Vomiting

Last updated

Vomiting
Other namesEmesis, puking, barfing, heaving, throwing up
3205 - Milano, Duomo - Giorgio Bonola - Miracolo di Marco Spagnolo (1681) - Foto Giovanni Dall'Orto, 6-Dec-2007-cropped.jpg
Miracle of Marco Spagnolo by Giorgio Bonola (Quadroni of St. Charles)
Specialty Gastroenterology
Vomiting of a man

Vomiting is the involuntary, forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose. [1]

Stomach digestive organ

The stomach is a muscular, hollow organ in the gastrointestinal tract of humans and many other animals, including several invertebrates. The stomach has a dilated structure and functions as a vital digestive organ. In the digestive system the stomach is involved in the second phase of digestion, following chewing. It performs a chemical breakdown due to enzymes and hydrochloric acid.

Mouth first portion of the alimentary canal that receives food

In animal anatomy, the mouth, also known as the oral cavity, buccal cavity, or in Latin cavum oris, is the opening through which many animals take in food and issue vocal sounds. It is also the cavity lying at the upper end of the alimentary canal, bounded on the outside by the lips and inside by the pharynx and containing in higher vertebrates the tongue and teeth. This cavity is also known as the buccal cavity, from the Latin bucca ("cheek").

Human nose feature of the face

The human nose is the most protruding part of the face that bears the nostrils and is the first organ of the respiratory system. The nose is also the principal organ in the olfactory system. The shape of the nose is determined by the nasal bones and the nasal cartilages, including the nasal septum which separates the nostrils and divides the nasal cavity into two. On average the nose of a male is larger than that of a female.

Contents

Vomiting can be caused by a wide variety of conditions; it may present as a specific response to ailments like gastritis or poisoning, or as a non-specific sequela of disorders ranging from brain tumors and elevated intracranial pressure to overexposure to ionizing radiation. The feeling that one is about to vomit is called nausea, which often precedes, but does not always lead to, vomiting. Antiemetics are sometimes necessary to suppress nausea and vomiting. In severe cases, where dehydration develops, intravenous fluid may be required. Self-induced vomiting can be a component of an eating disorder, such as bulimia nervosa, and is itself now an eating disorder on its own, purging disorder. [2]

Gastritis stomach disease that is an inflammation of the lining of the stomach.

Gastritis is inflammation of the lining of the stomach. It may occur as a short episode or may be of a long duration. There may be no symptoms but, when symptoms are present, the most common is upper abdominal pain. Other possible symptoms include nausea and vomiting, bloating, loss of appetite and heartburn. Complications may include bleeding, stomach ulcers, and stomach tumors. When due to autoimmune problems, low red blood cells due to not enough vitamin B12 may occur, a condition known as pernicious anemia.

Poison substance that causes disturbances to organisms

In biology, poisons are substances that cause disturbances in organisms, usually by chemical reaction or other activity on the molecular scale, when an organism absorbs a sufficient quantity.

A sequela is a pathological condition resulting from a disease, injury, therapy, or other trauma. Typically, a sequela is a chronic condition that is a complication which follows a more acute condition. It is different from, but is a consequence of, the first condition. Timewise, a sequela contrasts with a late effect, where there is a period, sometimes as long as several decades, between the resolution of the initial condition and the appearance of the late effect.

Vomiting is different from regurgitation, although the two terms are often used interchangeably. Regurgitation is the return of undigested food back up the esophagus to the mouth, without the force and displeasure associated with vomiting. The causes of vomiting and regurgitation are generally different.

Regurgitation (digestion)

Regurgitation is the expulsion of material from the pharynx, or esophagus, usually characterized by the presence of undigested food or blood.

Esophagus organ in vertebrates

The esophagus or oesophagus, commonly known as the food pipe or gullet, is an organ in vertebrates through which food passes, aided by peristaltic contractions, from the pharynx to the stomach. The esophagus is a fibromuscular tube, about 25 centimetres long in adults, which travels behind the trachea and heart, passes through the diaphragm and empties into the uppermost region of the stomach. During swallowing, the epiglottis tilts backwards to prevent food from going down the larynx and lungs. The word oesophagus is the Greek word οἰσοφάγος oisophagos, meaning "gullet".

