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Vomiting is the forceful retrograde expulsion of gastric contents through the mouth consequent to the coordinated contraction of diaphragm, abdominal, and respiratory muscles. It is associated with a characteristic autonomic response, including pallor, lethargy, hypersalivation, and tachycardia. This differentiates vomiting from regurgitation, which is an effortless involuntary reflux of undigested gastric contents and is not associated with abdominal/diaphragmatic contractions or autonomic responses. Nausea is the subjective unpleasant sensation of impending vomiting that precedes but is not always associated with vomiting. Emesis is a term that can be used to describe any expulsion of gastric contents, and is useful to the physician when describing symptoms that have not yet been fit into the more exact categories of vomiting or regurgitation. Rumination is voluntary reflux of gastric contents within the first hour after eating and is associated with chewing and reswallowing of undigested food. Retching or “dry heaves” is the activated emetic reflux without vomiting, due to vomiting motion against a closed glottis (Table 2–1). Vomiting should also be differentiated from coughing or spitting of mucus from the lungs.

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Table 2–1. Translation of Different Descriptions

Vomiting is a non-specific symptom caused by disorders affecting a wide range of organs. It can represent a mild self-limited illness (gastroenteritis), or occur as the result of severe life-threatening conditions (midgut volvulus). Vomiting is a common complaint among children who visit the pediatrician and the emergency department. Primary etiologies originate from the gastrointestinal tract, and are further divided into emergent disorders such as intussception and non-emergent causes such as viral gastroenteritis. Secondary causes involve etiologies that originate outside the gastrointestinal tract (Figure 2–1). Many of the secondary causes need immediate intervention, including cerebellar tumors, acute hydronephrosis from uretero-pelvic junction (UPJ) obstruction, and adrenal failure. In this chapter, we discuss a practical approach to a child who presents with vomiting.


Understanding the different neuroendocrine pathways and the neurotransmitters that mediate vomiting is useful in understanding the treatment of this symptom. Stimulation of the brain stem vomiting center is the final common result of many possible initiating events. ...

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