- Nausea can be pre-phase vomiting or independent phenomenon. Under the sickness we understand the unpleasant sensation (pressure) in the stomach, followed by pale skin, dizziness, salivation, cold extremities, drop in blood pressure and sometimes fainting. All this – the symptoms of hypertension vagus nerve. The mechanism of nausea, apparently, can be reduced to a sudden strong contractions of the stomach and irritate the nerve plexus in the abdomen.
- Nausea can be a central origin (at the sight of something unpleasant, if disgusting, “nauseating” smell, even the thought of nasty things) and peripheral, reflex on the part of both the stomach and many other organs (liver, gall bladder, appendix, kidneys, and others.). Often it can be caused, for example, pressing the nerve plexus, in particular solar and downstream aorta. Perhaps stretching plexus plays a certain role, and with frequent complaints of nausea immediately after eating at the omission of the abdominal viscera. You can also explain the nausea after meals in patients with gastritis and gastric cancer, where we may assume, along with hypotonia of the stomach, or that the degree of expansion and ptosis. Nausea is more often nezheludochnogo origin, and this fact must be considered when evaluating this symptom.
Vomiting is called involuntary jerky ejection of stomach contents through the persons mouth. Often it is a protective act in response to a hit in the stomach of a substance, its annoying.
The mechanism of vomiting consists of a series of coordinated movements: the closure of the pylorus occurs, termination of gastric motility, reduction in the pyloric part and filling the bottom of the stomach; followed by the opening of the cardia and filling of the esophagus; both by supporting movements of respiratory muscles and the abdominals are ejected masses of food from the stomach into the esophagus. The medulla oblongata near the cough and respiratory center is expected to find much of the emetic center.
There are central and peripheral vomiting. Vomiting of central origin are psychological (eg from one memory, or hysterical), brain (by increasing intracranial pressure), toxic (such as uremia), and vomiting caused by some means acting directly on the vomiting center (such as apomorphine). A characteristic feature of central vomiting is their stubbornness, lack of relief after them, the suddenness of their appearance without prior nausea.
Peripheral reflex or vomiting may occur as a result of stimulation of a variety of sensory nerves. But there are special places from irritation which is easiest to get a gag reflex: is the root of the tongue, soft palate and pharynx, mucous membrane of the stomach and the surface of the peritoneum.
There are the following vomiting, gastric nature.
- 1. Vomiting from irritation
a) different chemical substances introduced into the stomach, such as strong alkali or mineral acid, mercuric chloride, arsenic and m. p .;
b) medicinal substances (digitalis, adonis, ipecac, and others.);
c) food-or chemically irritating, such as rancid butter, spoiled meat, and so on. n., or due to an overflow hard digestible food. Vomiting due to irritation of the stomach is usually early (soon after a meal) and little abundant, because the significant content of the stomach is not possible because of the gag reflex. This kind of vomiting observed in dyspepsia, gastritis, and in the early stages of cancer.
- 2. Vomiting due to functional stenosis of the pylorus (pilorospazm) is always food, mostly very acid (hydrochloric acid), comes in 2-6 hours after eating (the duration of gastric digestion) and observed in hypersecretion and ulcer.
- 3. Vomiting due to organic pyloric stenosis (pyloric stenosis) is characterized by constancy and abundance. She often comes late in the evening or night, at intervals of a few days. In benign stenosis (scarring after ulceration) -rvota sour taste, and malignant (cancer) – often rotten.
Besides the gastric mucosa, the entire surface of the peritoneum can be a source of emesis. Vomiting is a constant companion of all peritonitis (in appendicular attack, periholetsistite, perimeter, etc.). Often there is vomiting due to irritation of the sensory nerves of the biliary tract (hepatic colic), renal pelvis (renal colic), female genital mutilation (with the inflammation of the uterus and appendages). For all these so-called reflex vomiting characterized by the fact that they do not stop, despite the complete emptying of the stomach.
Vomiting in gastric pathology is very important diagnostic symptom. If vomiting diagnostic evaluation should take into account: 1) the onset of vomiting, 2) the amount of vomit, 3) their reaction and 4) impurities gastric contents.
Time of onset of vomiting.
- Vomiting in the morning and on an empty stomach is found in alcoholic gastritis due to accumulated per night – usually in the esophagus than in the stomach – saliva and mucus hypersecretion and due to the accumulation in the stomach of a very large number of acidic liquid as a result of continuous separation of gastric juice.
- Vomiting immediately after eating (5-10 minutes) hypersensitivity is observed in the stomach of a local nature, such as ulcers and cancer of the cardiac portion of the stomach, or are the result of the general neurosis (hysteria).
- Vomiting 2-3 hours after a meal in the middle of the digestive characteristic of gastritis, ulcers and stomach cancer.
- Vomiting after 4-6 hours after eating observed in duodenal ulcer and chronic catarrh of the stomach with a large atoniej his muscles, especially if atony has led to the expansion of the stomach.
- Still later vomiting – 6-12 hours or more after a meal, t. E. Vomiting of food eaten the day before or even earlier, when there is pyloric stenosis. Such late onset vomiting indicates that the weakening of the muscles of the stomach longer required sum irritation of the gastric mucosa to induce vomiting by a single abdominals.
Number of vomit is negligible vomiting pregnancy, morning vomiting of alcoholics, the neuroses of the stomach, and so on. N. The number corresponds to the amount of vomit ingested food by vomiting due to gastric catarrh. Very abundant vomit when atonic, expanded, poorly emptying the stomach into the duodenum, pyloric stenosis. Gastric capacity hereinafter sometimes becomes large, and the ejection of gastric contents occurs only after all it is filled. This vomiting more abundant, less frequently repeated.
Reaction vomit is acidic by the presence in them of hydrochloric acid at hypersecretion, neutral – while ahilii and cancer of the stomach when the stomach does not emit hydrochloric acid or alkaline due resulting from the putrefaction of proteins ammonia compounds in advanced cancer with pyloric stenosis and expansion of the stomach .
Impurities to vomit. The presence of mucus is usually said about chronic gastritis.
The admixture of pus in small amounts, are detected only microscopically observed in gastritis, the greater the amount of pus in vomit are rare – when phlegmonous gastritis, or at the opening of the cavity of the stomach ulcer, located in one of the adjacent organs.
The bile in the vomit appears as a result of throwing it into the stomach from the duodenum. It is observed at low acidity of the stomach or ahilii (dehiscence pyloric), at least at high acidity, as well as the loss of contractility of the pylorus (cancerous its infiltration).
The admixture of blood in vomit can be due to the ingestion of it from bleeding of the oral mucosa after nasal bleeding and so forth. The small amount of blood can be mixed to vomit at any form of violent vomiting, especially if irritating pre-damaged mucosa.
Blood in the vomit just described should be origin by questioning and objective examination of the patient to be able to distinguish from the real gastric bleeding (haematemesis), which often occurs with ulcers and gastric cancer, and occasionally liver cirrhosis. Bloody vomiting, gastric ulcer is usually abundant, and often the blood with her scarlet, but in contrast to pulmonary hemorrhage, it has a bright color and arterial never foams. Scarlet bloody vomit gastric ulcer because the bleeding in this case and there is plenty fast, so vomiting occurs very soon, and the blood does not have time to change. In gastric cancer bloody vomiting occurs almost always in small quantities, the color of blood from gastric retention and chemical changes in the hemoglobin under the influence of hydrochloric acid becomes brown, like the color of coffee grounds. This feature, however, does not have anything specific, because it can be at least slowly developing stomach bleeding if vomiting occurs shortly after it began.