VOMITING

BY: Simranpreet kaur

DEFINITION
Nausea and vomiting are the most common
manifestations of GI disorders.
Nausea is an uneasiness of the stomach
that often comes before vomiting.
Vomiting is the forceful ejection of
partially digested food and secretions from
the upper GI tract.
ETIOLOGY
 GI disorders
 Pregnancy
 Infectious disease
 CNS disorders(meningitis, CNS tumor)
 Cardiovascular problems(MI, Heart failure)
 Metabolic disorders(DM, uremia)
 Side effects of drugs(chemotherapy, opioids)
 Psychologic factors (stress)
PATHOPHYSIOLOGY
Any of the etiological factors due to drugs

Triggers the chemoreceptor zone in the brain at the floor of 4 th ventricle

Transmits the impulses to vomiting center

Increases the intra abdominal pressure

Contraction of abdominal muscles

Release the esophageal sphincter

Forcing of food and contents from the stomach to the esophagus and pharynx.
CLINICAL MANIFESTATIONS
 Anorexia(loss of appetite)
 Loss of water and essential electrolytes
 Loss of extracellular fluid volume
 Circulatory failure
 Weight loss
 Aspiration
DIAGNOSTIC EVALUATION
 Careful history about the onset and duration
of vomiting
 Assess the color of vomiting and precipitating
factors
 Red and coffee brown-GI bleeding
Yellow color- Bile acids
 Physical examination to identify dryness,
decreased skin turgor and weight loss.
 CBC and electrolytes to identify the loss.
MANAGEMENT
 Administer Antiemetics to control vomiting
like Inj. Emeset
 Phenothiazine: chlorpromazine,
perphenazine, promazine, triflupromazine.
 Antihistamine: cyclizine, hydroxymine
 Prokinetic: Domperidone, metchlorpromide
 Seratonin agonist: Dolasteron, ondosterone,
granisteron.
 Anticholinergic: transdermal, scopolamine
 Others: benzquinamide, dexamethasone.
NUTRITIONAL THERAPY:
 IV glucose is adm until oral fluids tolerated.
 Oral fluids are given starting with clear fluids
 Extremely hot and cold liquids are not given as
they are not tolerated
 Carbonated beverages with warm tea is advised
 Rehydration of mouth with 5 to 15ml of water
is advised every 30 mins
 Client is advised to take diet high in
carbohydrate and low fatty acids.
 Foods should be eaten slowly and small amount
to prevent over distension of stomach.
NON DRUG THERPY
 Acupuncture is found to be more useful to
remove post operative nausea and vomiting.
 Botanicals like ginger and peppermint oil can
used to decrease vomiting
 Breathing exercises and change in body
positions or exercise can help in some
patients.