Causes of Vomiting | Motion Sickness Vomiting, Vomiting with Blood

What Causes Vomiting

• History of vomiting itself is not diagnostic of any condition. Vomiting may occur due to a wide variety of local and systemic disorders. Vomiting may occur from simple gastric irritation.
• Vomiting may occur in functional and organic disorders of the nervous system e.g. fear, motion sickness, migraine, labyrinthine disorders, meningitis and intra-cranial tumor.
• Vomiting may occur from severe pain as in any colic.
• Amongst systemic conditions pregnancy, renal failure and metabolic disorders e.
  g. diabetic ketoacidosis or hyperparathyroidism are important. A few drugs may cause vomiting e.g. digoxin, morphine etc.
• In surgical practice vomiting may occur in peptic ulceration, pyloric stenosis (gastric outlet obstruction), acute cholecystitis, acute pancreatitis and intestinal obstruction. In some cases of intracranial tumor the vomiting is an important symptom.

Vomiting Types

• The vomitus may contain recent ingested material. Such vomitus may be acid in reaction when it is probably due to the gastric outlet obstruction.
  If such vomitus is not acid in reaction the cause may be achalasia of the esophagus, benign or malignant stricture of the esophagus.
• Vomit may contain bile to give yellow coloration of the vomitus.
• Vomit containing upper small bowel contents may be green in color.
• Feculent vomitus contains lower small bowel contents, brown and of fecal odor.
  This is characteristic of advanced low small bowel obstruction.
• Vomit may contain feces. This may be due to abnormal communication between the stomach and transverse colon (gastro-colic fistula as a complication of gastric ulcer).
• Vomit containing blood may be of various types. The bleeding may be copious. The vomit may present pure blood or clots. Such bleeding may come from gastric ulcer or esophageal varies. The blood in the vomit may be altered to blackish or dark brown in color in contact with gastric juice. This is due to conversion of hemoglobin to hematin. This altered blood gives the vomitus a ‘coffee-ground’ appearance. Medicine containing iron or red wine may give rise to this type of vomitus. It must be remembered that blood in the vomit may have come from the nose or lungs which have been swallowed.

Further evaluation of the vomiting is as follows

• Character of the act
  • The vomiting may be projectile i.e. involuntary forceful ejection of a large quantity of vomitus in high intestinal obstruction, toxic enteritis etc.
  • In case of peptic ulcer perforation or general peritonitis the vomiting is quiet regurgitation of mouthfuls.
• Vomitus
  • In intestinal obstruction at first the stomach contents, next the duodenal contents (bilious) and lastly the intestinal contents (feculent) are voided. True fecal vomiting is uncommon. It is also seen in gastro-colic fistula. In case of biliary colic the vomiting is usually bilious. In case of peptic ulcer the vomitus is nothing but gastric contents. In late cases of peritonitis the vomitus becomes dark brown, feculent being mixed with altered blood. This type of vomitus is also seen in uremia.
• Frequency and quantity
  • Vomiting is constant, frequent and profuse in acute intestinal obstruction and acute pancreatitis. In peptic ulcer vomiting is periodical. In perforation of a peptic ulcer vomiting is not a diagnostic feature. It may be once or twice during the first stage; it is more or less absent in the second stage and may reappear in the last stage with the characteristic vomitus of diffuse peritonitis. Similarly in acute appendicitis it may or may not be present. But nausea is more often complained of. Both nausea and vomiting are the characteristic complaints in pre and post-ileal appendicitis.

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