Vomiting - wikipedia Vomiting This article needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. ( March 2018 ) `` Vomit '' redirects here. For other uses, see Vomit ( disambiguation ). `` Emesis '' redirects here. For the butterfly genus, see Emesis ( genus ). `` Heaving '' redirects here. For the sailing term, see Heaving to. For the sailing term `` heaving down '', see Careening. `` Puke '' redirects here. For other uses, see Puke ( disambiguation ). Vomiting Miracle of Marco Spagnolo by Giorgio Bonola ( Quadroni of St. Charles ) Classification and external resources Specialty Gastroenterology ICD - 10 R11 ICD - 9 - CM 787 MeSH D014839 ( edit on Wikidata ) Vomiting, also known as emesis, puking, barfing, throwing up, among other terms, is the involuntary, forceful expulsion of the contents of one 's stomach through the mouth and sometimes the nose. Vomiting can be caused by a wide variety of conditions ; it may present as a specific response to ailments like gastritis or poisoning, or as a non-specific sequela of disorders ranging from brain tumors and elevated intracranial pressure to overexposure to ionizing radiation. The feeling that one is about to vomit is called nausea, which often precedes, but does not always lead to, vomiting. Antiemetics are sometimes necessary to suppress nausea and vomiting. In severe cases, where dehydration develops, intravenous fluid may be required. Self - induced vomiting can be a component of an eating disorder, such as bulimia nervosa, and is itself now an eating disorder on its own, purging disorder. Vomiting is different from regurgitation, although the two terms are often used interchangeably. Regurgitation is the return of undigested food back up the esophagus to the mouth, without the force and displeasure associated with vomiting. The causes of vomiting and regurgitation are generally different. Contents 1 Complications 1.1 Aspiration 1.2 Dehydration and electrolyte imbalance 1.3 Mallory -- Weiss tear 1.4 Dentistry 2 Pathophysiology 2.1 Phases 2.2 Contents 3 Differential diagnosis 3.1 Digestive tract 3.2 Sensory system and brain 3.3 Emetics 3.4 Social cues 3.5 Miscellanea 3.6 Other types 4 Treatment 5 Epidemiology 6 Social and cultural aspects 7 See also 8 References 9 External links Complications Aspiration Vomiting can be dangerous if the gastric content enters the respiratory tract. Under normal circumstances the gag reflex and coughing prevent this from occurring ; however, these protective reflexes are compromised in persons under the influences of certain substances such as alcohol or anesthesia. The individual may choke and asphyxiate or suffer an aspiration pneumonia. Dehydration and electrolyte imbalance Prolonged and excessive vomiting depletes the body of water ( dehydration ), and may alter the electrolyte status. Gastric vomiting leads to the loss of acid ( protons ) and chloride directly. Combined with the resulting alkaline tide, this leads to hypochloremic metabolic alkalosis ( low chloride levels together with high HCO and CO and increased blood pH ) and often hypokalemia ( potassium depletion ). The hypokalemia is an indirect result of the kidney compensating for the loss of acid. With the loss of intake of food the individual may eventually become cachectic. A less frequent occurrence results from a vomiting of intestinal contents, including bile acids and HCO, which can cause metabolic acidosis. Mallory -- Weiss tear See also : Mallory -- Weiss syndrome Repeated or profuse vomiting may cause erosions to the esophagus or small tears in the esophageal mucosa ( Mallory -- Weiss tear ). This may become apparent if fresh red blood is mixed with vomit after several episodes. Dentistry Recurrent vomiting, such as observed in bulimia nervosa, may lead to destruction of the tooth enamel due to the acidity of the vomit. Digestive enzymes can also have a negative effect on oral health, by degrading the tissue of the gums. Pathophysiology 14th - century illustration of vomiting from the Casanatense Tacuinum Sanitatis Receptors on the floor of the fourth ventricle of the brain represent a chemoreceptor trigger zone, known as the area postrema, stimulation of which