Vomit
Introduction
Introduction Vomiting is a reflex action in which the contents of the stomach, even bile and intestinal fluid, flow back through the esophagus to the mouth and spit out. It can be divided into three stages, nausea, retching and vomiting, but some vomiting can be a precursor to nausea or retching. Vomiting is a common clinical symptom. The nausea is often a pre-existing sensation of vomiting. It can also appear alone. It shows a special discomfort in the upper abdomen, often accompanied by vagus nerve excitability such as dizziness, runny, pulsatile, and decreased blood pressure. Vomiting can spit out harmful substances that are swallowed into the stomach. It is a kind of defensive reflex of the body and has a certain protective effect, but most of them are not caused by it. Frequent and severe vomiting can cause complications such as dehydration and electrolyte imbalance. Basic discrimination of vomiting (1) Jet vomiting with headache, stiff neck, high blood pressure, coma, hemiplegia, aphasia, seen in cerebral hemorrhage, cerebral infarction. (2) Jet vomiting with fever, headache can be seen in meningitis, encephalitis. (3) Vomiting with dizziness, nystagmus, often vertigo of the inner ear, cerebellar disease. (4) Vomiting with diarrhea, seen in food poisoning, gastroenteritis. (5) Pregnancy, poisoning, and gastritis are common in vomiting in the morning. (6) After the meal, there is no vomiting action, more common in neurosis. (7) Vomiting with abdominal pain, more common in abdominal organs, but also in uremia, diabetic ketoacidosis.
Cause
Cause
Vomiting is due to the reverse peristalsis of the esophagus, stomach or intestines, accompanied by strong abdominal contractions of the abdominal muscles, forcing the esophagus or stomach contents to emerge from the mouth and nose. It can be divided into:
1. Digestive tract organic obstruction: the contents of the esophagus, stomach or intestine are blocked, and forced to retrograde to cause vomiting. Such as congenital digestive tract developmental malformation (occlusion or stenosis in different parts). Larger children are mostly acquired intestinal torsion, intussusception, and intestinal obstruction (such as common aphid obstruction).
2. Digestive tract infectious diseases: enteritis, gastritis, appendicitis due to inflammation of the stomach, intestinal stimulation, can be reflex vomiting, often accompanied by abdominal pain, nausea, diarrhea, bloating.
3. Abnormal body function: If a systemic infection or metabolic disorder occurs, it is often accompanied by symptoms such as fever, loss of appetite, nausea, and bloating.
4. Cranial nervous system diseases: such as intracranial hypertension symptoms, meningeal irritation or intracranial space-occupying lesions, can cause central jet vomiting, not nausea before vomiting, but accompanied by headache, lethargy, coma, convulsions, etc. Other neurological symptoms.
5. Poisoning: Toxic effects of toxic substances on the gastrointestinal tract and toxic substances in the central nervous system cause vomiting.
The mechanism
Gastric sinus and pyloric area contracted closed, stomach reverse peristalsis, gastric and gastric fundus tension decreased following the opening of the cardia, and finally the contraction of the diaphragm and abdominal muscles, the abdominal pressure increased sharply, so that the stomach chyme was discharged through the esophagus and pharynx. Some of the small intestines can also be spit out through intense vomiting. Vomiting can excrete toxic substances or foreign bodies, which is beneficial to the human body, but excessive vomiting is likely to cause imbalance of electrolyte balance in the body, such as metabolic alkalosis, pay attention to supplement some acidic substances, especially in children and the elderly.
Pathophysiology
Because of the complex and diverse causes of vomiting, the occurrence and duration of vomiting, and varying degrees of age and age, the impact on the body is very different. The lighter has no effect, only a temporary discomfort. Long-term chronic vomiting. It can cause metabolic disorders such as digestive esophagitis, hypovolemia, hypokalemia, low sodium, and alkalosis. Further, anemia, malnutrition, and growth and development are stagnant. When it is heavy, it can cause water-electrolyte balance disorder, shock or aspiration, suffocation, induced arrhythmia or even death. Caused by surgical reasons can also lead to serious consequences such as perforation of the digestive tract, diffuse peritonitis, shock, sepsis. Those with motor dysfunction are also prone to aspiration after vomiting and need to be vigilant.
TCM pathogenesis
(1) Causes
1. Feel the evil wind, cold, heat, humidity, heat and turbidity.
2, the diet is not too violent (stagnation).
3, emotional disorders are anger and worry.
4, physical deficiency, chronic illness, congenital and acquired.
(two) pathogenesis
1, the external evil spirits stomach, internal disturbance stomach sputum stomach gas upside.
2, the diet is stagnant, and the turbidity is reversed.
3, the spleen lost the Secretary, sipping inside stop.
4, the liver is not sparse, cross the stomach.
1 gram soil
2 spleen deficiency (water valley stay) + anger food with gas reverse.
