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NAUSEA & VOMITING
One of the most frequent and most definite symptoms of stomach disorder, nausea may be described as a feeling of sickness or a tendency to vomit. It is therefore, closely related to vomiting (q.v.), and practically any of the cause giving rise to the latter, except brain disease and the onset of acute fevers, may also cause nausea. Its relation to the special senses is shown by its occurrence in response to foul odours or to disgusting tastes or sights. In terms of a surgical history of disease, inappetance is the first stage of nausea, for example in timing the onset of appendicitis (q.v.). Since acute appendicitis can rapidly develop into abdominal sepsis within 24-48 hours, the surgeon considers the time when the patient lost appetite as the onset of the inflammation or infection of the appendix.
The digestive system is influenced by two scts of nerves, the sympathetic and the vagus; and their relationship and equilibrium may be disturbed by mental and emotional strain diseases of the stomacb and intestines, and diseases of the heart, kidneys, gall bladder, brain or glands of internal secretion. Nausea may be constant or periodic and is often quite independcnt of the kind of food taken. Save in the exceptional cases referred to above a feeling of sickness at intervals usually precedes vomiting, and also occurs during the process of gastric digestion in several nervous disorders of the stomach, in inflammatory affections of the mucous membrane, in cancer of the stomach, in appendicitis, in hangover, and in infection of the intestine with worms. In most of these conditions it may on ocoasion be the only symptom complained of, but when this is so the nausea may be of nervous origin.
 
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Nausea and vomiting frequently accompany the severe headache which is associated with migraine; indeed, any disturbance of nervous cquilibrium may give rise to the symptom, and hence neurasthenia, eye strain from defects of vision, and even certain forms of pelvic trouble, especially of the ovaries may cause a variable degree of nausea which is often wrongly attributed to indigestion.
Persistent nausea is frequently met with in alcoholic and other forms of toxic neuritis, and in the condition known as gastroptosis (q.v.). The irritation in the posterior wall of the pharynx, caused by chronic inflammation with lymphoid outgrowths and dilated veins, is a not uncommon cause of nausea, particularly in the mornings. Chronic rhinitis, also, when accompanied by a thick, sticky discharge, or when, from infection of the sinuses, there is a constant discharge of pus into the tliroat, may induce a proneness to nausea. In these circumstances the patient frequently has to clear the throat by hawking, and may carry on this process until he feels sick; if he clears the nose by blowing it the feeling of nausea will often pass off.
Treatment of Persistent Nausea as an intermittent symptom the nausea usually passes off as soon as vomiting has occurred, but the persistent forms are sometimes very difficult to treat. The administration of aperients, combined with alkalies like baking soda, is sometimes of service, another useful combination. Herbal teas like peppermint or chamomile are sometimes of service also.
Gastroptosis requires the use of a firm elastic belt to support the abdomen. In the nausea connected with ovarian irritation a free purge and the application of a blister or mustard leaf over the abdomen will be useful. Eye strain will be relieved by the wearing of appropriate glasses.
The special forms of nausea and vomiting associated with pregnancy and with seasickness are discussed under the headings Morning Sickness and Sea-sickness.
VOMITING
Vomiting implies the return and expulsion from the mouth of part or the whole of the stomach contents. The term does not apply to those cases in which, owing to some obstruction in the oesophagus, food is regurgitated soon after it is swallowed or where the act of swallowing is interfered with owing to nervous or other causes. regurgitation of food in infants due to overfilling of the stomach or the swallowing of air is also not true vomiting.
The act of vomiting is brought about in the following manner. The walls of the stomach contract, the diaphragm is pushed downward and the abdominal muscles contract strongly. At the same time the cardiac orifice of the stomach relaxes and the contents of the stomach are expelled owing to the pressure of the abdominal muscles aided to some extent by reversed peristalsis in the stomach wall.
There is a vomiting nerve centre in the brain, and this may be excited to action by influences reaching it from the stomach itself through the vagus nerve or from other parts of the body by different channels. The centre may also be stimulated by poisons acting on it directly. Examples of such poisons are certain drugs such as apomorphine, tobacco and various anaesthetics and the toxins produced in kidney disease, pregnancy and in the cyclical vomiting of children.
Reflex vomiting, i.e. vomiting due to stimuli of various kinds and origins, includes pharyngeal and gastric causes, intestinal, peritoneal and general visceral causes, and disorders of the central nervous system.
Among pharyngeal or gastric causes vomiting may be due to irritation set up in the throat or to irritating particles of food, emetics or poisons. Gastritis, whether acute or chronic, dilatation of the stomach as in the pyloric obstruction of infants, and cancer of the stomach are all associated with persistent vomiting.
Inflammation, spasm or obstruction taking place in any of the hollow organs within the abdomen is a common cause of reflex vomiting, which is often a prominent symptom therefore in such conditions as appendicitis, intestinal obstruction and renal or gall-stone colic. Vomiting in pregnancy and shock are other examples.
Finally there is vomiting due to nervous disorder usually in the higher centres of the brain. Concussion of the brain, inflammation of the brain or of its membranes, tumours of the brain may all give rise to vomiting due apart from any stomachic disorder. More common causes of this latter kind of vomiting are sea-sichness (q.v.), migraine, and the sickness that in some persons is caused by disagreeable sights and smells. There is, in this connexion, an hysterical type of vomiting set up easily by emotional disturbance or as a defence mechanism.
Treatment
The treatment of vomiting, will of course, depend on the cause of the trouble. Reflex vomiting calls for the removal of the irritating factor wherever possible. The act itself is nature's effort to remove the cause where this is in the stomach itself, where it is due to some poison circulating in the blood and acting on the vomiting centre, the condition giving rise to the poisoned condition must be dealt with. Surgical measures will often be indicated where the sickness is a symptom of abdominal disease, e.g. appendicitis or gall stones.
Relief can often be given in the more simple cases by the use of gastric or nervous sedatives. Bismuth and alkalies with a few drops of dilute hydrocanic acid will soothe an irritated stomach in gastritis, but washing out the stomach will usually be more successful with baking soda. 1 Drop doses of tincture of iodine in water will many times help and, where the cause is largely nervous, bromides in an effervescing mixture, or chloretone are useful. The application of a mustard leaf or an ice bag over the stomach is worth trying.
Vomited matter should in all cases of doubt be kept for the doctor's inspection. This will often throw much light on the cause of the trouble. Thus the presence of a poison, or of blood or faecal matter, the presence of undigested food material or bile will all be useful indications.
RETCHING
Also termed vomituration, retching is a strong, involuntary and ineffectual effort to vomit. There is a forcible contraction of the stomach walls, the diaphragm is pushed violently downwards, and the abdominal muscles also contract strongly, just as in vomiting, but the sphincter which surrounds the gullet where it opens into the stomach does not relax, and consequently the contents of the stomach are not expelled into the mouth, v,hich constitutes vomiting.
The causes of retching fall into two principal groups: those in which the vomiting centre in the brain is directly stimulated, as in the case of certain poisons, in pregnancy, diabetes, cte.; and the much larger group in which the centre is reflexly affected, as in most diseases of the stomach and the intestines, and in affections of the central nervous system.
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