can lead to vomiting. The area postrema is a circumventricular organ and as such lies outside the blood -- brain barrier ; it can therefore be stimulated by blood - borne drugs that can stimulate vomiting or inhibit it. There are various sources of input to the vomiting center : The chemoreceptor trigger zone at the base of the fourth ventricle has numerous dopamine D receptors, serotonin 5 - HT receptors, opioid receptors, acetylcholine receptors, and receptors for substance P. Stimulation of different receptors are involved in different pathways leading to emesis, in the final common pathway substance P appears involved. The vestibular system, which sends information to the brain via cranial nerve VIII ( vestibulocochlear nerve ), plays a major role in motion sickness, and is rich in muscarinic receptors and histamine H receptors. The cranial nerve X ( vagus nerve ) is activated when the pharynx is irritated, leading to a gag reflex. The vagal and enteric nervous system inputs transmit information regarding the state of the gastrointestinal system. Irritation of the GI mucosa by chemotherapy, radiation, distention, or acute infectious gastroenteritis activates the 5 - HT receptors of these inputs. The CNS mediates vomiting that arises from psychiatric disorders and stress from higher brain centers. The vomiting act encompasses three types of outputs initiated by the chemoreceptor trigger zone : Motor, parasympathetic nervous system ( PNS ), and sympathetic nervous system ( SNS ). They are as follows : Increased salivation to protect tooth enamel from stomach acids. ( Excessive vomiting leads to dental erosion ). This is part of the PNS output. The body takes a deep breath to avoid aspirating vomit. Retroperistalsis starts from the middle of the small intestine and sweeps up digestive tract contents into the stomach, through the relaxed pyloric sphincter. Intrathoracic pressure lowers ( by inspiration against a closed glottis ), coupled with an increase in abdominal pressure as the abdominal muscles contract, propels stomach contents into the esophagus as the lower esophageal sphincter relaxes. The stomach itself does not contract in the process of vomiting except for at the angular notch, nor is there any retroperistalsis in the esophagus. Vomiting is ordinarily preceded by retching. Vomiting also initiates an SNS response causing both sweating and increased heart rate. The neurotransmitters that regulate vomiting are poorly understood, but inhibitors of dopamine, histamine, and serotonin are all used to suppress vomiting, suggesting that these play a role in the initiation or maintenance of a vomiting cycle. Vasopressin and neurokinin may also participate. Phases The vomiting act has two phases. In the retching phase, the abdominal muscles undergo a few rounds of coordinated contractions together with the diaphragm and the muscles used in respiratory inspiration. For this reason, an individual may confuse this phase with an episode of violent hiccups. In this retching phase, nothing has yet been expelled. In the next phase, also termed the expulsive phase, intense pressure is formed in the stomach brought about by enormous shifts in both the diaphragm and the abdomen. These shifts are, in essence, vigorous contractions of these muscles that last for extended periods of time - much longer than a normal period of muscular contraction. The pressure is then suddenly released when the upper esophageal sphincter relaxes resulting in the expulsion of gastric contents. Individuals who do not regularly exercise their abdominal muscles may experience pain in those muscles for a few days. The relief of pressure and the release of endorphins into the bloodstream after the expulsion causes the vomiter to feel better. Contents Gastric secretions and likewise vomit are highly acidic. Recent food intake appears in the gastric vomit. Irrespective of the content, vomit tends to be malodorous. The content of the vomitus ( vomit ) may be of medical interest. Fresh blood in the vomit is termed hematemesis ( `` blood vomiting '' ). Altered blood bears resemblance to coffee grounds ( as the iron in the blood is oxidized ) and, when this