What Can Cause Vomiting in Pregnancy?

Nausea and vomiting are common clinical symptoms. Nausea is the feeling of upset stomach and urgent vomiting. May be accompanied by symptoms of vagus nerve excitement, such as pale skin, sweating, salivation, decreased blood pressure and bradycardia, etc., often a prelude to vomiting. Usually nausea is followed by vomiting, but it can also be nausea without vomiting, or vomiting without nausea. Vomiting is a phenomenon in which the contents of the stomach or small intestine are forced out of the body through the esophagus and mouth through the strong contraction of the stomach. Both are complex reflection actions.

Basic Information

English name: Nausea and Vomiting
Visiting department: Emergency Department
Common causes: Reflex vomiting is irritation of the pharynx, stomach, duodenal disease, intestinal and hepatobiliary and pancreatic diseases, central vomiting is central system disease, systemic disease, etc.

Common symptoms: Upper abdominal discomfort and urge to vomit, with pale skin, sweating, salivation, decreased blood pressure, bradycardia; general nausea and vomiting

Causes of nausea and vomiting

There are many causes of nausea and vomiting, which can be summarized into the following categories according to the pathogenesis:

Reflex vomiting

(1) Pharyngeal irritation such as smoking, severe cough, nasopharyngeal inflammation or pus.

(2) Acute gastric and duodenal diseases , chronic gastroenteritis, peptic ulcer, functional dyspepsia, acute gastric dilatation or pyloric obstruction, duodenal stagnation, etc.

(3) Intestinal diseases: acute appendicitis, intestinal obstruction, etc.

(4) Hepatobiliary and pancreatic diseases: acute hepatitis, cirrhosis, and liver congestion.

(5) Peritoneal and mesenteric diseases such as acute peritonitis.

(6) Other stones such as renal ureter.

2. Central vomiting

(1) Nervous system diseases Intracranial infections such as various encephalitis; Cerebrovascular diseases such as cerebral hemorrhage; Craniocerebral injuries such as cerebral contusion and laceration; Epilepsy, especially persistent.

(2) Systemic diseases: uremia, liver coma, diabetic ketoacidosis, hyperthyroidism crisis, parathyroid crisis, etc.

(3) Drugs such as certain antibiotics, anticancer drugs, digitalis and the like can excite the vomiting center and cause vomiting.

(4) Poisoning caused by poisoning such as ethanol, heavy metals and carbon monoxide can cause vomiting.

(5) Psychological factors Gastric neurosis, hysteria, and anorexia nervosa.

3. Vestibular disorders

For those with vomiting accompanied by otic symptoms such as hearing impairment and dizziness, vestibular vomiting should be considered. Common diseases include labyrinthitis, Meniere's disease, and motion sickness.

Clinical manifestations of nausea and vomiting

Vomiting time

Early morning vomiting in women of childbearing age is seen in early pregnancy. It can also be seen in uremia, chronic alcoholism or functional dyspepsia. Patients with sinusitis may have nausea and nausea in the morning due to pus flowing out of the nostril after stimulation. . Dinner or nighttime vomiting is seen in pyloric obstruction.

2. The relationship between vomiting and eating

Vomiting during or immediately after eating may be pyloric ulcer or mental vomiting; vomiting more than 1 hour after a meal is called delayed vomiting, which indicates decreased gastric tension or delayed gastric emptying. Vomiting after a long meal or several meals is seen in pyloric obstruction, and vomit may have overnight accommodations; recent vomiting after meals is mostly caused by food poisoning.

3. Characteristics of vomiting

If vomiting immediately after eating, nausea is very light, you can eat after vomiting, long-term repeated attacks without affecting the nutritional status, mostly neurological vomiting. Jet vomiting is mostly intracranial hypertension.

4. Nature of vomit

Fermented, spoiled odors suggest gastric retention; fecal odors indicate low intestinal obstruction; no bile indicates that the level of obstruction is above the duodenal nipple; a large amount of bile indicates below this level; those with a large amount of acidic liquid, more It is gastrinoma or duodenal ulcer; those without acidity may be caused by stenosis or achalasia of the cardia; upper gastrointestinal bleeding is often coffee-colored vomit.

Nausea and vomiting

Physical examination

Pay attention to blood pressure, breathing odor, abdominal tenderness, rebound pain, gastrointestinal peristaltic wave and bowel type, abdominal mass, bowel sounds, water vibrations, etc. Nervous system, vestibular nerve function and ophthalmological examination are performed when necessary.