Complications

Aspiration

Vomiting can be dangerous if the gastric content enters the respiratory tract. Under normal circumstances the gag reflex and coughing prevent this from occurring; however, these protective reflexes are compromised in persons under the influences of certain substances such as alcohol or anesthesia. The individual may choke and asphyxiate or suffer an aspiration pneumonia.[ citation needed ]

Respiratory tract Organs involved in transmission of air to and from the point where gases diffuse into tissue

In humans, the respiratory tract is the part of the anatomy of the respiratory system involved with the process of respiration. Air is breathed in through the nose or the mouth. In the nasal cavity, a layer of mucous membrane acts as a filter and traps pollutants and other harmful substances found in the air. Next, air moves into the pharynx, a passage that contains the intersection between the oesophagus and the larynx. The opening of the larynx has a special flap of cartilage, the epiglottis, that opens to allow air to pass through but closes to prevent food from moving into the airway.

Ethanol is a chemical compound, a simple alcohol with the chemical formula C
2
H
6
O
. Its formula can be also written as CH
3
CH
2
OH or C
2
H
5
OH, and is often abbreviated as EtOH. Ethanol is a volatile, flammable, colorless liquid with a slight characteristic odor. It is a psychoactive substance and is the principal type of alcohol found in alcoholic drinks.

Anesthesia State of medically controlled temporary loss of sensation or awareness

Anesthesia or anaesthesia is a state of controlled, temporary loss of sensation or awareness that is induced for medical purposes. It may include analgesia, paralysis, amnesia, or unconsciousness. A patient under the effects of anesthetic drugs is referred to as being anesthetized.

Dehydration and electrolyte imbalance

Prolonged and excessive vomiting depletes the body of water (dehydration), and may alter the electrolyte status. Gastric vomiting leads to the loss of acid (protons) and chloride directly. Combined with the resulting alkaline tide, this leads to hypochloremic metabolic alkalosis (low chloride levels together with high HCO
3
and CO
2
and increased blood pH) and often hypokalemia (potassium depletion). The hypokalemia is an indirect result of the kidney compensating for the loss of acid. With the loss of intake of food the individual may eventually become cachectic. A less frequent occurrence results from a vomiting of intestinal contents, including bile acids and HCO
3
, which can cause metabolic acidosis.[ citation needed ]

Alkaline tide refers to a condition, normally encountered after eating a meal, where during the production of hydrochloric acid by parietal cells in the stomach, the parietal cells secrete bicarbonate ions across their basolateral membranes and into the blood, causing a temporary increase in pH.

Hypochloremia is an electrolyte disturbance in which there is an abnormally low level of the chloride ion in the blood. The normal serum range for chloride is 97 to 107 mEq/L.

Metabolic alkalosis

Metabolic alkalosis is a metabolic condition in which the pH of tissue is elevated beyond the normal range (7.35–7.45). This is the result of decreased hydrogen ion concentration, leading to increased bicarbonate, or alternatively a direct result of increased bicarbonate concentrations. The condition typically cannot last long if the kidneys are functioning properly.

Mallory–Weiss tear

Repeated or profuse vomiting may cause erosions to the esophagus or small tears in the esophageal mucosa (Mallory–Weiss tear). This may become apparent if fresh red blood is mixed with vomit after several episodes.[ citation needed ]

Mallory–Weiss syndrome

Mallory–Weiss syndrome or gastro-esophageal laceration syndrome refers to bleeding from a laceration in the mucosa at the junction of the stomach and esophagus. This is usually caused by severe vomiting because of alcoholism or bulimia, but can be caused by any conditions which causes violent vomiting and retching such as food poisoning. The syndrome presents with hematemesis. The laceration is sometimes referred to as a Mallory-Weiss tear.

Dentistry

Recurrent vomiting, such as observed in bulimia nervosa, may lead to destruction of the tooth enamel due to the acidity of the vomit. Digestive enzymes can also have a negative effect on oral health, by degrading the tissue of the gums.[ citation needed ]

Pathophysiology

14th-century illustration of vomiting from the Casanatense Tacuinum Sanitatis 49-aspetti di vita quotidiana, vomito,Taccuino Sanitatis, Ca.jpg
14th-century illustration of vomiting from the Casanatense Tacuinum Sanitatis

Receptors on the floor of the fourth ventricle of the brain represent a chemoreceptor trigger zone, known as the area postrema, stimulation of which can lead to vomiting. The area postrema is a circumventricular organ and as such lies outside the blood–brain barrier; it can therefore be stimulated by blood-borne drugs that can stimulate vomiting or inhibit it. [3]