matter is identified, the term coffee - ground vomiting is used. Bile can enter the vomit during subsequent heaves due to duodenal contraction if the vomiting is severe. Fecal vomiting is often a consequence of intestinal obstruction or a gastrocolic fistula and is treated as a warning sign of this potentially serious problem ( signum mali ominis ). If the vomiting reflex continues for an extended period with no appreciable vomitus, the condition is known as non-productive emesis or `` dry heaves '', which can be painful and debilitating. Color of vomit Bright red in the vomit suggests bleeding from the esophagus Dark red vomit with liver - like clots suggests profuse bleeding in the stomach, such as from a perforated ulcer Coffee - ground - like vomit suggests less severe bleeding in the stomach, because the gastric acid has had time to change the composition of the blood Yellow vomit suggests bile, indicating that the pyloric valve is open and bile is flowing into the stomach from the duodenum ( this is more common in older people ) Differential diagnosis Vomiting may be due to a large number of causes, and protracted vomiting has a long differential diagnosis. Digestive tract Causes in the digestive tract Gastritis ( inflammation of the gastric wall ) Gastroenteritis Gastroesophageal reflux disease Celiac disease Non-celiac gluten sensitivity Pyloric stenosis ( in babies, this typically causes a very forceful `` projectile vomiting '' and is an indication for urgent surgery ) Bowel obstruction Overeating Acute abdomen and / or peritonitis Ileus Food allergies ( often in conjunction with hives or swelling ) Cholecystitis, pancreatitis, appendicitis, hepatitis Food poisoning In children, it can be caused by an allergic reaction to cow 's milk proteins ( Milk allergy or lactose intolerance ) Sensory system and brain Causes in the sensory system : Movement : motion sickness ( which is caused by overstimulation of the labyrinthine canals of the ear ) Ménière 's disease Causes in the brain : Concussion Cerebral hemorrhage Migraine Brain tumors, which can cause the chemoreceptors to malfunction Benign intracranial hypertension and hydrocephalus Metabolic disturbances ( these may irritate both the stomach and the parts of the brain that coordinate vomiting ) : Hypercalcemia ( high calcium levels ) Uremia ( urea accumulation, usually due to renal failure ) Adrenal insufficiency Hypoglycemia Hyperglycemia Pregnancy : Hyperemesis, morning sickness Drug reaction ( vomiting may occur as an acute somatic response to ) : alcohol ( being sick while being drunk or being sick the next morning, suffering from the after - effects, i.e., the hangover ) opioids selective serotonin reuptake inhibitors many chemotherapy drugs some entheogens ( such as peyote or ayahuasca ) Illness ( sometimes colloquially known as `` stomach flu '' -- a broad name that refers to gastric inflammation caused by a range of viruses and bacteria ) : Norovirus ( formerly Norwalk virus or Norwalk agent ) Swine influenza Psychiatric / behavioral Bulimia Nervosa Purge disorder Emetics An emetic, such as syrup of ipecac, is a substance that induces vomiting when administered orally or by injection. An emetic is used medically when a substance has been ingested and must be expelled from the body immediately ( for this reason, many toxic and easily digestible products such as rat poison contain an emetic ). Inducing vomiting can remove the substance before it is absorbed into the body. Ipecac abuse can cause detrimental health effects. Salt water and mustard water have been used since ancient times as emetics. Care must be taken with salt, as excessive intake can potentially be harmful. Copper sulfate was also used in the past as an emetic. It is now considered too toxic for this use. Hydrogen peroxide is used as an emetic in veterinary practice. Social cues A drunk man vomiting, while a young slave is holding his forehead. Brygos Painter, 500 -- 470 BC It is quite common that, when one person vomits, others nearby become nauseated, particularly when smelling the vomit of others, often to the point of vomiting themselves. It is believed that this is an evolved trait