical obstruction of the bowel

    Acute gastritis and nausea and vomiting

    Acute gastritis is often caused by an something that irritates the lining of the stomach. Examples of these circumstances include:

    • Infections: Infections are often the cause of stomach irritation, whether it is a common virus or another type of infection. There may be associated crampy upper abdominal pain that is associated with the nausea and vomiting. Fever ,and chills may be present. Common viral infections include noroviruses and rotavirus. Infection by bacteria in the Helicobacter family (such as H. Pylori) can also be the infectious agent.
    • Stomach flu: Stomach flu (gastroenteritis) is when vomiting and diarrhea occur together that is associated with a viral infection. It should not be confused with influenza (symptoms include fever, chills, cough, and muscle pain.
    • Food poisoning: Food poisoning may cause significant vomiting, and the most common cause is a toxin released by the bacteria Staphylococcus aureus.  Symptoms of food poisoning begin within a couple hours of eating contaminated or poorly prepared food. Other bacterial causes of food poisoning include Salmonella, Campylobacter, Shigella, E. coli, Listeria, or Clostridium botulinum (botulism).
    • Other stomach irritants: alcohol, smoking, and nonsteroidal anti-inflammatory medications (NSAIDs) such as aspirin and ibuprofen may irritate the stomach lining and cause nausea and vomiting.
    • Peptic ulcer disease: Peptic ulcer disease can range from mild irritation of the stomach lining to the formation of a defect in the protective lining of the stomach called an ulcer.
    • Gastroesophageal reflux disease (GERD, reflux esophagitis): Nausea or vomiting is also associated with GERD (acid from the stomach is refluxed into the esophagus).

    Central causes of nausea and vomiting

    • Headache: especially migraine, is commonly associated with nausea and vomiting.
    • Inner ear: Motion sickness, labyrinthitis, benign positional vertigo, or Meniere's disease
    • Increased intracranial pressure: Any illness or injury that increases the pressure within the skull can cause vomiting.
      • Brain swelling due to trauma (includes bleeding within the brain)
      • Infection (meningitis or encephalitis)
      • Tumors (benign or malignant)
      • Abnormal electrolyte concentrations in the bloodstream and associated water imbalance
      • Concussion, patients with head injuries do not have to have detectable bleeding in the brain or brain swelling to have symptoms of brain irritation, which can include headache, nausea, vomiting, changes in vision, confusion, difficulty concentrating, difficulty sleeping, among other symptoms.
    • Noxious stimulus: Certain smells or sounds can cause centrally mediated nausea and vomiting that originates in the brain. Whether it is the pain of a broken bone or the emotional shock of observing an event, vasovagal events can cause significant symptoms. In a vasovagal episode, the vagus nerve (one of the nerves that helps control basic body functions like heart rate, breathing, and blood pressure) is overly stimulated can cause the heart rate to slow and blood vessels to dilate. This decreases the blood flow to the brain and can cause fainting, known as a syncopal episode.
    • Heat related illness: For example heat exhaustion, extreme sunburn, or dehydration

    Nausea and vomiting associated with illness

    • Diabetes: Persons with diabetes may develop nausea because of gastroparesis, a condition in which the stomach fails to empty properly and is likely due to the generalized neuropathy (failure of the nerves in the body to send proper signals to and from the brain) that is a complication of the disease.

    People with diabetes can also develop nausea and vomiting should their blood sugars become abnormally high or low (hyperglycemia or hypoglycemia) because the sugar and insulin balance is disturbed.

