Retching Health Dictionary

A thick, bitter, greenish-brown ?uid, secreted by the liver and stored in the gall-bladder (see LIVER). Consisting of water, mucus, bile pigments including BILIRUBIN, and various salts, it is discharged through the bile ducts into the intestine a few centimetres below the stomach. This discharge is increased shortly after eating, and again a few hours later. It helps in the digestion and absorption of food, particularly fats, and is itself reabsorbed, passing back through the blood of the liver. In JAUNDICE, obstruction of the bile ducts prevents discharge, leading to a build-up of bile in the blood and deposition in the tissues. The skin becomes greenish-yellow, while the stools become grey or white and the urine dark. Vomiting of bile is a sign of intestinal obstruction, but may occur in any case of persistent retching or vomiting, and should be fully investigated.... bile

Vomiting means the expulsion of the STOMACH contents through the mouth. When the e?ort of vomiting is made, but nothing is brought up, the process is known as retching. When vomiting occurs, the chief e?ort is made by the muscles of the abdominal wall and by the diaphragm contracting together and squeezing the stomach. The contraction of the stomach wall is no doubt also a factor, and an important step in the act consists in the opening at the right moment of the cardiac or upper ori?ce of the stomach. This concerted action of various muscles is brought about by a vomiting centre situated on the ?oor of the fourth ventricle in the BRAIN.

Causes Vomiting is brought about by stimulation of this nervous centre, and in most cases this is e?ected through sensations derived from the stomach itself. Thus, of the drugs which cause vomiting, some act only after being absorbed into the blood and carried to the brain, although most are irritants to the mucous membrane of the stomach (see EMETICS); various diseases of the stomach, such as cancer, ulcer and food poisoning act in a similar way. Stimulation – not only of the nerves of the stomach, but also of those supplying other abdominal organs – produces vomiting; thus in obstruction of the bowels, peritonitis, gall-stone colic, renal colic, and even in some women during pregnancy, vomiting is a prominent symptom.

Severe emotional shock may cause vomiting, as may acute anxiety and unpleasant experiences such as seeing an accident, suffering severe pain or travel sickness.

Direct disturbance of the brain itself is a cause: for example, a blow on the head, a cerebral tumour, a cerebral abscess, meningitis. Nausea and vomiting are common symptoms that may arise from local disease of the gastrointestinal tract, but they are also associated with systemic illness – for example, DIABETES MELLITUS or kidney failure (see KIDNEYS, DISEASES OF) – and also with disturbances of labyrinthine function, such as motion sickness and acute labyrinthitis.

Treatment The cause of the vomiting must be sought and treatment directed towards this. Symptomatic treatment for vomiting can be dangerous since accurate diagnosis of the cause may be hindered. If antinauseant drug treatment is indicated, the choice of drug depends on the cause of the vomiting.

Granisetron and ondansetron are 5hydroxytryptamine (5HT3) antagonists valuable in the treatment of nausea and vomiting induced by cytotoxic CHEMOTHERAPY or RADIOTHERAPY and prevention and treatment of post-operative nausea and vomiting. Prochlorperazine is valuable in the treatment of severe nausea, vomiting, VERTIGO and disorders of the LABYRINTH of the EAR, although extrapyramidal symptoms may occur, particularly in children, elderly and debilitated patients.

Vomiting may occur after surgical operations and this is due to the combined effects of analgesics, anaesthetic agents and the psychological stress of operation. Various drugs can be used to prevent or stop post-operative vomiting.

Nausea and vomiting are common symptoms in pregnancy. Drugs are best avoided in this situation as they may damage the developing FETUS. Simple measures, such as the taking of food before getting up in the morning and reassurance, are often all that is necessary.... vomiting

A tear at the lower end of the oesophagus, causing vomiting of blood. The syndrome is commonly caused by retching and vomiting after drinking excessive amounts of alcohol. Less often, violent coughing, a severe asthma attack, or epileptic convulsions may be the cause.

An endoscope is passed down the oesophagus to confirm the diagnosis. The tear generally heals within 10 days and no special treatment is usually required. However, a blood transfusion may sometimes be necessary.... mallory–weiss syndrome

spontaneous rupture (see perforation) of the gullet (oesophagus) following forceful retching and vomiting. Usual symptoms are severe chest and upper abdominal pain (that is aggravated by swallowing), fever, and shortness of breath. Surgical *emphysema is often present. Diagnosis is usually made with CT scanning. Surgery is required in most of the cases, combined with broad-spectrum antibiotics and parenteral *nutrition. [H. Boerhaave (1668–1738), Dutch physician]... boerhaave’s syndrome

trauma of the mucosal lining at the junction of the oesophagus (gullet) and stomach following protracted vomiting and retching. It is associated with *haematemesis and rarely perforation of the oesophagus. [G. K. Mallory (1926– ), US pathologist; S. Weiss (1899–1942), US physician]... mallory–weiss syndrome

Several disorders, most of which cause swallowing difficulties and/or chest pain.

Infections of the oesophagus are rare but may occur in immunosuppressed patients. The most common are herpes simplex and candidiasis (thrush). Oesophagitis is usually due to reflux of stomach contents, causing heartburn. Corrosive oesophagitis can occur as a result of swallowing caustic chemicals. Both may cause an oesophageal stricture.

Congenital defects include oesophageal atresia, which requires surgery soon after birth. Tumours of the oesophagus are quite common; about 90 per cent are cancerous (see oesophagus, cancer of). Injury to the oesophagus is most commonly caused by a tear or rupture due to severe vomiting and retching. (See also swallowing difficulty.)... oesophagus, disorders of