Psychogenic vomiting

Vomiting associated with emotional distress and anxiety.

(http://www.medilexicon.com/medicaldictionary.php?t=99424)
Cases
!. "motional #tress
2. #rreptitios Vomiting
$. Cyclic Vomiting in Children
#ymptoms
!. %rotracted history o& Vomiting
2. Vomiting occrs with meals or shortly therea&ter
#igns
!. 'ppearance o& ade(ate ntrition
2. )o weight loss &rom *aseline
'ssociated Conditions
!. +a,or -epression
2. 'nxiety -isorder
(http://www.&pnote*oo..com//0/%sych/%sychgncVmtng.htm)
Postoperative nausea and vomiting
1he term acute postoperati2e nasea and 2omiting is de&ined

as any episode o& nasea or
2omiting that occrs within 24 hors

o& recei2ing anesthesia. 'lthogh signi&icant
progress has *een

made in pre2enting this type o& nasea and 2omiting3 it still

occrs in
245 to $45 o& patients a&ter srgery.
Mechanism
0n postoperati2e nasea and 2omiting3 a wide range o& stimli

contri*te to the emetic
response. +ost anesthetic agents and

opioids stimlate the 2omiting center indirectly
throgh the

C16. 'ssociated &actors that directly stimlate the 2omiting

center inclde
sensory inpt (2isal3 ol&actory3 and pain) and

the 2esti*lar apparats. )itros oxide
directly stimlates

the gastrointestinal tract3 which acti2ates the 2omiting center.
Causes
Preoperative Factors.
1he occrrence o& postoperati2e nasea and 2omiting is in&lenced

*y se2eral &actors1he
ris. is higher in adlts than

in children3 in women than in men3 and in patients with a
history

o& motion sic.ness or pre2ios postoperati2e nasea and 2omiting
Postoperative Factors.
-ring the postoperati2e period3 the 2 most common cases o&

nasea and 2omiting are
nrelie2ed pain (especially 2isceral

or pel2ic) and the opioids prescri*ed to control the
pain.
http://ccn.aacn,ornals.org/cgi/content/&ll/2$/!/$!
Cyclic vomiting syndrome (7# "nglish) or cyclical vomiting syndrome (78 "nglish)
(CVS) is a condition whose symptoms are recrring attac.s o& intense nasea3 2omoting
and sometimes a*dominal pain and/or headaches or migraines. CV# can a&&ect *oth
children and adlts. 0t was &irst descri*ed in the !9th centry with one o& the earliest
re&erences *eing that o& #amel /ee in !992. :nset o& the condition is possi*le at any age
*t is seen to occr more o&ten in a yong age. ;hy anyone de2elops it is not clear since
it is o& n.nown etiology. 1here is a strong sggestion o& maternal inheritance. %ersons
who s&&er &rom migraines in some cases also ha2e Cyclic Vomiting #yndrome.
Background
CV# di&&ers &rom other &orms o& 2omiting as it is an acte condition. #&&erers may 2omit
or retch six to twel2e times an hor and an episode may last &rom a &ew hors to well
o2er 2 or $ wee.s. #ome people &ind it hard to concei2e how anyone can 2omit a&ter that
length o& time3 as the stomach will ha2e emptied a&ter the &irst &ew emeses. 'cid3 *ile and
(i& the 2omiting is se2ere) *lood may *e 2omited. #ome s&&erers will intentionally ingest
water to redce the irritation o& *ile and acid on the esophags dring emeses. <etween
episodes the s&&erer is sally otherwise normal and healthy. 1he median dration o& an
episode is 4! hors (=i > ?leisher !999). 0n approximately hal& o& s&&erers the attac.s3
or episodes3 occr in a time related manner. "ach attac. is stereotypical3 i.e. in any gi2en
indi2idal their timing3 &re(ency and se2erity o& attac.s is similar.
"pisodes may happen e2ery &ew days or e2ery &ew months. ?or some there is not a
pattern in time that can *e recogni@ed. #ome s&&erers ha2e a warning o& an attac.3 they
may experience a prodrome3 sally intense nasea and pallor. 1he ma,ority o& s&&erers3
*t not all can identi&y AtriggersA that may precipitate an attac..
1he most common are 2arios &oods3 in&ections (sch as colds)3 extreme physical
exertion3 lac. o& sleep3 and psychological stresses *oth positi2e and negati2e.
-ring an attac. a s&&erer may *e light sensiti2e (photopho*ic)3 sond sensiti2e
(phonopho*ic) and may ta.e on a semiBconscios state (=indley > 'ndrews3 C %ediatric
/astorenterol > )tr 244D)
Diagnostic criteria
1he case o& CV# has not *een determined3 there are no diagnostic tests &or CV#.
#e2eral other medical conditions can mimic the same symptoms3 and it is important to
rle these ot. 0& all other possi*le cases ha2e *een exclded a diagnosis o& CV# may *e
appropriate.
1here are esta*lished criteria to aid diagnosis o& CV#3 essential criteria are
!. ' history o& three or more periods o& intense3 acte nasea3 and nremitting
2omiting lasting hors to days
2. 0nter2ening symptomB&ree inter2als3 lasting wee.s to months
$. "xclsion o& meta*olic3 gastrointestinal or central ner2os system strctral or
*iochemical disease e.g. indi2idals with speci&ic physical cases (e.g. intestinal
malrotation)
Treatment
1here is no set cre &or Cyclic Vomiting #yndrome3 *t there are medications that can *e
sed to treat3 inter2ene in3 and pre2ent attac.s. 1here is a growing *ody o& p*lications
on either indi2idal cases or experiences o& cohorts o& CV# patients. 1reatment is sally
on an indi2idal *asis3 *ased on trial and error.
1he most common therapetic strategies &or those already in an attac. are maintenance o&
salt *alance *y appropriate intra2enos &lids andE in some cases3 sedation. Fa2ing
2omited &or a long period prior to attending a hospital3 patients are typically se2erely
dehydrated and s&&er &rom massi2e 2olme depletion. '*orti2e therapy has limited
sccess3 *t &or a nm*er o& patients potent antiBemetic drgs sch as ondansetron
(6o&ran) or granisetron (8ytril)3 drona*inol (+arinol)3 and more recently
dextromethorphan (Coricidin) may *e help&l in either pre2enting an attac.3 a*orting an
attac. or redcing the se2erity o& an attac..
http://en.wi.ipedia.org/wi.i/CyclicG2omitingGsyndrome