among primates. Many primates in the wild tend to browse for food in small groups. Should one member of the party react adversely to some ingested food, it may be advantageous ( in a survival sense ) for other members of the party to also vomit. This tendency in human populations has been observed at drinking parties, where excessive consumption of alcoholic beverages may cause a number of party members to vomit nearly simultaneously, this being triggered by the initial vomiting of a single member of the party. This phenomenon has been touched on in popular culture : notorious instances appear in the films Monty Python 's The Meaning of Life ( 1983 ) and Stand By Me ( 1986 ). Intense vomiting in ayahuasca ceremonies is a common phenomenon. However, people who experience `` la purga '' after drinking ayahuasca, in general, regard the practice as both a physical and spiritual cleanse and often come to welcome it. It has been suggested that the consistent emetic effects of ayahuasca -- in addition to its many other therapeutic properties -- was of medicinal benefit to indigenous peoples of the Amazon, in helping to clear parasites from the gastrointestinal system. There have also been documented cases of a single ill and vomiting individual inadvertently causing others to vomit, when they are especially fearful of also becoming ill, through a form of mass hysteria. Special bags are often supplied on boats for sick passengers to vomit into. Most people try to contain their vomit by vomiting into a sink, toilet, or trash can, as vomit is difficult and unpleasant to clean. On airplanes and boats, special bags are supplied for sick passengers to vomit into. A special disposable bag ( leakproof, puncture - resistant, odorless ) containing absorbent material that solidifies the vomit quickly is also available, making it convenient and safe to store until there is an opportunity to dispose of it conveniently. People who vomit chronically ( e.g., as part of an eating disorder such as bulimia nervosa ) may devise various ways to hide this disorder. An online study of people 's responses to `` horrible sounds '' found vomiting `` the most disgusting ''. Professor Trevor Cox of the University of Salford 's Acoustic Research Centre said that `` We are pre-programmed to be repulsed by horrible things such as vomiting, as it is fundamental to staying alive to avoid nasty stuff. '' It is thought that disgust is triggered by the sound of vomiting to protect those nearby from possibly diseased food. Miscellanea Self - induced Eating disorders ( anorexia nervosa or bulimia nervosa ) To eliminate an ingested poison ( some poisons should not be vomited as they may be more toxic when inhaled or aspirated ; it is better to ask for help before inducing vomiting ) Some people who engage in binge drinking induce vomiting to make room in their stomachs for more alcohol consumption. People suffering from nausea may induce vomiting in hopes of feeling better. After surgery ( postoperative nausea and vomiting ) Disagreeable sights or disgust, smells or thoughts ( such as decayed matter, others ' vomit, thinking of vomiting ), etc. Extreme pain, such as intense headache or myocardial infarction ( heart attack ) Violent emotions Cyclic vomiting syndrome ( a poorly understood condition with attacks of vomiting ) High doses of ionizing radiation sometimes trigger a vomit reflex. Violent fits of coughing, hiccups, or asthma Anxiety Depression Overexertion ( doing too much strenuous exercise can lead to vomiting shortly afterward ). Rumination syndrome, an underdiagnosed and poorly understood disorder that causes sufferers to regurgitate food shortly after ingestion. Other types Projectile vomiting refers to vomiting that ejects the gastric contents with great force. It is a classic symptom of infantile hypertrophic pyloric stenosis, in which it typically follows feeding and can be so forceful that some material exits through the nose. Treatment An antiemetic is a drug that is effective against vomiting and nausea. Antiemetics are typically used to treat motion sickness and the side effects of medications such as opioids and chemotherapy. Antiemetics act by