VOMITING

The act of vomiting is a movement caused by the active contraction of the abdominal wall against a fixed diaphragm, with the cardiac sphincter relaxed, Vomiting is often preceded by nausea and salivation. Reflex salivation is called waterbrash, and the fluid either runs directly out of the mouth or is swallowed and then regurgitated from the oesophagus. Vomiting is a reflex act, which may be elicited by a variety of stimuli and over a wide area.

Therefore for this reason vomiting is not a useful localizing symptom. In the abdomen, the most common causes of vomiting are diseases of the stomach or small intestine, peritonitis, appendicitis or cholecystitis. Diseases of the large bowel cause vomiting less frequently. Outside the abdomen there are numerous conditions which may be responsible, e.g. migraine, meningitis, uraemia etc.

When vomiting has an abdominal cause, it is usually preceded by nausea; when the vomiting is due to direct stimulation of the vomiting centre in the medulla, it may occur suddenly without any warning. Vomiting in the morning occurs in pregnancy and alcoholic gastritis or may be psychogenic in origin. If the size of the vomitus is unaccountably large, there must be dilatation of the stomach, most probably due to obstruction of part of the pyloroduodenal canal. Vomiting that produces relief of pain is likely to be due to an obstructive cause. If there is a history of repeated vomiting unattended by any loss of weight, the vomiting is probably psychogenic in origin. In assessing the significance of vomiting as a symptom, it is helpful to find out if the patient vomits readily and has frequently vomited in the past with but little cause. The significance of vomiting in such a patient is unlikely to be great. 

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