Projectile Vomiting

What is Projectile Vomiting?

Projectile vomiting is a sudden and temporary illness that happens when the digestive system of our body decides that it must immediately get rid of the stomach nutrients. The projectile vomit is not only unexpected and uncontrollable, it is also quite uncomfortable. When the body does not have time to predict its need to vomit, it can lead to strong vomiting and, due to extreme force, the contents of the stomach is projected out. Nausea is the strong need to vomit.

Projectile vomiting is the violent expulsion of the stomach contents through the mouth. Vomiting is usually a protective mechanism to eject some ingested harmful substance, but it can also occur due to several other infectious or inflammatory body conditions not related to this kind of intake. The muscles of the abdominal wall contract tightly to create the pressure needed to vomit. Arcades do not always lead to vomiting, but it may be preceded or followed by vomiting. Nausea may happen without or prior to vomiting.

Main Causes of Projectile Vomiting

Causes of Projectile Vomiting

After thorough clinical history and physical examination, the doctor can usually determine the cause of the projectile vomiting. For a correct diagnosis and treatment, it is necessary to know what preceded the onset of vomiting, in addition to the following symptoms:

• Sudden onset of fever, body aches, colds, coughs and diarrhea may indicate an infection, usually a virus, although sometimes it may also be bacterial.
• If the symptoms appear after receiving anesthesia or chemotherapy, the cause may be medication. Similarly, a person can also experience projectile vomiting after consuming drugs such as marijuana, cocaine or alcohol.
• Vomiting early in the morning is usually something that occurs during pregnancy, but it may also happen in case of kidney failure.
• Projectile vomiting occurring several hours after a meal may indicate a stomach or intestinal obstruction.
• Abdominal pain followed by projectile vomiting may suggest abdominal inflammation, such as pancreatitis or bowel obstruction.
• Projectile vomiting can be linked to increased pressure within the brain, such as meningitis or tumors.
• Vomiting just after eating may indicate a stomach obstruction, although it could also be related to psychiatric disorders such as anorexia or bulimia.
• Chronic projectile vomiting may be due to a hormonal disorder (diabetes, pregnancy).
• Cyclic vomiting syndrome is characterized by intense vomiting that lasts from a few hours to a few days, with prolonged periods in which no symptoms appear.
• The result of long-term projectile vomiting could be weight loss, bad nutrition and dehydration, since the situation could be related to a minor or inadequate intake of nutrients.

In Adults

Several common problems can cause projectile vomiting in adults, such as:

Allergies to food, gastric or intestinal infections, gastroesophageal reflux, treatments such as radiation therapy or chemotherapy for cancer, migraines, pregnancy nausea, dizziness or motion sickness, intense pain such as caused by kidney stones.

In Children

The most common cause of projectile vomiting in children is viral infection called gastroenteritis (“stomach virus”). The infection aggravates the digestive system. Children who suffer from vomiting due to gastroenteritis may also have diarrhea. Other causes of projectile vomiting in children include headaches or head injuries, urinary tract infections, obstructions in the intestinal tract, coughing episodes, food allergies, and food poisoning.

Summarizing, the common causes of projectile vomiting are:

• Medication – Vomiting may be the result of some medication. Some drugs, such as chemotherapy for cancer, and anesthetic substances, are especially known to lead nausea and vomiting.
• Infections inside the gastrointestinal tract, which can be derived from viruses or bacteria, including gallbladder infections (cholecystitis), appendicitis, viral hepatitis and diverticulitis.
• Infections outside the gastrointestinal tract, such as pneumonia, kidney infections, meningitis and ear infections.
• Motion disease
• Pregnancy
• Bacterial contaminants in food we intake
• Heart attack that can sometimes manifest as nausea and vomiting
• Migraine
• Alcoholism
• Slow intestinal transit, such as gastroparesis (delayed stomach emptying), ileus or pseudo-obstruction
• Psychiatric disorders, such as anxiety, anorexia and bulimia
• Cyclic vomiting syndrome
• Hormonal disorders, such as diabetes, hyperactivity of the thyroid (hyperthyroidism) and little activity of the adrenal glands (Addison’s disease)
• Brain disorders, including brain tumors, convulsions, brain trauma and multiple sclerosis
• Renal insufficiency.

