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SOURCE

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Source: Gravatt LAH, Donohoe KL, DiPiro CV. Nausea and vomiting. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach. 10th ed. New York, NY: McGraw-Hill; 2017. http://accesspharmacy.mhmedical.com/content.aspx?bookid=1861&sectionid=146059308. Accessed March 25, 2017.

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DEFINITION

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  • Nausea: inclination to vomit; feeling in throat or epigastric region alerting individual that vomiting imminent.

  • Vomiting: ejection or expulsion of gastric contents through mouth, often requiring forceful event.

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ETIOLOGY

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  • Specific etiologies associated with nausea and vomiting presented in Table 1.

  • Chemotherapeutic agents.

  • Nonchemotherapeutic cancer-related causes.

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Table Graphic Jump Location
TABLE 1.Specific Etiologies of Nausea and Vomiting
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PATHOPHYSIOLOGY

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  • Three consecutive phases of emesis:

    • Nausea.

    • Retching.

    • Vomiting.

  • Vomiting triggered by afferent impulses to vomiting center from:

    • Sensory centers.

      • Chemoreceptor trigger zone (CTZ)

      • Cerebral cortex.

    • Visceral afferents.

      • Pharynx.

      • Gastrointestinal (GI) tract.

  • Vomiting center sends efferent impulses to:

    • Salivation center.

    • Respiratory center.

    • Pharyngeal, GI, and abdominal muscles.

  • Neurotransmitter receptors in vomiting center, CTZ, and GI tract.

    • Cholinergic.

    • Histaminic.

    • Dopaminergic.

    • Opiate.

    • Serotonin.

    • Neurokinin.

    • Benzodiazepine.

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CLINICAL PRESENTATION

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SIGNS AND SYMPTOMS
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  • Mild to severe distress (Table 2)

  • Queasiness.

  • Discomfort.

  • Weight loss.

  • Abdominal pain.

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Table Graphic Jump Location
TABLE 2.Presentation of Nausea and Vomiting

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