pathogenesis of vomiting

Vomiting: Pathogenesis
Authors: Julena Foglia Reviewers: Varun Suresh Matthew Harding Haotian Wang *Yan Yu *Eldon Shaffer *MD at time of publication
Trauma, Infection, Tumor, Stroke
↑ Intracranial pressure
Mechanism Unknown
Irritation of GI mucosa: Inflammation, Distention, Chemotherapy, Radiation
Activates receptors in gut mucosa
GI Disease: Upper: GERD, PUD, Cancer Lower: Ischemia, obstruction, IBD
Mechanical pharyngeal stimulation
Signal travels via vagal and sympathetic afferent nerves
Pregnancy, Diabetes, Uremia,
Thyroid disease, Hypercalcemia
Pain, Smells, Foul Sights, Memories
Sensory inputs to cortical region
Cerebral Cortex
Vomiting (Emetic) Center
Toxins circulating in bloodstream: Chemotherapy, Opioids
Offending substance travels through circulation and binds to receptors in the CTZ, outside the blood brain barrier
GERD: Gastroesophageal Reflux Disease PUD: Peptic Ulcer Disease
IBD: Inflammatory Bowel Disease
CTZ: Chemoreceptor Trigger Zone
CNX: Cranial Nerve Ten
H1: Histamine Receptor
M1: Muscarinic Receptor
Disrupted inner ear balance: Motion Sickness
Activation of H1 & M1 receptors in vestibular center traveling via Cerebellum
Stimulates Solitary Tract Nucleus (Medulla)
Vagus Nerve (CNX) and enteric nervous system activation, resulting in:
Gastric relaxation, ↓ pylorus tone, retrograde duodenal peristalsis
Downward diaphragm contraction, abdominal & chest wall muscles contract: ↑ intra-gastric pressure
(Forceful expulsion of material from stomach and intestines)
Upper and lower esophageal sphincter relaxation and glottis closure
Sign/Symptom/Lab Finding
Re-published February 16, 2020 on www.thecalgaryguide.com