Treatment

The causes of projectile vomiting are usually determined by a detailed clinical history and physical examination. Several clinical examinations are performed only when the origin is indeterminate. Sometimes, tests are also done to determine if vomiting leads to harmful consequences. When the projectile vomiting is due to a minor illness, or a short-term health problem, the doctor can determine if it is necessary to hospitalize the patient, to do more outpatient exams, and to assess the utility of the medications. The hospitalization is more common among the elderly and children, because both are rapidly dehydrated. If, in addition to vomiting, there is diarrhea or dehydration, it may be necessary to dispense fluids intravenously and, for this, it is necessary go to the medical clinic. Finally, even though projectile vomiting does not seem particularly severe, symptoms do not improve after several days, it may be necessary to get the patient to the hospital for further tests and other treatments.

It is advisable to evaluate projectile vomiting with a three-step approach. The first step is to evaluate and treat the harmful consequences of vomiting, such as dehydration or altered levels of blood chemicals (electrolyte imbalance). Then, the origin of vomiting should be investigated. Finally, if it is not possible to determine the cause, therapy will be introduced in order to improve the symptoms.

The treatment of projectile vomiting depends on the cause, but there are general measures that serve for all patients suffering from it:

Correction of fluid and electrolyte imbalance

Loss of body fluids leads to dehydration and alteration of levels of blood minerals. Fluids are usually replaced with intravenous saline containing potassium. When blood levels are low, it may be necessary to add potassium and sometimes magnesium to intravenous fluids.

Nutritional support

At the beginning, patients should not eat solid foods, it may even be necessary to suspend all food and drink. When the patients return to eat, they will first ingest fluids and soft feed. In cases of obstruction or chronic symptoms, do not feed the patients orally, using supportive fluids. A nasoenteral catheter can be placed through the nose into the small intestine to deliver food liquids directly into the intestine. The food probe may also be placed through the abdominal wall, in the stomach (percutaneous endoscopic gastrostomy), or in the intestines (percutaneous endoscopic jejunostomy). Another alternative is to place a venous catheter in one of the arm veins, infusing a prepared solution containing basic nutrients and vitamins directly into the bloodstream.

Therapy to mitigate symptoms

Medications to alleviate vomiting may be given to avoid these symptoms. There are several types of medications available, such as phenothiazines, 5-HT 3 receptor antagonists, dopamine receptor antagonists, antihistamines, and anticholinergics. Other substances that could be used for chronic projectile vomiting include benzodiazepines and tricyclic antidepressants. In patients suffering from prolonged vomiting, medications may be required to reduce acid production, thus protecting the esophagus from the acidic content of vomiting.

Dealing with Projectile Vomiting

There are not many treatment opportunities for projectile vomiting. It happens so suddenly, there is no real warning, our body doesn’t have chance to anticipate it. However, getting rid of several foods from the diet can help. Foods with spices, chocolate and caffeine are examples of some probable risks. Food allergies may also lead to projectile vomiting. It is possible to avoid sporadic projectile vomiting (known cause), through medicines that are taken just before the administration of the medication that cause such vomiting. Symptoms that result from medications and toxins are improved when the drug or toxin is discontinued. Pregnant woman’s motion sickness usually resolves as pregnancy progresses, or with childbirth. Projectile vomiting due to chronic disorders, such as functional problems, psychiatric and endocrine disorders, or  even cancer, may be difficult to manage, and chronically medications may be needed to control projectile vomiting. When vomiting is linked to infections or inflammations, the symptoms usually resolve completely when treating the primary condition.

Should I be worried falling off?

Since projectile vomiting help to eject damaging substances, this disorder may specify poisoning. When a person has drug overdose, for example, projectile vomiting may occur. In addition to drug overdose, explosive vomiting may also be sign of serious health problem, such as concussion, ulcer, flu etc. Recurrent projectile vomiting in young children can lead to lack of moisture and dehydration. It critical to visit to the medicine professional in order to know the origin of projectile vomiting, especially if the state lasts longer than one day, or continues after the stomach has completely emptied.