There are various sources of input to the vomiting center:

The vomiting act encompasses three types of outputs initiated by the chemoreceptor trigger zone: Motor, parasympathetic nervous system (PNS), and sympathetic nervous system (SNS). They are as follows:[ citation needed ]

The neurotransmitters that regulate vomiting are poorly understood, but inhibitors of dopamine, histamine, and serotonin are all used to suppress vomiting, suggesting that these play a role in the initiation or maintenance of a vomiting cycle. Vasopressin and neurokinin may also participate.[ citation needed ]

Phases

The vomiting act has two phases. In the retching phase, the abdominal muscles undergo a few rounds of coordinated contractions together with the diaphragm and the muscles used in respiratory inspiration. For this reason, an individual may confuse this phase with an episode of violent hiccups. In this retching phase, nothing has yet been expelled. In the next phase, also termed the expulsive phase, intense pressure is formed in the stomach brought about by enormous shifts in both the diaphragm and the abdomen. These shifts are, in essence, vigorous contractions of these muscles that last for extended periods of time - much longer than a normal period of muscular contraction. The pressure is then suddenly released when the upper esophageal sphincter relaxes resulting in the expulsion of gastric contents. Individuals who do not regularly exercise their abdominal muscles may experience pain in those muscles for a few days. The relief of pressure and the release of endorphins into the bloodstream after the expulsion causes the vomiter to feel better.[ citation needed ]

Contents

Gastric secretions and likewise vomit are highly acidic. Recent food intake appears in the gastric vomit. Irrespective of the content, vomit tends to be malodorous.[ citation needed ]

The content of the vomitus (vomit) may be of medical interest. Fresh blood in the vomit is termed hematemesis ("blood vomiting"). Altered blood bears resemblance to coffee grounds (as the iron in the blood is oxidized) and, when this matter is identified, the term coffee-ground vomiting is used. Bile can enter the vomit during subsequent heaves due to duodenal contraction if the vomiting is severe. Fecal vomiting is often a consequence of intestinal obstruction or a gastrocolic fistula and is treated as a warning sign of this potentially serious problem (signum mali ominis).[ citation needed ]

If the vomiting reflex continues for an extended period with no appreciable vomitus, the condition is known as non-productive emesis or "dry heaves", which can be painful and debilitating.[ citation needed ]

Color of vomit[ citation needed ]

Differential diagnosis

Vomiting may be due to a large number of causes, and protracted vomiting has a long differential diagnosis.[ citation needed ]

Digestive tract

Causes in the digestive tract

Sensory system and brain

Causes in the sensory system:[ citation needed ]

Causes in the brain:[ citation needed ]

Metabolic disturbances (these may irritate both the stomach and the parts of the brain that coordinate vomiting):[ citation needed ]

Pregnancy:[ citation needed ]

Drug reaction (vomiting may occur as an acute somatic response to):[ citation needed ]

Illness (sometimes colloquially known as "stomach flu"—a broad name that refers to gastric inflammation caused by a range of viruses and bacteria):[ citation needed ]

Psychiatric/behavioral

Emetics

An emetic, such as syrup of ipecac, is a substance that induces vomiting when administered orally or by injection. An emetic is used medically when a substance has been ingested and must be expelled from the body immediately (for this reason, many toxic and easily digestible products such as rat poison contain an emetic). Inducing vomiting can remove the substance before it is absorbed into the body. Ipecac abuse can cause detrimental health effects.[ citation needed ]

Salt water and mustard water have been used since ancient times as emetics. [11] Care must be taken with salt, as excessive intake can potentially be harmful. [12] [13]

Copper sulfate was also used in the past as an emetic. [14] [15] It is now considered too toxic for this use. [16]

Hydrogen peroxide is used as an emetic in veterinary practice. [17] [18]

Social cues

A drunk man vomiting, while a young slave is holding his forehead. Brygos Painter, 500-470 BC Nationalmuseet - Cophenaghen - brygos vomiting1.jpg
A drunk man vomiting, while a young slave is holding his forehead. Brygos Painter, 500–470 BC