    • Diseases or illness: Many illnesses associated with the intra-abdominal organs can produce the symptoms of nausea and vomiting. These include digestive organ diseasessuch as:
      • Hepatitis
      • Gallbladder disease
      • Pancreatitis
      • Crohn's disease
      • Kidney diseases (for example, kidney stones, infection, kidney failure)
      • Some forms of cancer
    • Vomiting as an atypical symptom of another disease: Some illnesses will cause nausea and vomiting, even though there is no direct involvement of the stomach or gastrointestinal tract.
      • Heart attack victims may experience nausea and vomiting as an atypical symptom of angina, especially if the heart attack affects the inferior or lower part of the heart.
      • Lung infections, for example, pneumonia and bronchitis, may also cause nausea and vomiting, especially if the area of lung involved is near the diaphragm, the muscle that separates the chest form the abdomen.
    • Sepsis: An overwhelming body infection spread through the bloodstream may also be associated with nausea and vomiting.
    • Eating disorders: Patients with bulimia will have self-induced vomiting, purging as part of their psychiatric illness

    Nausea and vomiting from medications and medical treatments

    • Side effects from medications: The side effect of many medications include stomach irritation and/or nausea and vomiting. Anti-cancer dugs used for chemotherapy commonly cause nausea and vomiting that is not easily relieved. Narcotic pain medications, anti-inflammatory medications, steroids, and antibiotics all have nausea and vomiting listed as common side effects.
    • Radiation therapy: Nausea and vomiting can be associated with radiation therapy.

    Nausea and vomiting and bowel obstruction

    Abdominal pain and distention, nausea and vomiting, and inability to pass flatus (gas) or have a bowel movement are symptoms of bowel obstruction. Due to a variety of potential reasons, the small intestine becomes blocked and doesn't allow contents to pass through to the colon. This acts like a dam where food, fluid, and secretions back up, causing the symptoms of an obstruction. Common causes of bowel obstruction include previous surgery with the formation of adhesions, hernias, abnormal twisting of the GI tract (volvulus), tumors, and inflammatory bowel disease (IBD).

    Nausea and vomiting in pregnancy (morning sickness)

    Vomiting in pregnancy is especially common in the first trimester due to hormone level changes in the bloodstream.

    Vomiting in infants

    It may be hard to decide if an infant is vomiting or spitting up. If the episodes occur shortly after feeding and only a small amount comes up, this may be spitting up.

    • Forceful vomiting: In the first two or three months, if the vomiting is forceful after eating (imagine it flying across the room), this may be a sign of pyloric stenosis, or an abnormal narrowing of the pylorus, the location where the stomach empties into the duodenum (the first part of the small intestine). The vomiting is impressive and is described as projectile. The diagnosis is often made by history and physical examination, confirmed by ultrasound. The treatment is surgery.
    • Vomiting associated with pain: if the infant cries uncontrollably, and if the stool is bloody or red, the diagnosis may be an intussusception (the pushing of one segment of the bowel into an adjacent segment). The stool is classically described as like being currant jelly, but any blood in the stool is not normal and should always be a cause for concern. It is reasonable to seek medical care for any inconsolable infant.
    • Viral infection: If there is vomiting with associated diarrhea that is not bloody, then a viral infection is a possibility. Alternatively, there may be an issue with intolerance to the type of baby formula. Infants and children are at greater risk of dehydration if the vomiting episodes last for more than 24 hours. If dehydration is suspected, seek medical care. Signs and symptoms of dehydration in an infant include dry mouth, lack of sweat in the armpits and groin, suken eyes, weakness with a poor cry, and decreased muscle tone.

    What are home remedies for nausea or vomiting?

    It is important to rest the stomach and yet still avoid dehydration. Clear fluids should be attempted for the first 24 hours of an illness, and then the diet should be advanced as tolerated.

    Clear fluids are easy for the stomach to absorb and include:

    • Water
    • Sports drinks
    • Clear broths
    • Popsicles
    • Jello

    It is important not to take too much fluid at one time since stretching the stomach may cause the nausea to worsen. One to two ounces of fluid at a time, taken every 10-15 minutes, may be all that the stomach will be able to tolerate. In infants and children, the amount may be as little as 5 or 10 cc's or less than a third of an ounce at a time.

