Vomiting is when the stomach contents are ejected through the mouth.
Most people have vomited at least once in their lives. Though unpleasant, vomiting is often the body's way of trying to get rid of harmful toxins. There are many different causes of vomiting.
The healthcare professional needs to know several things when a person is vomiting, including: when the vomiting startedif the vomiting takes place at night or wakes the patient upwhat the vomited material looks likehow many times a person has vomitedwhether any friends or close family members have been vomitingwhether or not the person has any abdominal distress or chest pain whether or not the person has a fever or is sick in any other waywhether the person has a decreased appetite, which does not always happen with vomitingwhat the person was doing on the day he or she started vomitingany other symptoms, such as weight loss, dark-colored stools, history of stomach problems or diabetes, or other symptoms
The healthcare provider may ask other questions depending on the history and on the physical exam findings, in order to narrow the list of possible causes.
Any illness can cause vomiting, especially in infants. For instance, ear infections are a common cause of vomiting in infants. Influenza infection (the flu) can also cause vomiting. Other causes include: stomach or intestinal infections, such as food poisoning or gastroenteritispeptic ulcers or gastroesophageal reflux diseaseinflammation in or around the gut, such as appendicitis, pancreatitis, hepatitis, or gastritisblockage in the bowels, such as pyloric stenosis or duodenal atresia in infants, or small or large bowel obstruction at any agefood allergies or lactose intolerancetoxins or medications, such as alcohol, many antibiotics, or chemotherapy in cancer patients acute renal (kidney) failure heart attack pregnancy, which often causes morning sickness tumors or cancer, which may be in the stomach, intestines, or in other parts of the bodyincreased intracranial pressure (that is, pressure inside the skull)certain types of uncontrolled diabetesextreme anxiety or a sense of disgust, such as from a foul odorextreme overexertion or exerciseseasickness or motion sicknessmigraine headachesbulimia nervosa, an eating disorder with self-induced vomiting
Other causes are also possible. Sometimes, no cause can be found.
Prevention depends on the cause. For instance, avoiding alcohol can prevent vomiting due to alcohol. Avoiding extreme exercise can prevent vomiting due to exercise. In most settings, vomiting cannot be avoided, but can often be treated.
Sometimes, the cause of vomiting is obvious to the healthcare professional from the history and physical exam. In other cases, further testing must be done, depending on the suspected condition(s). For instance, blood tests can diagnose hepatitis, pancreatitis, and other conditions.
An x-ray of the abdomen, done with or without a special dye, may show an ulcer or bowel blockage. If cancer is suspected, a special x-ray test, such as an abdominal or brain CT scan, may be ordered. Other tests are also possible.
Prolonged vomiting can lead to dehydration and salt imbalances. In chronic vomiting, the stomach acid may damage the enamel of the teeth. This phenomenon is likely to be observed in a person who has bulimia.
Most other long-term effects are related to the cause. For instance, food poisoning usually goes away within 48 hours and causes no long-term effects. On the other hand, cancer may result in death.
Vomiting itself is not contagious and poses no risk to others. However, if the cause is an infection, the infection may be contagious.
Medicine to prevent nausea and vomiting, such as prochlorperazine or metoclopramide (i.e., Reglan), may be used. Fluids can be given through an IV in the vein if a person is dehydrated and unable to keep anything in his or her stomach. If the cause is a viral infection or food poisoning, this may be all the treatment that is given.
Other treatments are directed at the cause. For instance, drugs such as ranitidine (i.e., Zantac) or omeprazole (i.e., Prilosec) are often given for gastroesophageal reflux or peptic ulcers. Cancer may require surgery, chemotherapy, or radiation therapy. People with kidney failure may need to go on dialysis or get a kidney transplant.
All medications have possible side effects, including allergic reactions, stomach upset, or headache. Specific side effects depend on the medications used. Surgery can be complicated by infection, bleeding, or reactions to anesthesia. Dialysis requires surgery first to put in a shunt or catheter, and may result in infection or serious salt imbalances.
This depends on the cause. For instance, morning sickness from pregnancy often goes away within a few months. No further treatment may be needed in this case. People with chronic renal failure or cancer, however, may need monitoring and treatment for the rest of their lives.
The most important thing to watch for with vomiting is dehydration, especially in children. There also may be an increased risk of electrolyte abnormalities. Other monitoring depends on the cause of the vomiting. For instance, people with bulimia may need regular counseling and therapy.
Harrison's Principles of Internal Medicine, 1998, Fauci et al.
