Vomiting causes
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causes of vomiting etiology
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nausea vomiting pathophysiology central peripheral mechanisms
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Causes of Vomiting
Vomiting is coordinated by the brainstem and triggered by stimulation at one of four sites: the GI tract, vestibular system, chemoreceptor trigger zone (CTZ), and the cerebral cortex (Harrison's, p. 456, 1212).
Gastrointestinal Causes
- Gastroenteritis (viral, bacterial, parasitic)
- Peptic ulcer disease / gastritis
- Gastroparesis (delayed gastric emptying)
- Gastroesophageal reflux disease (GERD)
- Bowel obstruction (small or large bowel)
- Appendicitis, cholecystitis, pancreatitis
- Intestinal ischemia
- Constipation / fecal impaction
- Hepatitis
- Peritonitis
Central Nervous System Causes
(via cerebral cortex or direct brainstem activation)
- Increased intracranial pressure (meningitis, encephalitis, brain tumor, hemorrhage)
- Migraine
- Seizures
- Head trauma
Vestibular Causes
(via histamine and acetylcholine receptors)
- Motion sickness
- Labyrinthitis
- Ménière's disease
- Benign paroxysmal positional vertigo (BPPV)
Chemoreceptor Trigger Zone (CTZ) Causes
(via dopamine D2 and 5-HT₃ receptors)
- Medications: opioids, NSAIDs, antibiotics, chemotherapy, digoxin, levodopa
- Metabolic disorders: uremia, diabetic ketoacidosis, hypercalcemia, hyponatremia, Addison's disease
- Toxins and overdoses
- Radiation therapy
Cortical / Psychogenic Causes
- Anticipatory nausea (e.g., pre-chemotherapy)
- Anxiety and panic disorders
- Cyclic vomiting syndrome
- Psychogenic vomiting
Pregnancy-Related
- Morning sickness (first trimester)
- Hyperemesis gravidarum
Cardiac
- Acute myocardial infarction (especially inferior MI — vagal activation)
- Heart failure
Endocrine / Metabolic
- Diabetic ketoacidosis
- Hypercalcemia
- Adrenal insufficiency
- Thyrotoxicosis
Postoperative
- Postoperative nausea and vomiting (PONV) — common after general anesthesia
Key Receptor Targets (Basis for Treatment)
| Site | Receptors Involved |
|---|---|
| GI tract | Mechanoreceptors, chemoreceptors, 5-HT₃ |
| Vestibular system | Histamine (H1), Acetylcholine (muscarinic) |
| CTZ | Dopamine D2, 5-HT₃, chemoreceptors |
| Cerebral cortex | Cognitive/emotional processing |
(Harrison's, p. 456)
Red flags warranting urgent evaluation: projectile vomiting, blood in vomitus (hematemesis), vomiting with severe headache/stiff neck, signs of obstruction, or vomiting with chest pain.
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