    Milk products should be avoided for the first 24-48 hours during an episode of nausea and vomiting. The enzyme that helps digest milk is located in cells lining the stomach. With vomiting, the body can become relatively lactose intolerant. Abdominal pain, bloating, vomiting, and diarrhea may occur. As the affected individual begins to feel better, they can begin to reintroduce foods, but to help the stomach readjust, health care professionals often recommend limiting the diet to bland foods such as bananas, applesauce, rice, toast (the BRAT diet).

    When should I call the doctor regarding nausea and vomiting?

    If the symptoms last for more than 24 hours, if the diagnosis is uncertain, if there is concern about dehydration, or if the patient has underlying medical conditions that make them more fragile, medical care should be accessed sooner, rather than later.

    Infants and children are more susceptible to dehydration and may not have as much reserve as an adult. If there is concern about dehydration or the inability to tolerate fluids, a health care professional should be contacted.

    If nausea and vomiting are associated with pain, fever, vomiting blood, or having bloody or black, tarry bowel movements, medical care should be sought immediately.

    Vomiting is a symptom of an illness, if the symptom persists for more than 24-48 hours, it may be wise to contact a health care professional.

    Acute gastritis and nausea and vomiting

    Acute gastritis is often caused by an something that irritates the lining of the stomach. Examples of these circumstances include:

    • Infections: Infections are often the cause of stomach irritation, whether it is a common virus or another type of infection. There may be associated crampy upper abdominal pain that is associated with the nausea and vomiting. Fever ,and chills may be present. Common viral infections include noroviruses and rotavirus. Infection by bacteria in the Helicobacter family (such as H. Pylori) can also be the infectious agent.
    • Stomach flu: Stomach flu (gastroenteritis) is when vomiting and diarrhea occur together that is associated with a viral infection. It should not be confused with influenza (symptoms include fever, chills, cough, and muscle pain.
    • Food poisoning: Food poisoning may cause significant vomiting, and the most common cause is a toxin released by the bacteria Staphylococcus aureus.  Symptoms of food poisoning begin within a couple hours of eating contaminated or poorly prepared food. Other bacterial causes of food poisoning include Salmonella, Campylobacter, Shigella, E. coli, Listeria, or Clostridium botulinum (botulism).
    • Other stomach irritants: alcohol, smoking, and nonsteroidal anti-inflammatory medications (NSAIDs) such as aspirin and ibuprofen may irritate the stomach lining and cause nausea and vomiting.
    • Peptic ulcer disease: Peptic ulcer disease can range from mild irritation of the stomach lining to the formation of a defect in the protective lining of the stomach called an ulcer.
    • Gastroesophageal reflux disease (GERD, reflux esophagitis): Nausea or vomiting is also associated with GERD (acid from the stomach is refluxed into the esophagus).

    Central causes of nausea and vomiting

    • Headache: especially migraine, is commonly associated with nausea and vomiting.
    • Inner ear: Motion sickness, labyrinthitis, benign positional vertigo, or Meniere's disease
    • Increased intracranial pressure: Any illness or injury that increases the pressure within the skull can cause vomiting.
      • Brain swelling due to trauma (includes bleeding within the brain)
      • Infection (meningitis or encephalitis)
      • Tumors (benign or malignant)
      • Abnormal electrolyte concentrations in the bloodstream and associated water imbalance
      • Concussion, patients with head injuries do not have to have detectable bleeding in the brain or brain swelling to have symptoms of brain irritation, which can include headache, nausea, vomiting, changes in vision, confusion, difficulty concentrating, difficulty sleeping, among other symptoms.
    • Noxious stimulus: Certain smells or sounds can cause centrally mediated nausea and vomiting that originates in the brain. Whether it is the pain of a broken bone or the emotional shock of observing an event, vasovagal events can cause significant symptoms. In a vasovagal episode, the vagus nerve (one of the nerves that helps control basic body functions like heart rate, breathing, and blood pressure) is overly stimulated can cause the heart rate to slow and blood vessels to dilate. This decreases the blood flow to the brain and can cause fainting, known as a syncopal episode.
    • Heat related illness: For example heat exhaustion, extreme sunburn, or dehydration

    Nausea and vomiting associated with illness

    • Diabetes: Persons with diabetes may develop nausea because of gastroparesis, a condition in which the stomach fails to empty properly and is likely due to the generalized neuropathy (failure of the nerves in the body to send proper signals to and from the brain) that is a complication of the disease.