"Responsibility for ruling and vomiting": "The qi and vomiting is due to the anger in the diet."
5, spleen and yang, lack of stomach yin (spleen and stomach weakness).
The main pathogenesis: stomach loss and drop, stomach ups and downs.
Examine
an examination
Related inspection
Sikh test hepatitis E antibody (anti-HEIgM) serum anion determination isotonic saline low pressure enema test gastroscope
Physical examination. : General conditions should pay attention to consciousness, nutritional status, dehydration, circulatory failure, anemia and fever.
Abdominal signs should pay attention to the appearance of pyloric obstruction such as stomach type, gastric peristalsis wave, and water sound. Acute intestinal obstruction such as bowel sounds and intestinal type. Abdominal muscle tension, tenderness, rebound tenderness and other acute abdomen manifestations, in addition, should also pay attention to the presence of abdominal lumps, sputum and so on.
Others: 1 Eye examination pay attention to nystagmus, measurement of intraocular pressure, or whether there is optic disc edema in the fundus. 2 with or without pathological reflex and peritoneal irritation.
Auxiliary examinations mainly include laboratory tests related to inflammation, endocrine metabolism, and water, salt and electrolyte metabolism disorders. If necessary, special examinations such as B-ultrasound, X-ray, gastroscope, ERCP, endoscopic ultrasonography, enteroscopy, CT, and magnetic resonance can be selected to determine the diagnosis.
Diagnosis
Differential diagnosis
Differential diagnosis and analysis of vomiting
If you or your family, colleagues, or friends have nausea and vomiting, if you can judge the cause and classification according to the morbidity, you can know what is the number of the department when you go to the hospital, and when you tell the doctor about the condition Detailed and thoughtful.
Understand the history of vomiting in the near future after a meal, and there are sudden cases of collective morbidity. Food poisoning should be considered first. Active peptic ulcer is located in the pylorus, where edema, congestion, and spasm often lead to postprandial vomiting. Neurological vomiting occurs more immediately after a meal. Vomiting occurs after a long meal or after a few meals. It is more common in pyloric and duodenal chronic insufficiency caused by peptic ulcer and gastric cancer.
Vomiting time
Morning vomiting should consider early pregnancy reactions in women of childbearing age, sometimes in uremia or chronic alcoholism. Some sinusitis stimulates the pharynx due to secretions, but also nausea and retching in the morning. Vomiting at night is more common in pyloric obstruction.
Vomiting characteristics
In general, vomiting often has obvious nausea and then vomiting. But neurological vomiting can be accompanied by nausea or only mild nausea. Vomiting is not laborious and can even vomit as desired. When hypertensive encephalopathy or intracranial lesions cause an increase in intracranial pressure, there is often no nausea and sudden vomiting.
The nature of vomit
The pyloric obstruction of the pyloric contains a separate meal or food every other day, with a smell of rotting acid. The vomit contains a lot of yellow bitter bile, which is more common in frequent vomiting or intestinal obstruction below the duodenal papilla. A large amount of vomiting is more common in pyloric obstruction or acute gastric dilatation, and a vomiting can exceed 1000 ml. The vomit may have a bowel odor that may be low intestinal obstruction. Vomiting a large amount of acidic gastric juice is more common in high acid gastritis, active duodenal ulcer or gastrinoma. The vomit is coffee or bright red. Consider upper gastrointestinal bleeding, see hematemesis and melena.
Vomiting with abdominal pain
Patients with abdominal pain should first consider acute abdomen and seek medical attention in time. Please see abdominal pain. Chronic abdominal pain can be temporarily relieved after vomiting, which may be peptic ulcer, acute gastritis or high intestinal obstruction. However, in cholecystitis, cholelithiasis, biliary ascariasis, acute pancreatitis, etc., vomiting generally does not relieve abdominal pain.
Vomiting with headache and dizziness
With headache, hypertensive encephalopathy, migraine, sinusitis, glaucoma, refractive error, etc. should be considered. Those with vertigo may be Meniere's disease, labyrinthitis, etc. It is also necessary to know whether it is caused by drugs such as streptomycin sulfate, kanamycin, neomycin or gentamicin.
In addition, nausea and vomiting accompanied by anorexia, fatigue, and even jaundice, should be alert to whether it is viral hepatitis, timely treatment and isolation. Women of childbearing age must understand the menstrual situation. If they have not been treated for more than 4 weeks without contraception (or contraceptive failure), consider whether it is nausea and vomiting caused by early pregnancy.
Vomiting is very common in the clinic. Due to the disease of the digestive system itself, it can also be caused by systemic diseases other than the digestive system. To make a correct diagnosis of nausea and vomiting, you need to go to the hospital for a comprehensive system check. Repeated and persistent severe vomiting causes serious complications, so it should be taken seriously and promptly went to the hospital for examination and treatment.
