Development of palliative medicine in the United Kingdom and Ireland
Eduardo Bruera, Irene Higginson, Charles F von Gunten, Tatsuya Morita in Textbook of Palliative Medicine and Supportive Care, 2015
While nausea is an expression of autonomic stimulation, characterized by a decrease in gastric tone and peristalsis and associated with an increase in the tone of duodenum, retching and vomiting are mediated by somatic nerves. Retching is an attempt to vomit without bringing anything up. It is characterized by a spasmodic movement of the diaphragm and abdominal musculature with the glottis closed, and denotes the labored rhythmic respiratory activity that frequently precedes emesis. The vomiting act involves forceful contraction of the abdominal muscles, contraction of pylorus and antrum, a raised gastric cardias, diminished lower esophageal sphincter pressure, and esophageal dilatation. Intestinal contents are commonly present in vomited material, implying a possible reverse peristalsis [5]. Hypersalivation and cardiac rhythm disturbances are frequently associated phenomena. Although the neural pathways that mediate nausea are not known, evidence suggests that they are the same pathways that mediate vomiting. Â 4 It may be that mild activation leads to nausea, whereas more intense activation leads to retching or vomiting.
Assessment of Acute Pain and Anxiety and Chemotherapy-Related Nausea and Vomiting in Children and Adolescents
David M. Dush, Barrie R. Cassileth, Dennis C. Turk in Psychosocial Assessment in Terminal Care, 2014
The next consideration is how to assess nausea and vomiting. For anticipatory emesis and post-chemotherapy emesis in hospitalized children, a seemingly simple solution might be to observe and count emeses. These data are not as objective as they may appear. First, there are individual differences in the definition of a “vomit.” In their study of an antiemetic, Allen et al. (1985) defined vomit as “explusion of any vomitus or up to five nonproductive retches within a five-minute period.” Yet some children accumulate enough saliva in their mouth to have this be confused with gastric contents (although fastidious investigators could assess the pH of the material to differentiate the two). Also, retching (also known as “dry heaves”) may occur when the stomach is empty. Should retching then be considered different from vomiting from a clinical distress standpoint? Although some investigators have measured volume of vomitus in an attempt to be objective, they have not considered the patient's oral intake. This important variable affects gastric content. For children who intermittently retch and vomit, the observed and recorded emesis count may be influenced by the severity of the child's distress while vomiting. That is, we have found that an observer is likely to record a higher number of emeses for a child who vomits with much distress than for the child who is less bothered by the same amount of vomiting.
The abdomen
Kevin G Burnand, John Black, Steven A Corbett, William EG Thomas, Norman L Browse in Browse’s Introduction to the Symptoms & Signs of Surgical Disease, 2014
Age and sex Pancreatitis is equally common in males and females. The peak incidence is in the fourth and fifth decades of life, but it can occur at any age. Symptoms The common presenting symptom is pain that begins suddenly, high in the epigastrium, and steadily increases in severity until it is very severe, causing the patient to lie still and breathe shallowly. It usually radiates through to the back. Nothing relieves the pain, which is exacerbated by movement. Frequent vomiting and retching are very common, and are an important pointer to the correct diagnosis. There is persistent nausea between the bouts of vomiting. Many patients have eaten an unusually large meal or drunk some alcohol before the pain began.
Current understanding of the etiology of cyclic vomiting syndrome and therapeutic strategies in its management
Published in Expert Review of Clinical Pharmacology, 2022
Rosita Frazier, Thangam Venkatesan
Patients with CVS usually have four phases which were first described by Fleisher [13] and are shown in Figure 1. The inter-episodic or the well phase is the time between episodes when patients are usually asymptomatic and when lifestyle modifications, and prophylactic medications are used to prevent future episodes. The prodromal phase occurs before the emesis starts and patients can sense an impending CVS attack. Symptoms include nausea, sweating, abdominal pain, fatigue, weakness, feeling hot or cold, shivering, and interrupted sleep. Often, patients experience an impending sense of doom and exhibit symptoms of panic. This phase can last from a few minutes to several hours and medications to abort or terminate progression to a full-blown CVS episode or attenuate symptoms are usually recommended as early as possible in this phase. This is then followed by the vomiting phase, which is characterized by severe nausea, vomiting, and retching. Symptomatic treatment with IV fluids, anti-emetics, and anxiolytics is usually administered during this phase. This is then followed by recovery when patients slowly resume oral intake and return to baseline. This period of recovery is variable and can last from several hours to days. If CVS is left untreated or poorly managed, this episodic pattern can be lost over time when episodes become longer, and periods of normalcy are shortened and is referred to as coalescence of symptoms. A careful history and chronological account will help establish the diagnosis and initiate therapy.
Recalling the severity of nausea and vomiting of pregnancy – a study using Pregnancy-Unique Quantification of Emesis Questionnaire
Published in Journal of Obstetrics and Gynaecology, 2023
Linda Laitinen, Miina Nurmi, Mari Koivisto, Päivi Rautava, Päivi Polo-Kantola
The continuous PUQE scores and the points of each PUQE questions were similar in women answering ≤20 gwks and >20 gwks. For women answering ≤20 gwks and ≥24 gwks, the continuous PUQE scores were similar, as well. However, in this comparison, the women answering ≤20 gwks reported longer duration of nausea (higher mean points in question 1). Instead, the frequency of both vomiting (question 2) and retching (question 3) episodes were similar. Alike, when comparing the women answering in ≤16 gwks and ≥24 gwks, the continuous PUQE scores were similar, but the women answering ≤16 gwks had higher mean points in question 1 (longer duration of nausea) than women answering ≥24 gwks. Otherwise, the answers to PUQE questions 2 and 3 were similar also in this comparison (Table 2).
Ciguatera fish poisoning in the age of discovery and the age of enlightenment
Published in Clinical Toxicology, 2022
The symptoms at first were universal lassitude and weakness, followed by retching; and in some by gripings [abdominal cramping] and looseness [diarrhea]. To these succeeded a flushing heat and violent pains in the face and head, with a giddiness and increase of weakness; also a pain, or, as they expressed it, a burning heat in the mouth and throat. Some had the mouth affected in such a manner, that they imagined their teeth were loose; which might really be the case, as a considerable spitting attended this symptom. The pulse all this time was rather slow and low. The retching and looseness did not last long; but the pain and heat of the head were extended to the arms, hands, and legs.
Related Knowledge Centers
- Glottis
- Stress
- Vomiting
- Abdomen
- Thorax
- Esophagus
- Stomach
- Retroperistalsis
- Fluid Balance
- Electrolyte Imbalance