It is quite common that, when one person vomits, others nearby become nauseated, particularly when smelling the vomit of others, often to the point of vomiting themselves. It is believed that this is an evolved trait among primates. Many primates in the wild tend to browse for food in small groups. Should one member of the party react adversely to some ingested food, it may be advantageous (in a survival sense) for other members of the party to also vomit. This tendency in human populations has been observed at drinking parties, where excessive consumption of alcoholic beverages may cause a number of party members to vomit nearly simultaneously, this being triggered by the initial vomiting of a single member of the party. This phenomenon has been touched on in popular culture: notorious instances appear in the films Monty Python's The Meaning of Life (1983) and Stand By Me (1986). [19]

Intense vomiting in ayahuasca ceremonies is a common phenomenon. However, people who experience "la purga" after drinking ayahuasca, in general, regard the practice as both a physical and spiritual cleanse and often come to welcome it. [20] It has been suggested that the consistent emetic effects of ayahuasca—in addition to its many other therapeutic properties—was of medicinal benefit to indigenous peoples of the Amazon, in helping to clear parasites from the gastrointestinal system. [21]

There have also been documented cases of a single ill and vomiting individual inadvertently causing others to vomit, when they are especially fearful of also becoming ill, through a form of mass hysteria.[ citation needed ]

Special bags are often supplied on boats for sick passengers to vomit into. Sea-sickness bag, Merseyside Maritime Museum.png
Special bags are often supplied on boats for sick passengers to vomit into.

Most people try to contain their vomit by vomiting into a sink, toilet, or trash can, as vomit is difficult and unpleasant to clean. On airplanes and boats, special bags are supplied for sick passengers to vomit into. A special disposable bag (leakproof, puncture-resistant, odorless) containing absorbent material that solidifies the vomit quickly is also available, making it convenient and safe to store until there is an opportunity to dispose of it conveniently.[ citation needed ]

People who vomit chronically (e.g., as part of an eating disorder such as bulimia nervosa) may devise various ways to hide this disorder.[ citation needed ]

An online study of people's responses to "horrible sounds" found vomiting "the most disgusting". Professor Trevor Cox of the University of Salford's Acoustic Research Centre said that "We are pre-programmed to be repulsed by horrible things such as vomiting, as it is fundamental to staying alive to avoid nasty stuff." It is thought that disgust is triggered by the sound of vomiting to protect those nearby from possibly diseased food. [22]

Miscellanea

Other types

Treatment

An antiemetic is a drug that is effective against vomiting and nausea. Antiemetics are typically used to treat motion sickness and the side effects of medications such as opioids and chemotherapy.[ citation needed ]

Antiemetics act by inhibiting the receptor sites associated with emesis. Hence, anticholinergics, antihistamines, dopamine antagonists, serotonin antagonists, and cannabinoids are used as antiemetics. [26]

Evidence to support the use of antiemetics for nausea and vomiting among adults in the emergency department is poor. [27] It is unclear if any medication is better than another or better than no active treatment. [27]

Epidemiology

Nausea and/or vomiting are the main complaints in 1.6% of visits to family physicians in Australia. [28]

Society and culture

Herodotus, writing on the culture of the ancient Persians and highlighting the differences with those of the Greeks, notes that to vomit in the presence of others is prohibited among Persians. [29] [30]

See also

Related Research Articles

An antiemetic is a drug that is effective against vomiting and nausea. Antiemetics are typically used to treat motion sickness and the side effects of opioid analgesics, general anaesthetics, and chemotherapy directed against cancer. They may be used for severe cases of gastroenteritis, especially if the patient is dehydrated.

Bulimia nervosa eating disorder characterized by binge eating followed by purging

Bulimia nervosa, also known as simply bulimia, is an eating disorder characterized by binge eating followed by purging. Binge eating refers to eating a large amount of food in a short amount of time. Purging refers to the attempts to get rid of the food consumed. This may be done by vomiting or taking laxatives. Other efforts to lose weight may include the use of diuretics, stimulants, water fasting, or excessive exercise. Most people with bulimia are at a normal weight. The forcing of vomiting may result in thickened skin on the knuckles and breakdown of the teeth. Bulimia is frequently associated with other mental disorders such as depression, anxiety, and problems with drugs or alcohol. There is also a higher risk of suicide and self-harm.

Esophagitis is a disease characterized by inflammation of the esophagus. The esophagus is a tube composed of a mucosal lining, and longitudinal and circular smooth muscle fibers. It connects the pharynx to the stomach; swallowed food and liquids normally pass through it.