inhibiting the receptor sites associated with emesis. Hence, anticholinergics, antihistamines, dopamine antagonists, serotonin antagonists, and cannabinoids are used as antiemetics. Evidence to support the use of antiemetics for nausea and vomiting among adults in the emergency department is poor. It is unclear if any medication is better than another or better than no active treatment. Epidemiology Nausea and / or vomiting are the main complaints in 1.6 % of visits to family physicians in Australia. Social and cultural aspects Herodotus, writing on the culture of the ancient Persians and highlighting the differences with those of the Greeks, notes that to vomit in the presence of others is prohibited among Persians. See also Bulimia nervosa Emetophilia Cancer and nausea Emetophobia References Jump up ^ Tintinalli, Judith E. ( 2010 ). Emergency Medicine : A Comprehensive Study Guide ( Emergency Medicine ( Tintinalli ) ). New York : McGraw - Hill Companies. p. 830. ISBN 0 - 07 - 148480 - 9. Jump up ^ `` New Eating Disorder : No Binge, Just Purge ''. 20 September 2007. 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Jump up ^ Li -- gui, Huang ; En -- tong, Wang ; Wei, Chen ; Wei -- xi, Gong ( June 2011 ). `` Role of Histamine H1 Receptors in Vestibular Nucleus in Motion Sickness ''. Journal of Otology. 6 ( 1 ) : 20 -- 25. doi : 10.1016 / S1672 - 2930 ( 11 ) 50003 - 0. Jump up ^ Ray Andrew P. ; Chebolu Seetha ; Ramirez Juan ; Darmani Nissar A ( 2009 ). `` Ablation of Least Shrew Central Neurokinin NK1 Receptors Reduces GR73632 - Induced Vomiting ''. Behavioural Neuroscience. 123 ( 3 ) : 701 -- 706. doi : 10.1037 / a0015733. Jump up ^ `` Symptoms & Causes of Celiac Disease NIDDK ''. National Institute of Diabetes and Digestive and Kidney Diseases. June 2016. Archived from the original on 24 April 2017. Retrieved 24 April 2017. Jump up ^ Volta U, Caio G, Karunaratne TB, Alaedini A, De Giorgio R ( 2017 ). `` Non-coeliac gluten / wheat sensitivity : advances in knowledge and relevant questions ''. Expert Review of Gastroenterology & Hepatology ( Review ). 11 ( 1 ) : 9 -- 18. doi : 10.1080 / 17474124.2017. 1260003. PMID 27852116. A lower proportion of NCG / WS patients ( from 30 % to 50 % ) complain of upper gastrointestinal tract manifestations, e.g. vomiting, nausea, gastroesophageal reflux disease, aerophagia and aphthous stomatitis. ( NCG / WS : Non-coeliac gluten / wheat sensitivity ) Jump up ^ Decker, W.J. ( 1971 ). `` In Quest of Emesis : Fact, Fable, and Fancy ''. Clinical Toxicology. 4 ( 3 ) : 383 -- 387. doi : 10.3109 / 15563657108990490. PMID 4151103. Jump up ^ Moder, K.G. ; Hurley, D.L. ( 1991 ). `` Fatal hypernatremia from exogenous salt intake : report of a case and review of the literature ''. Mayo Clinic Proceedings. 65 ( 12 ) : 1587 -- 94. doi : 10.1016 / S0025 - 6196 ( 12 ) 62194 - 6. PMID 2255221. Jump up ^ Salt : a natural antidepressant ? The Scotsman. April 6, 2009. Jump up ^ Holtzmann NA, Haslam RH ( July 1968 ). `` Elevation of serum copper following copper sulfate as an emetic ''. Pediatrics. 42 ( 1 ) : 189 -- 93. PMID 4385403. Jump up ^ Wang, S.C. ; Borison, Herbert L. ( 1951 ). `` Copper Sulphate Emesis : A Study of Afferent Pathways from the Gastrointestinal Tract ''. American Journal of Physiology. 164 ( 2 ) : 520 -- 526. Jump up ^ Olson, Kent C. ( 2004 ). Poisoning & drug overdose. New York : Lange Medical Mooks / McGraw - Hill. p. 175. ISBN 0 - 8385 - 8172 - 2. Jump up ^ `` Drugs to Control or Stimulate Vomiting ''. Merck Veterinary manual. Merck & Co., Inc. 2006. Jump up ^ `` How to Induce Vomiting ( Emesis ) in Dogs ''. Petplace.com. Retrieved 2014 - 05 - 03. Jump up ^ 9 Best Vomit Scenes On Film, screenjunkies.com Jump up ^ Shanon, B. ( 2002 ). The antipodes of the mind : Charting the phenomenology of the ayahuasca experience. Oxford : Oxford University Press. Jump up ^ Andritzky, W. ( 1989 ). `` Sociopsychotherapeutic functions of ayahuasca healing in Amazonia ''. Journal of Psychoactive Drugs. 21 ( 1 ) : 77 -- 89. doi : 10.1080 / 02791072.1989. 