Vomiting resident survival guide
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# Overview
Vomiting or Emesis means forcible emptying of the contents of stomach in which the stomach has to overcome the pressures that are normally in place to keep food and secretions within the stomach.Nausea and vomiting are most common causes for patients to seek primary care treatment, so it is very important to identify  and properly manage the underlying problems causing vomiting.Though the mechanisms causing of nausea and vomiting are not completely understood, it is thought that the activation of a medullary vomiting centre by either afferent input from the gastrointestinal tract due to presence of local irritants or  stimulation of the central chemoreceptor trigger zone by circulating emetogenic substances may cause vomiting.Dopamine and serotonin are the main transmitters both in central nervous system and  gastrointestinal tract related vomiting. The most common causes of vomiting are Gastroenteritis, Migraine, Gastro peresis,Post operative, radiation and chemotherapy related vomiting, tumor, increased intracranial pressure,Hepatitis, Cholecystitis,Labyrithitis, Alcohol abuse, pregnancy induced vomiting. The management of  most cases of nausea and vomiting depends on a good history and a detailed complete physical examination. Most episodes of  vomiting that lasts for less than 48 hours have an existing triggering factor such as infection, viral illness, or food poisoning and can be managed by removing the triggering factor and by supportive therapy. Chronic and unexplained nausea and vomiting can be a difficult to treat as the cause is often obscure and requires special investigation.

# Causes

## Life Threatening Causes
Life-threatening causes of vomiting include:
- Head injury
- Bowel obstruction
- Appendicitis
- Meningitis
- Myocardial Infarction
- Brain tumor
- Pancreatitis

## Common Causes
Common causes include: 
- Gastric outlet obstruction
- Small bowel obstruction
- Irritable bowel syndrome
- Pancreatic adenocarcinoma
- Hepatitis
- Cholecystitis
- Pancreatitis
- Crohns disease
- Gastroparesis
- Chronic intestinal pseudo-obstruction
- Post-operative nausea and vomiting
- CNS causes
Migraine
Increased intracranial pressure
Malignancy
Hemorrhage
Infarction
Abscess
Meningitis
Congenital malformation
Hydrocephalus
Pseudotumor cerebri
Seizure disorders
Demyelinating disorders
- Migraine
- Increased intracranial pressure
Malignancy
Hemorrhage
Infarction
Abscess
Meningitis
- Malignancy
- Hemorrhage
- Infarction
- Abscess
- Meningitis
- Congenital malformation
- Hydrocephalus
- Pseudotumor cerebri
- Seizure disorders
- Demyelinating disorders
- Infectious causes
Gastroenteritis
Otitis media
Pseudotumor cerebri
Acute intermittent porphyria
- Gastroenteritis
- Otitis media
- Pseudotumor cerebri
- Acute intermittent porphyria
- Labyrinthine disorders
Motion sickness
Labyrinthitis
Tumors
Menieres disease
Iatrogenic
- Motion sickness
- Labyrinthitis
- Tumors
- Menieres disease
- Iatrogenic
- Endocrinological and metabolic causes
Pregnancy
Uremia
Diabetic ketoacidosis
Hyperparathyroidism
Hypoparathyroidism
Hyperthyroidism
Addisons disease
- Pregnancy
- Uremia
- Diabetic ketoacidosis
- Hyperparathyroidism
- Hypoparathyroidism
- Hyperthyroidism
- Addisons disease
- Miscellaneous causes
Cardiac disease
Myocardial infarction
Congestive heart failure
Radiofrequency ablation
Starvation
- Cardiac disease
Myocardial infarction
Congestive heart failure
- Myocardial infarction
- Congestive heart failure
- Radiofrequency ablation
- Starvation
- Cancer chemotherapy
- Radiation therapy
- Cardiovascular medications
Digoxin
Antiarrhythmics	 
Antihypertensives
-Blockers
Calcium-channel antagonists
- Digoxin
- Antiarrhythmics
- Antihypertensives
- -Blockers
- Calcium-channel antagonists
- Antibiotics/Antivirals
- Ethanol Abuse
- Renal infection and renal stone

# Diagnosis
Shown below is an algorithm summarizing the diagnosis of Vomiting

# Treatment
Shown below is the treatment of Vomiting. 
Below is the algorithm showing the treatment of vomiting :

# Dos
- Encourage patient to keep taking small sips of water frequently so that they don't become dehydrated.
- Recommend patients to take sweet drink such as fruit juice  for replacing lost sugar, although they should avoid sweet drinks if those make them feel sick.
- Recommend to have salty snacks, such as crisps, can help replace lost salt.

# Don'ts
- Patient who is vomiting continuously and also has past medical history of Diabetes corrected with Insulin should consult with their physicians before taking insulin as vomiting alters blood sugar levels.
- Renal consultation should be acquired especially with severe hyponatremia