Perphenazine chemical compound

Perphenazine is a typical antipsychotic drug. Chemically, it is classified as a piperazinyl phenothiazine. Originally marketed in the US as Trilafon, it has been in clinical use for decades.

Metoclopramide chemical compound

Metoclopramide is a medication used mostly for stomach and esophageal problems. It is commonly used to treat and prevent nausea and vomiting, to help with emptying of the stomach in people with delayed stomach emptying, and to help with gastroesophageal reflux disease. It is also used to treat migraine headaches.

Syrup of ipecac, commonly referred to as ipecac, is a drug that was once widely used as an expectorant and a rapid-acting emetic. It is obtained from the dried rhizome and roots of Carapichea ipecacuanha from which it derives its name.

The chemoreceptor trigger zone (CTZ) is an area of the medulla oblongata that receives inputs from blood-borne drugs or hormones, and communicates with other structures in the vomiting center to initiate vomiting. The CTZ is located within the area postrema, which is on the floor of the fourth ventricle and is outside of the blood–brain barrier. It is also part of the vomiting center itself. The neurotransmitters implicated in the control of nausea and vomiting include acetylcholine, dopamine, histamine, substance P, and serotonin. There are also opioid receptors present, which may be involved in the mechanism by which opiates cause nausea and vomiting. The blood–brain barrier is not as developed here; therefore, drugs such as dopamine which cannot normally enter the CNS may still stimulate the CTZ.

Rumination syndrome eating disorder that is characterized by effortless regurgitation of most meals following consumption

Rumination syndrome, or Merycism, is an under-diagnosed chronic motility disorder characterized by effortless regurgitation of most meals following consumption, due to the involuntary contraction of the muscles around the abdomen. There is no retching, nausea, heartburn, odour, or abdominal pain associated with the regurgitation, as there is with typical vomiting. The disorder has been historically documented as affecting only infants, young children, and people with cognitive disabilities . Today it is being diagnosed in increasing numbers of otherwise healthy adolescents and adults, though there is a lack of awareness of the condition by doctors, patients and the general public.

Area postrema medullary structure in the brain that controls vomiting

The area postrema is a structure in the medulla oblongata in the brainstem that controls vomiting. Its location in the brain also allows it to play a vital role in the control of autonomic functions by the central nervous system. It is one of the circumventricular organs, enabling the dual role of being a sensor for circulating chemical messengers in the blood, as well as integrating neural inputs in the brainstem.

The consumption of grapes and raisins presents a potential health threat to dogs. Their toxicity to dogs can cause the animal to develop acute kidney injury with anuria. The phenomenon was first identified by the Animal Poison Control Center (APCC), run by the American Society for the Prevention of Cruelty to Animals (ASPCA). Approximately 140 cases were seen by the APCC in the one year from April 2003 to April 2004, with 50 developing symptoms and seven dying.

5-HT<sub>3</sub> antagonist

The 5-HT3 antagonists, informally known as "setrons", are a class of drugs that act as receptor antagonists at the 5-HT3 receptor, a subtype of serotonin receptor found in terminals of the vagus nerve and in certain areas of the brain. With the notable exceptions of alosetron and cilansetron, which are used in the treatment of irritable bowel syndrome, all 5-HT3 antagonists are antiemetics, used in the prevention and treatment of nausea and vomiting. They are particularly effective in controlling the nausea and vomiting produced by cancer chemotherapy and are considered the gold standard for this purpose.

Retching is the reverse movement (retroperistalsis) of the stomach and esophagus without vomiting. It can be caused by bad smell or choking, or by withdrawal from some medications after vomiting stops. Retching can also occur as a result of an emotional response or from stress, which produces the same physical reaction. The function is thought to be mixing gastric contents with intestinal refluxate in order to buffer the former and give it momentum in preparation of vomiting. Treatments include medication and correction of the fluid and electrolyte balance.

Gastroparesis, also called delayed gastric emptying, is a medical disorder consisting of weak muscular contractions (peristalsis) of the stomach, resulting in food and liquid remaining in the stomach for a prolonged period of time. Stomach contents thus exit more slowly into the duodenum of the digestive tract.

Biliary reflux, bile reflux or duodenogastric reflux is a condition that occurs when bile flows upward (refluxes) from the duodenum into the stomach and esophagus.

Stomach disease gastrointestinal system disease that is located in the stomach.

Stomach diseases include gastritis, gastroparesis, diarrhea, Crohn's disease and various cancers.