    People with diabetes can also develop nausea and vomiting should their blood sugars become abnormally high or low (hyperglycemia or hypoglycemia) because the sugar and insulin balance is disturbed.

    • Diseases or illness: Many illnesses associated with the intra-abdominal organs can produce the symptoms of nausea and vomiting. These include digestive organ diseasessuch as:
      • Hepatitis
      • Gallbladder disease
      • Pancreatitis
      • Crohn's disease
      • Kidney diseases (for example, kidney stones, infection, kidney failure)
      • Some forms of cancer
    • Vomiting as an atypical symptom of another disease: Some illnesses will cause nausea and vomiting, even though there is no direct involvement of the stomach or gastrointestinal tract.
      • Heart attack victims may experience nausea and vomiting as an atypical symptom of angina, especially if the heart attack affects the inferior or lower part of the heart.
      • Lung infections, for example, pneumonia and bronchitis, may also cause nausea and vomiting, especially if the area of lung involved is near the diaphragm, the muscle that separates the chest form the abdomen.
    • Sepsis: An overwhelming body infection spread through the bloodstream may also be associated with nausea and vomiting.
    • Eating disorders: Patients with bulimia will have self-induced vomiting, purging as part of their psychiatric illness

    Nausea and vomiting from medications and medical treatments

    • Side effects from medications: The side effect of many medications include stomach irritation and/or nausea and vomiting. Anti-cancer dugs used for chemotherapy commonly cause nausea and vomiting that is not easily relieved. Narcotic pain medications, anti-inflammatory medications, steroids, and antibiotics all have nausea and vomiting listed as common side effects.
    • Radiation therapy: Nausea and vomiting can be associated with radiation therapy.

    Nausea and vomiting and bowel obstruction

    Abdominal pain and distention, nausea and vomiting, and inability to pass flatus (gas) or have a bowel movement are symptoms of bowel obstruction. Due to a variety of potential reasons, the small intestine becomes blocked and doesn't allow contents to pass through to the colon. This acts like a dam where food, fluid, and secretions back up, causing the symptoms of an obstruction. Common causes of bowel obstruction include previous surgery with the formation of adhesions, hernias, abnormal twisting of the GI tract (volvulus), tumors, and inflammatory bowel disease (IBD).

    Nausea and vomiting in pregnancy (morning sickness)

    Vomiting in pregnancy is especially common in the first trimester due to hormone level changes in the bloodstream.

    Vomiting in infants

    It may be hard to decide if an infant is vomiting or spitting up. If the episodes occur shortly after feeding and only a small amount comes up, this may be spitting up.

    • Forceful vomiting: In the first two or three months, if the vomiting is forceful after eating (imagine it flying across the room), this may be a sign of pyloric stenosis, or an abnormal narrowing of the pylorus, the location where the stomach empties into the duodenum (the first part of the small intestine). The vomiting is impressive and is described as projectile. The diagnosis is often made by history and physical examination, confirmed by ultrasound. The treatment is surgery.
    • Vomiting associated with pain: if the infant cries uncontrollably, and if the stool is bloody or red, the diagnosis may be an intussusception (the pushing of one segment of the bowel into an adjacent segment). The stool is classically described as like being currant jelly, but any blood in the stool is not normal and should always be a cause for concern. It is reasonable to seek medical care for any inconsolable infant.
    • Viral infection: If there is vomiting with associated diarrhea that is not bloody, then a viral infection is a possibility. Alternatively, there may be an issue with intolerance to the type of baby formula. Infants and children are at greater risk of dehydration if the vomiting episodes last for more than 24 hours. If dehydration is suspected, seek medical care. Signs and symptoms of dehydration in an infant include dry mouth, lack of sweat in the armpits and groin, suken eyes, weakness with a poor cry, and decreased muscle tone.

