Clear bile vomit11/23/2023 ![]() ![]() The chemoreceptor trigger zone at the base of the fourth ventricle has numerous dopamine D 2 receptors, serotonin 5-HT 3 receptors, opioid receptors, acetylcholine receptors, and receptors for substance P.There are various sources of input to the vomiting center: 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. 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. Digestive enzymes can also have a negative effect on oral health, by degrading the tissue of the gums. Recurrent vomiting, such as observed in bulimia nervosa, may lead to the destruction of the tooth enamel due to the acidity of the vomit. This may become apparent if fresh red blood is mixed with vomit after several episodes. Repeated or profuse vomiting may cause erosions to the esophagus or small tears in the esophageal mucosa ( Mallory–Weiss tear). A less frequent occurrence results from a vomiting of intestinal contents, including bile acids and HCO − With the loss of intake of food the individual may eventually become cachectic. The hypokalemia is an indirect result of the kidney compensating for the loss of acid. ![]() Combined with the resulting alkaline tide, this leads to hypochloremic metabolic alkalosis (low chloride levels together with high HCO −Ģ and increased blood pH) and often hypokalemia ( potassium depletion). Gastric vomiting leads to the loss of acid (protons) and chloride directly. Prolonged and excessive vomiting depletes the body of water ( dehydration), and may alter the electrolyte status. The individual may choke and asphyxiate or develop aspiration pneumonia. Under normal circumstances the gag reflex and coughing prevent this from occurring however, these protective reflexes are compromised in persons who are under the influence of certain substances (including alcohol) or even mildly anesthetized. Vomiting is dangerous if gastric content enters the respiratory tract. Self-induced vomiting can be a component of an eating disorder such as bulimia, and is itself now classified as an eating disorder on its own, purging disorder. Antiemetics are sometimes necessary to suppress nausea and vomiting. In severe cases, where dehydration develops, intravenous fluid may be required. Impairment due to alcohol or anesthesia can cause inhalation of vomit. The feeling that one is about to vomit is called nausea it often precedes, but does not always lead to vomiting. Vomiting can be the result of ailments like food poisoning, gastroenteritis, pregnancy, motion sickness, or hangover or it can be an after effect of diseases such as brain tumors, elevated intracranial pressure, or overexposure to ionizing radiation. Vomiting (also known as emesis and throwing up) is the involuntary, forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose. History of migraine, history of PONV or motion sickness in a child's parent or sibling, better ASA physical status, intense preoperative anxiety, certain ethnicities or surgery types, decreased perioperative fluids, crystalloid versus colloid administration ![]() Emesis, puking, barfing, heaving, throwing up, hurlingġ4th-century illustration of vomiting from the Casanatense Tacuinum SanitatisĪspiration, electrolyte and water loss, damage to the enamel of the teeth, tear of the esophageal mucosa ![]()
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