Nausea medical symptom or condition

Nausea is an unpleasant, diffuse sensation of unease and discomfort, often perceived as an urge to vomit. While not painful, it can be a debilitating symptom if prolonged, and has been described as placing discomfort on the chest, upper abdomen, or back of the throat.

Dazopride chemical compound

Dazopride (AHR-5531) is an antiemetic and gastroprokinetic agent of the benzamide class which was never marketed. It acts as a 5-HT3 receptor antagonist and 5-HT4 receptor agonist. In addition to its gastrointestinal effects, dazopride facilitates learning and memory in mice.

Chemotherapy-induced nausea and vomiting (CINV) is a common side-effect of many cancer treatments. Nausea and vomiting are two of the most feared cancer treatment-related side effects for cancer patients and their families. In 1983, Coates et al. found that patients receiving chemotherapy ranked nausea and vomiting as the first and second most severe side effects, respectively. Up to 20% of patients receiving highly emetogenic agents in this era postponed, or even refused, potentially curative treatments. Since the 1990s, several novel classes of antiemetics have been developed and commercialized, becoming a nearly universal standard in chemotherapy regimens, and helping to better manage these symptoms in a large portion of patients. Efficient mediation of these unpleasant and sometimes crippling symptoms results in increased quality of life for the patient, and better overall health of the patient, and, due to better patient tolerance, more effective treatment cycles.

Cancer and nausea

Cancer and nausea are associated in about fifty percent of people affected by cancer. This may be as a result of the cancer itself, or as an effect of the treatment such as chemotherapy, radiation therapy, or other medication such as opiates used for pain relief. About 70 to 80% of people undergoing chemotherapy experience nausea or vomiting. Nausea and vomiting may also occur in people not receiving treatment, often as a result of the disease involving the gastrointestinal tract, electrolyte imbalance, or as a result of anxiety. Nausea and vomiting may be experienced as the most unpleasant side effects of cytotoxic drugs and may result in patients delaying or refusing further radiotherapy or chemotherapy.