10472145. PMID 2656954. Jump up ^ ( 1 ) University of Salford. January 28, 2007. Archived February 24, 2009, at the Wayback Machine. Jump up ^ `` vomiting - definition of vomiting in the Medical dictionary - by the Free Online Medical Dictionary, Thesaurus and Encyclopedia ''. Medical-dictionary.thefreedictionary.com. Retrieved 2014 - 05 - 03. Jump up ^ Mark Feldman ; Lawrence S. Friedman ; Lawrence J. Brandt, eds. ( 2009 ). Sleisenger & Fordtran 's gastrointestinal and liver disease pathophysiology, diagnosis, management ( PDF ) ( 9th ed. ). St. Louis, Mo. : MD Consult. p. 783. ISBN 1 - 4160 - 6189 - 4. Jump up ^ Mitchelson, F ( March 1992 ). `` Pharmacological agents affecting emesis. A review ( Part I ) ''. Drugs. 43 ( 3 ) : 295 -- 315. doi : 10.2165 / 00003495 - 199243030 - 00002. PMID 1374316. ^ Jump up to : Furyk, JS ; Meek, RA ; Egerton - Warburton, D ( 28 September 2015 ). `` Drugs for the treatment of nausea and vomiting in adults in the emergency department setting ''. Cochrane Database of Systematic Reviews. 9 : CD010106. doi : 10.1002 / 14651858. CD010106. pub2. PMID 26411330. Jump up ^ Helena Britt ; Fahridin, S ( September 2007 ). `` Presentations of nausea and vomiting '' ( PDF ). Australian Family Physician. 36 ( 9 ) : 673 -- 784. PMID 17885697. Jump up ^ electricpulp.com. `` HERODOTUS iii. DEFINING THE PERSIANS -- Encyclopaedia Iranica ''. www.iranicaonline.org. Jump up ^ `` Internet History Sourcebooks ''. sourcebooks.fordham.edu. External links Wikimedia Commons has media related to Vomiting. Wikiquote has quotations related to : Vomiting Look up vomiting in Wiktionary, the free dictionary. Cyclical Vomiting Syndrome `` Emetics ''. The American Cyclopædia. 1879. Symptoms and signs : digestive system and abdomen ( R10 -- R19, 787,789 ) Upper Nausea Vomiting Heartburn Aerophagia Dysphagia oropharyngeal esophageal Odynophagia Halitosis Xerostomia Hypersalivation Burping Wet burp Defaecation Flatulence Fecal incontinence Encopresis Blood : Fecal occult blood Rectal tenesmus Constipation Obstructed defecation Diarrhea Rectal discharge Psoas sign Obturator sign Rovsing 's sign Hamburger sign Heel tap sign Aure - Rozanova 's sign Dunphy sign Alder 's sign Lockwood 's sign Rosenstein 's sign Abdomen Abdominal pain Acute abdomen Colic Baby colic Abdominal guarding Rebound tenderness Abdominal distension Bloating Ascites Tympanites Shifting dullness Bulging flanks Fluid wave test Abdominal mass Hepatosplenomegaly Hepatomegaly Splenomegaly Jaundice Mallet - Guy sign Puddle sign LCCN : sh85144382 GND : 4015109 - 8 SUDOC : 027256154 BNF : cb119338174 ( data ) NDL : 00568990 BNE : XX534064 Retrieved from `` https://en.wikipedia.org/w/index.php?title=Vomiting&oldid=835359774 '' Categories : Reflexes Symptoms and signs : Digestive system and abdomen Body fluids Vomiting Hidden categories : Webarchive template wayback links Articles needing additional references from March 2018 All articles needing additional references Wikipedia indefinitely semi-protected pages Infobox medical condition All articles with unsourced statements Articles with unsourced statements from June 2015 Wikipedia articles incorporating a citation from The American Cyclopaedia Wikipedia articles incorporating a citation from The American Cyclopaedia with a Wikisource reference Wikipedia articles with LCCN identifiers Wikipedia articles with GND identifiers Wikipedia articles with BNF identifiers Talk View source Contents About Wikipedia Wikiquote Azərbaycanca বাংলা Беларуская Български Bosanski Brezhoneg Català Čeština ChiShona Cymraeg Dansk Deutsch ދިވެހިބަސް Eesti Ελληνικά Emiliàn e rumagnòl Español Esperanto Euskara فارسی Français Galego 한국어 Հայերեն हिन्दी Hrvatski Bahasa Indonesia Íslenska Italiano עברית ქართული Қазақша Kiswahili Latina Latviešu Lietuvių Limburgs Magyar Македонски മലയാളം मराठी Bahasa Melayu Mìng - dĕ̤ng - ngṳ̄ Nederlands 日本 語 Norsk Norsk nynorsk Oʻzbekcha / ўзбекча ਪੰਜਾਬੀ Polski Português Română Runa Simi Русский Simple English Slovenčina Slovenščina کوردی Српски / srpski Srpskohrvatski / српскохрватски Suomi Svenska தமிழ் తెలుగు ไทย Türkçe Українська Tiếng Việt Walon 粵語 中文 63 more Edit links This page was last edited on 8 April 2018, at 06 : 40. 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Question: where does bile come from when you vomit
Answer: the duodenum