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Pathophysiology of Vomiting

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Vomiting is a complex physiological response to expel harmful or irritating substances from the body. It's a defensive mechanism triggered by stimuli like poisons, microbial toxins, cytotoxic drugs, and mechanical abdominal distension. The process is centrally coordinated by the vomiting (or emetic) center located in the medulla of the brainstem. This area, rich in muscarinic M1, histamine H1, neurokinin 1 (NK1), and serotonin 5-HT3 receptors, coordinates the act of vomiting through...

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5-HT3 receptor antagonists, such as dolasetron, granisetron (Kytril), ondansetron (Zofran), and palonosetron (Axoli), are crucial in managing chemotherapy-induced nausea and vomiting (CINV) and postoperative nausea. These drugs selectively block 5-HT3 receptors in the visceral vagal and spinal afferent nerves, chemoreceptor trigger zone, and the vomiting center. They have a rapid onset of action and can be given as a single dose before chemotherapy. Ondansetron and granisetron, in particular,...

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Neurokinin 1 (NK1) receptors are distributed across the GI tract, vagal afferents, and key CNS regions including the central vomiting center and chemoreceptor trigger zone (CTZ) Chemotherapy agents stimulate enterochromaffin cells in the gastrointestinal (GI) tract to release large amounts of substance P (SP). SP is a neuropeptide released by specific sensory nerves in response to many different stressors, including those in the GI mucosa affected by chemotherapy. SP binds and activates...

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Dopamine receptor antagonists, also known as antipsychotic agents, are critical in managing chemotherapy-induced vomiting. These antiemetic agents block dopamine receptors in the chemoreceptor trigger zone (CTZ), inhibiting signal transmission to the vomiting center. Antipsychotic agents encompass phenothiazines (PTZ), butyrophenones, benzamides, and thienobenzodiazepines (Zyprexa), which are utilized for their antiemetic and sedative properties.
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Equilibrium and Balance

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The inner ear assumes dual functionalities of auditory perception and equilibrium maintenance. The vestibule is the organ responsible for balance. This organ contains mechanoreceptors, specifically hair cells, endowed with stereocilia, which aid in deciphering information regarding the position and motion of our heads. Two intrinsic components, the utricle and saccule, help perceive head position, while the semicircular canals track head movement. Neurological messages initiated in the...

Chemotherapy-Induced Nausea and Vomiting: Cannabinoids

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Tetrahydrocannabinol (THC) is a phytocannabinoid that primarily interacts with the CB1 receptor, a type of G protein-coupled receptor (GPCR) predominantly in and around the chemoreceptor trigger zone (CTZ) and emetic center. THC also blocks the serotonin receptor activity in the dorsal vagal complex (DVC) by inhibiting serotonin release. THC exerts its anti-emetic effects through these interactions, which are beneficial for patients undergoing chemotherapy.
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A Practical 5-Step Approach to Nausea and Vomiting.

June Tome¹, Amrit K Kamboj², Seth Sweetser²

¹Department of Internal Medicine, Mayo Clinic, Rochester, MN.

Mayo Clinic Proceedings

|March 5, 2022

Summary

Nausea and vomiting (N/V) are common and challenging symptoms. This review offers a practical 5-step approach for evaluating and treating N/V, aiding clinicians in diagnosis and management.

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Area of Science:

Gastroenterology
Clinical Medicine
Pharmacology

Background:

Nausea and vomiting (N/V) are prevalent symptoms impacting patient quality of life.
The clinical management of N/V is complex due to diverse causes and treatment options.

Purpose of the Study:

To present a practical 5-step clinical approach for the evaluation and treatment of nausea and vomiting.
To guide primary care and subspecialty clinicians in managing N/V.

Main Methods:

A concise review outlining a 5-step strategy for N/V assessment.
Discussion of pathophysiology, differential diagnoses, and treatment based on emetic pathways.

Main Results:

The 5-step approach includes defining symptoms, determining chronicity, considering toxins, differential diagnosis, and targeted treatment.
Acute or mild N/V may be managed empirically, while chronic or severe cases require thorough investigation.

Conclusions:

A structured approach simplifies N/V evaluation and treatment.
Understanding neurotransmitters and receptors is key to effective N/V management.