A Family Doctor's Tale - VOMITING

DOC I AM VOMITING

Vomiting and nausea are common symptoms seen by the family doctor.

Vomiting has been described as forceful emptying of food and liquids in the stomach out through the mouth.

Nausea  on the other hand is a feeling that the patient feels like he wants to vomit.

There are many causes of vomiting:
1.acute gastritis

2.acute food poisoning

3.giddiness

4.motion sickness or labyrinthitis,

5.Migraine

6.Pregnancy especially in the first 3 months

7.Noxious stimulus like certain smells

8.Heat stroke or dehydration

Most vomiting are minor and disappear after a major vomit.

However, vomiting can also point to more serious disorders.
These include:

1.Liver and gall bladder disease
Liver and gall bladder disease is often accompanied by nausea and vomiting.
Pancreatitis is another disease which can cause nausea and vomiting

2.People with Diabetes

3.Intestinal obstruction

4.Infection of the brain and meninges

5.Eating disorders like bulimia

6.Cancer and anticancer drugs and radiation therapy

When the family doctor see a case of nausea or vomiting, he will ask for

1.duration of vomiting - to determine if whether if it is till happening or has stopped.

2.If the vomiting has stopped then he will try to determine the cause eg gastroenteritis

3.If it still persist, then he will want to find out whether th patient can swallow the anti emetic medicines that I will giving the patient

4.If the patient cannot hold  the medicines after swallowing, the patient may need an injection to stop the vomiting or an anti emetic suppository in a child who is scared of injections.

5. If the injection still do not stop the vomiting the patient may need to be referred to the hospital to exclude some condition more serious like liver disease and intestinal obstruction

The family doctor will examine for any possible cause of the vomiting:

1.An abdominal examination will exclude conditions such as intestinal obstruction, liver problem or acute gastritis

2.Blood pressure taken when lying down and again after rapidly arising to standing position. Very High blood pressure may cause giddiness and associated vomiting
Low blood pressure or postural drop in blood pressure may also cause giddiness and associated vomiting

3.A blood sugar test will also exclude low blood sugar or diabetic ketosis with associated vomiting.

4.Complete nervous system examination should be performed including visual acuity, inspecting for nystagmus, cranial nerve and cerebellar signs.

5.dehydration after vomiting may require rehydration

Treatment of vomiting depends on whether the symptom indicates a more serious condition.
Most cases of nausea and vomiting are mild and self-treatable disorders.

1.Medications given usually act to stop the vomiting and nausea
Other than medicines, the following may relieve some of your discomfort:
2.Medicines to reduce abdominal discomfort and gas

3.rehydration of dehydrated patient with isotonic drinks and rehydration salts

4.Avoid full strength liquid or food. Always start with small amount of food so the stomach is not over bloated.

5.Avoid stress or anxiety which may aggravate the nausea sensation and vomiting

6.Treating balance disorders and motion sickness.

If The vomiting do not stop the best treatment is to admit to hospital for intravenous nutrition and medication. 
The cause can also be determined and treated.

All Patients who cannot control their vomiting should always carry a plastic bag with them to prevent them from vomiting in the taxis, cars, public transport or in public places.