2. Laboratory and other inspections

According to the patient's condition, blood routine, urine routine, uroketone body, blood glucose, electrolyte series, blood gas analysis, urea nitrogen, blood and urine amylase, cerebrospinal fluid routine, and toxicological analysis of vomiting fluid can be selected.

When indicated, do X-ray or plain radiography of the abdomen, barium meal radiography, fiber gastroduodenoscope, electrocardiogram, B-mode ultrasound of the abdomen or brain, CT or magnetic resonance, and cerebral angiography.

Nausea and Vomiting Diagnosis

Diagnosis can be made based on medical history, laboratory tests, and physical examinations.

Nausea and Vomiting Treatment

Based on the active treatment of the cause, the necessary symptomatic treatment is performed.

Gastrointestinal diseases

Lesions in the esophagus, stomach, duodenum through the jejunum, ileum, colon, and rectum can cause nausea and vomiting. Vomiting due to narrowing or obstruction caused by benign or malignant gastrointestinal tract, drug treatment is ineffective. The symptoms of vomiting will only disappear after dilatation, stent placement or surgical treatment to relieve stenosis or obstruction. For patients with achalasia, prior to dilation or surgery, calcium channel antagonists or nitroglycerin can be taken orally half an hour before a meal, which can improve vomiting and obstruction symptoms in the early stage; or try botulinum toxin for local narrow injection . For vomiting caused by acute inflammatory lesions of the gastrointestinal tract, you should actively choose antibiotics and correct electrolyte disorders and vitamin supplements; nausea and vomiting caused by gastrointestinal motility disorders, you can use mosapride and other gastrointestinal motility agents; if vomiting is Caused by gastrointestinal spasm, anticholinergic drugs such as scopolamine can be applied.

2. Liver, biliary and pancreatic diseases

Liver, biliary, and pancreatic diseases are one of the common causes of nausea and vomiting. Nausea and vomiting can be early symptoms of acute viral hepatitis. They often occur at the same time as loss of appetite, greasy food, and fullness in the upper abdomen. After liver protection treatment and proper rest, nausea and vomiting can gradually disappear. Vomiting is also a symptom often accompanied by biliary obstruction or colic. Vomiting will stop only when the biliary obstruction or inflammation is eliminated. Acute pancreatitis is often accompanied by nausea and vomiting. Only gastrointestinal decompression can reduce pancreatic juice and pancreatic enzymes. After measures such as secretion, vomiting will gradually ease or stop.

3. Central nervous system disease

Including encephalitis, meningitis, brain tumors, cerebral parasitic disease, cerebrovascular disease and craniocerebral trauma caused by various reasons, can cause increased intracranial pressure and cause nausea and vomiting. One of the important treatment measures is the application of medications that reduce intracranial hypertension and reduce brain cell edema. Dehydration treatment can not only improve the symptoms of vomiting, but also play a role in protecting or restoring brain cell function.

4. Drug-induced vomiting

Many drugs have adverse reactions that cause nausea and vomiting. Generally speaking, as long as the application of vomiting drugs is stopped immediately, the symptoms of vomiting will be reduced until they disappear, so it is not necessary to apply antiemetic drugs. At present, combined chemotherapy or radiotherapy is often used for certain malignant tumors or hematological malignancies (such as leukemia, malignant lymphoma, multiple myeloma, malignant histiocytosis, etc.), or anticancer drugs are used for certain malignant tumors. Interventional treatment. However, during or after treatment, it can cause serious gastrointestinal adverse reactions, the most prominent manifestations of which are nausea and vomiting. In order to prevent or reduce this adverse reaction, antiemetic drugs can often be used for treatment. It must be pointed out that after the application of these powerful antiemetic drugs, adverse reactions of the central nervous system, cardiovascular system or gastrointestinal tract will also occur, so the dose and interval of the drugs should be strictly controlled.

5. Vomiting due to nerve and mental factors

Psychotherapy is the key to vomiting caused by such causes. First, the patient's mental and psychological disorders should be eliminated, and secondly, it can be combined with drug treatment. The commonly used drugs are sedatives and gastrointestinal prokinetic agents. In severe cases, antidepressants such as doxepin or fluoxetine can be used for treatment. It is contraindicated to use strong antiemetics such as ondansetron (Ondansetron).