Nausea and vomiting in adults: causes, complications, treatment

general information

Nausea - this is an unpleasant sensation of approaching vomiting. People may also experience dizziness, vague abdominal discomfort, and unwillingness to eat.

Vomit - This is a strong contraction of the stomach, pushing its contents through the esophagus and from the mouth. Vomiting empties the stomach and often makes people who are sick feel significantly better, at least for a while. Vomiting causes significant discomfort and can be severe. Severe vomiting can push stomach contents several meters (vomiting). Vomiting is not the same as regurgitation (belching), which is regurgitation of stomach contents and is not accompanied by violent abdominal muscle contractions or nausea. For example, people with achalasia or Zenker's diverticulum may regurgitate undigested food without nausea.

Vomit, material expelled during vomiting, usually contains food recently eaten. Sometimes they contain pieces of food. When there is blood in the vomit, the vomit is usually red (bloody vomit), but if the blood is partially digested, the vomit looks like coffee grounds. In the presence of bile, the vomit is bitter and yellow-green.

Complications

In addition to feeling uncomfortable, vomiting can cause complications:

• Inhalation of vomit (aspiration);
• Rupture of the esophagus (Mallory-Weiss rupture);
• Dehydration and abnormal electrolyte levels;
• Inadequate nutrition and weight loss.

People who are unconscious or partially conscious can inhale their vomit. The acid in vomit can be very irritating to the lungs.

Vomiting significantly increases pressure in the esophagus, and violent vomiting can rupture the lining of the esophagus. A small tear is painful and sometimes causes bleeding, but a large tear can be fatal.

Because people lose water and minerals (electrolytes) through vomit, severe vomiting can lead to dehydration and abnormalities in electrolyte levels. The elderly are particularly prone to these complications.

Chronic vomiting can cause malnutrition, weight loss, and metabolic disorders.

Causes of Nausea and Vomiting in Adults

Nausea and vomiting in adults occurs when the vomiting center in the brain is activated. Causes usually include diseases of the digestive tract or brain, or ingested substances.

- Common reasons.

The most common causes of nausea and vomiting are as follows:

• Gastroenteritis (digestive tract infection);
• Medications;
• Toxins.

Nausea and vomiting usually occur with any dysfunction of the digestive tract, but are especially common with gastroenteritis. A less common digestive tract disorder is intestinal obstructionwhich causes vomiting because food and fluids return to the stomach due to obstruction. Many other abdominal abnormalities that cause vomiting also cause significant abdominal pain. With such disorders (for example, appendicitis or pancreatitis) it is pain, not vomiting, that drives people to seek medical attention.

Many drugs, including alcohol, opioid analgesics (such as morphine), and chemotherapy drugs, can cause nausea and vomiting. Toxins such as lead or substances found in certain foods and plants can cause severe nausea and vomiting.

- Less common reasons.

Less common causes of nausea and vomiting include:

• Brain disorders or disorders of the central nervous system;
• Motion sickness;
• Metabolic changes or diseases of the whole organism (systemic);
• Psychological disorders;
• Cyclic vomiting syndrome.

The vomiting center can also be activated by certain brain or central nervous system disorders, including infections (such as meningitis and encephalitis), migraine and disorders that increase pressure in the skull (intracranial pressure). Disorders that increase intracranial pressure include brain tumors, cerebral bleeding, and severe head injuries.

The balance organs of the inner ear (vestibular apparatus) are associated with the vomiting center. It is as a result of this connection, as well as due to certain diseases of the inner ear (such as labyrinthitis and positional vertigo), some people get seasick on a ship, in a car, or in plane.

Nausea and vomiting in adults can also occur when there are metabolic changes in the body, for example, during early pregnancy (in women) or when there is a diabetes treatment, heavy liver failure or renal failure.

Psychological problems can also cause nausea and vomiting (known as functional or psychogenic vomiting). This vomiting may be deliberate. For example, people suffering bulimia, induce vomiting in order to lose weight. Vomiting can also be unintentional. For example, children who are afraid to go to school vomit as a reaction to psychological stress.

Cyclic vomiting syndrome is an uncommon disorder in which people experience severe bouts of vomiting (or sometimes just nausea) at varying intervals. People feel normal between attacks. Although it usually begins in childhood, it sometimes continues into adulthood. Cyclic vomiting that begins in adulthood is often associated with chronic marijuana use.