    What are home remedies for nausea or vomiting?

    It is important to rest the stomach and yet still avoid dehydration. Clear fluids should be attempted for the first 24 hours of an illness, and then the diet should be advanced as tolerated.

    Clear fluids are easy for the stomach to absorb and include:

    • Water
    • Sports drinks
    • Clear broths
    • Popsicles
    • Jello

    It is important not to take too much fluid at one time since stretching the stomach may cause the nausea to worsen. One to two ounces of fluid at a time, taken every 10-15 minutes, may be all that the stomach will be able to tolerate. In infants and children, the amount may be as little as 5 or 10 cc's or less than a third of an ounce at a time.

    Milk products should be avoided for the first 24-48 hours during an episode of nausea and vomiting. The enzyme that helps digest milk is located in cells lining the stomach. With vomiting, the body can become relatively lactose intolerant. Abdominal pain, bloating, vomiting, and diarrhea may occur. As the affected individual begins to feel better, they can begin to reintroduce foods, but to help the stomach readjust, health care professionals often recommend limiting the diet to bland foods such as bananas, applesauce, rice, toast (the BRAT diet).

    When should I call the doctor regarding nausea and vomiting?

    If the symptoms last for more than 24 hours, if the diagnosis is uncertain, if there is concern about dehydration, or if the patient has underlying medical conditions that make them more fragile, medical care should be accessed sooner, rather than later.

    Infants and children are more susceptible to dehydration and may not have as much reserve as an adult. If there is concern about dehydration or the inability to tolerate fluids, a health care professional should be contacted.

    If nausea and vomiting are associated with pain, fever, vomiting blood, or having bloody or black, tarry bowel movements, medical care should be sought immediately.

    Vomiting is a symptom of an illness, if the symptom persists for more than 24-48 hours, it may be wise to contact a health care professional.

    Source: http://www.rxlist.com

    Acute gastritis is often caused by an something that irritates the lining of the stomach. Examples of these circumstances include:

    • Infections: Infections are often the cause of stomach irritation, whether it is a common virus or another type of infection. There may be associated crampy upper abdominal pain that is associated with the nausea and vomiting. Fever ,and chills may be present. Common viral infections include noroviruses and rotavirus. Infection by bacteria in the Helicobacter family (such as H. Pylori) can also be the infectious agent.
    • Stomach flu: Stomach flu (gastroenteritis) is when vomiting and diarrhea occur together that is associated with a viral infection. It should not be confused with influenza (symptoms include fever, chills, cough, and muscle pain.
    • Food poisoning: Food poisoning may cause significant vomiting, and the most common cause is a toxin released by the bacteria Staphylococcus aureus.  Symptoms of food poisoning begin within a couple hours of eating contaminated or poorly prepared food. Other bacterial causes of food poisoning include Salmonella, Campylobacter, Shigella, E. coli, Listeria, or Clostridium botulinum (botulism).
    • Other stomach irritants: alcohol, smoking, and nonsteroidal anti-inflammatory medications (NSAIDs) such as aspirin and ibuprofen may irritate the stomach lining and cause nausea and vomiting.
    • Peptic ulcer disease: Peptic ulcer disease can range from mild irritation of the stomach lining to the formation of a defect in the protective lining of the stomach called an ulcer.
    • Gastroesophageal reflux disease (GERD, reflux esophagitis): Nausea or vomiting is also associated with GERD (acid from the stomach is refluxed into the esophagus).

      Source: http://www.rxlist.com

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