References

  1. Tintinalli, Judith E. (2010). Emergency Medicine: A Comprehensive Study Guide (Emergency Medicine (Tintinalli)). New York: McGraw-Hill Companies. p. 830. ISBN   978-0-07-148480-0.
  2. "New Eating Disorder: No Binge, Just Purge". 20 September 2007.
  3. Holland, James F.; Kufe, Donald W.; Weichselbaum, Ralph R.; Pollock, Raphael E.; Frei III, Emil; Gansler, Ted S.; Bast Jr., Robert C. (2003). Cancer medicine (6. [ed.]. ed.). Hamilton, Ontario [u.a.]: Decker. ISBN   9781550092134.
  4. Hornby, PJ (2001). "Central neurocircuitry associated with emesis". The American Journal of Medicine. 111 Suppl 8A (8): 106S–112S. doi:10.1016/S0002-9343(01)00849-X. PMID   11749934.
  5. Naylor, RJ; Inall, FC (January 1994). "The physiology and pharmacology of postoperative nausea and vomiting". Anaesthesia. 49 Suppl: 2–5. doi:10.1111/j.1365-2044.1994.tb03575.x. PMID   8129158.
  6. Matsuoka, I; Ito, J; Takahashi, H; Sasa, M; Takaori, S (1984). "Experimental vestibular pharmacology: a minireview with special reference to neuroactive substances and antivertigo drugs". Acta Oto-Laryngologica Supplementum. 419: 62–70. PMID   6399658.
  7. Li–gui, Huang; En–tong, Wang; Wei, Chen; Wei–xi, Gong (June 2011). "Role of Histamine H1 Receptors in Vestibular Nucleus in Motion Sickness". Journal of Otology. 6 (1): 20–25. doi:10.1016/S1672-2930(11)50003-0.
  8. Ray Andrew P.; Chebolu Seetha; Ramirez Juan; Darmani Nissar A (2009). "Ablation of Least Shrew Central Neurokinin NK1 Receptors Reduces GR73632-Induced Vomiting". Behavioral Neuroscience. 123 (3): 701–706. doi:10.1037/a0015733. PMC   2714262 . PMID   19485577.
  9. "Symptoms & Causes of Celiac Disease | NIDDK". National Institute of Diabetes and Digestive and Kidney Diseases. June 2016. Archived from the original on 24 April 2017. Retrieved 24 April 2017.
  10. Volta U, Caio G, Karunaratne TB, Alaedini A, De Giorgio R (2017). "Non-coeliac gluten/wheat sensitivity: advances in knowledge and relevant questions". Expert Review of Gastroenterology & Hepatology (Review). 11 (1): 9–18. doi:10.1080/17474124.2017.1260003. PMID   27852116. A lower proportion of NCG/WS patients (from 30% to 50%) complain of upper gastrointestinal tract manifestations, e.g. vomiting, nausea, gastroesophageal reflux disease, aerophagia and aphthous stomatitis. (NCG/WS: Non-coeliac gluten/wheat sensitivity)
  11. Decker, W. J. (1971). "In Quest of Emesis: Fact, Fable, and Fancy". Clinical Toxicology. 4 (3): 383–387. doi:10.3109/15563657108990490. PMID   4151103.
  12. Moder, K. G.; Hurley, D. L. (1991). "Fatal hypernatremia from exogenous salt intake: report of a case and review of the literature". Mayo Clinic Proceedings. 65 (12): 1587–94. doi:10.1016/S0025-6196(12)62194-6. PMID   2255221.
  13. Salt: a natural antidepressant? The Scotsman . April 6, 2009.
  14. Holtzmann NA, Haslam RH (July 1968). "Elevation of serum copper following copper sulfate as an emetic". Pediatrics. 42 (1): 189–93. PMID   4385403.
  15. Wang, S. C.; Borison, Herbert L. (1951). "Copper Sulphate Emesis: A Study of Afferent Pathways from the Gastrointestinal Tract". American Journal of Physiology. 164 (2): 520–526. doi:10.1152/ajplegacy.1951.164.2.520. PMID   14810961.
  16. Olson, Kent C. (2004). Poisoning & drug overdose. New York: Lange Medical Mooks/McGraw-Hill. p. 175. ISBN   978-0-8385-8172-8.
  17. "Drugs to Control or Stimulate Vomiting". Merck Veterinary manual. Merck & Co., Inc. 2006.
  18. "How to Induce Vomiting (Emesis) in Dogs". Petplace.com. Retrieved 2014-05-03.
  19. 9 Best Vomit Scenes On Film, screenjunkies.com
  20. Shanon, B. (2002). The antipodes of the mind: Charting the phenomenology of the ayahuasca experience. Oxford: Oxford University Press.
  21. Andritzky, W. (1989). "Sociopsychotherapeutic functions of ayahuasca healing in Amazonia". Journal of Psychoactive Drugs. 21 (1): 77–89. doi:10.1080/02791072.1989.10472145. PMID   2656954.
  22. University of Salford. January 28, 2007. Archived February 24, 2009, at the Wayback Machine
  23. "Why Is It So Difficult To Chug A Gallon Of Milk?". YouTube . HowStuffWorks.
  24. "vomiting - definition of vomiting in the Medical dictionary - by the Free Online Medical Dictionary, Thesaurus and Encyclopedia". Medical-dictionary.thefreedictionary.com. Retrieved 2014-05-03.
  25. Mark Feldman; Lawrence S. Friedman; Lawrence J. Brandt, eds. (2009). Sleisenger & Fordtran's gastrointestinal and liver disease pathophysiology, diagnosis, management (PDF) (9th ed.). St. Louis, Mo.: MD Consult. p. 783. ISBN   978-1-4160-6189-2.
  26. Mitchelson, F (March 1992). "Pharmacological agents affecting emesis. A review (Part I)". Drugs. 43 (3): 295–315. doi:10.2165/00003495-199243030-00002. PMID   1374316.
  27. 1 2 Furyk, JS; Meek, RA; Egerton-Warburton, D (28 September 2015). "Drugs for the treatment of nausea and vomiting in adults in the emergency department setting". Cochrane Database of Systematic Reviews. 9 (9): CD010106. doi:10.1002/14651858.CD010106.pub2. PMID   26411330.
  28. Helena Britt; Fahridin, S (September 2007). "Presentations of nausea and vomiting" (PDF). Australian Family Physician. 36 (9): 673–784. PMID   17885697.
  29. electricpulp.com. "HERODOTUS iii. DEFINING THE PERSIANS – Encyclopaedia Iranica". www.iranicaonline.org.
  30. "Internet History Sourcebooks". sourcebooks.fordham.edu.
Classification
D