Diagnostics

Not every case of nausea and vomiting requires an immediate visit to the doctor. The following information will help you decide if you should see a doctor. You will also find out exactly how the examination takes place.

- Warning signs.

Some symptoms and signs are cause for concern: These include:

• Signs of dehydration (such as thirst, dry mouth, minimal urine output and a feeling of weakness and fatigue);
• Headache, tight neck, disorientation, or decreased focus;
• Persistent abdominal pain;
• Soreness when touching the abdomen;
• Bloated (swollen) belly.

- When to see a doctor?

People with warning signs should see a doctor immediately, as well as those who vomit blood or have recently suffered a head injury.

Those who have nausea and vomiting but do not have warning signs should see a doctor. if vomiting continues for more than 24 to 48 hours or if they cannot drink more than a few sips liquids. Those who have experienced multiple episodes of vomiting (with diarrhea or without), but anyone who is able to drink at least some liquid should call their doctor. Depending on the patient's age, other symptoms, and known medical conditions (such as cancer disease or diabetes), your doctor may recommend getting tested or staying at home and using simple funds.

- What does the doctor do?

Doctors first ask the patient about their symptoms and medical history. They then do a physical examination. The history and physical examination findings often suggest a cause for vomiting and determine what tests may be needed.

During the history taking, doctors ask about pregnancy or the presence of diabetes, migraines, liver disease or kidney or cancer (including the timing of chemotherapy or radiation therapy). Pay attention to all recently taken drugs and substances, because some substances (such as acetaminophen and some mushrooms) can be toxic a few days after reception.

During the physical examination, doctors look for the following:

• Signs of dehydration (such as increased heart rate, low blood pressure, and dry mouth).
• Symptoms of a serious abdominal disorder (such as a swollen abdomen and / or severe soreness to touch).
• Decreased clarity of consciousness or any other neurological abnormality suggestive of a brain disorder.

Doctors pay attention to previous abdominal surgical interventions, since fibrous cords of scar tissue (adhesions) could form, causing intestinal obstruction.

Although people with previously known disorders that cause vomiting (such as migraines) may simply develop a relapse of the disorder, doctors are carefully looking for signs of a new, different problem.

- Carrying out analyzes.

The need for tests depends on the results obtained by doctors from the history and physical examination, especially on the presence of warning signs and on whether the test results indicate a specific disorder.

It is possible to carry out the following types of examinations:

• Pregnancy analysis;
• Urine tests and blood.

For girls and women of childbearing age, a pregnancy test is usually necessary.

For healthy adults and older children who have experienced only a few episodes of vomiting (with or without diarrhea) and no other symptoms, usually no testing is required.

For people who have been vomiting severely, have lasted more than 1 day, or have symptoms dehydration, laboratory blood tests are needed (especially electrolyte levels and sometimes function tests liver) and urine.

Treatment

Specific diseases are being treated. In the absence of any major underlying disorder and signs of dehydration about 30 minutes after the last episode of vomiting, a small amount can be given clear liquid. To begin with, usually give 30-60 milliliters. Plain water is a suitable liquid, but broth or weak sweet tea can be used. Sports drinks have no specific benefits, but they are not harmful. If a person can tolerate these fluids, their dose is gradually increased. If the person was able to tolerate these increased doses, then he can resume the intake of normal food. Carbonated drinks and alcohol should be avoided.

Even with mild dehydration, doctors usually recommend oral rehydration solutions if people can tolerate oral ingestion of certain fluids. People with significant dehydration or abnormal electrolyte levels, people with active vomiting, and people who intolerant of oral fluids, usually fluids and / or drugs must be given by vein (intravenously).

For some adults and adolescents, doctors prescribe drugs to relieve nausea (antiemetics), depending on the cause and severity of the vomiting:

• For vomiting caused by motion sickness: Antihistamines (eg, dimensionhydrinate), scopolamine patch, or a combination of both
• For mild to moderate symptoms: Prochlorperazine or metoclopramide
• For severe vomiting (including vomiting caused by chemotherapy): Dolasetron, ondansetron, or granisetron, and sometimes aprepitant