What are the Causes of Nausea and Vomiting?

Nausea and vomiting are caused by various conditions such as causes that are within or outside the gut, drugs and toxins etc. Causes of nausea and vomiting can be broadly categorized under three heading namely:

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  1. Intra-peritoneal causes (stimulus for vomiting originates in peritoneal area)
  2. Extra-peritoneal (stimulus for vomiting originates in peritoneal area)
  3. Medications/toxins/metabolic disorders.

Intra-peritoneal causes:

Inflammation of viscera and obstruction of hollow organs such as intestine, stomach can produce vomiting as the main symptom. Obstruction of intestine (small as well as large intestine) may occur due to tumors (benign and malignant), intussusception, adhesion, inflammatory diseases (e.g. Crohn’s disease) and gastric obstruction may be due to tumors and ulcer. Inflammation of various abdominal organs such as pancreas, liver, appendix etc. may cause vomiting. Infection of intestine by bacteria or virus also produces vomiting.

Intra-peritoneal causes of vomiting are:

  • Obstructive disorders such as obstruction of pyloric part of stomach, small intestine obstruction, colon obstruction, Superior mesenteric artery syndrome etc.
  • Infection by virus ((cytomegalovirus or herpes simplex virus, especially among immunocompromised individuals)) or bacteria (Staphylococcus aureus, Bacillus cereus etc.).
  • Inflammatory diseases such as cholecystitis (inflammation/infection of gall bladder) pancreatitis, appendicitis, hepatitis etc.
  • Billiary colic and radiotherapy in abdomen.
  • Altered sensorimotor function such as gastroparesis, GERD, pseudoobstruction of intestine, functional dyspepsia, functional vomiting, cyclic vomiting syndrome etc.

Extra-peritoneal causes:

Vomiting may be caused by various extra-peritoneal causes. Surgery, myocardial infarction, congestive heart failure, large abdominal tumors (put pressure in abdomen), psychiatric illnesses such as anorexia nervosa, bulimia nervosa, anxiety and depression may cause vomiting.

Extra-peritoneal causes of vomiting include:

  • Postoperative vomiting (25% of patients experience postoperative vomiting).
  • Cardiac diseases such as MI (myocardial infarction), CHF (congestive heart failure).
  • Disorders of labyrinth such as inflammation of labyrinth, motion sickness, tumors.
  • Psychiatric illnesses such as anorexia nervosa, bulimia nervosa, anxiety and depression.
  • Cerebral disorders such as hemorrhage, abscess, malignancy, hydrocephalus etc.

Medications/toxins/metabolic disorders that lead to vomiting are:

  • Drugs such as anticancer drugs (e.g. cisplatin, 5-FU, methotraxate, daunorubicin, azathioprine, cyclophosphamide, 6-mercaptopurine, paclitaxel, busulfan, vincristine etc.), antibiotics, oral contraceptives, oral antidiabetic drugs, digoxin, antiarrhythmics etc.
  • Metabolic/endocrine disorders such as pregnancy, uremia, adrenal insufficiency, thyroid and parathyroid diseases etc.
  • Alcohol (ethanol)
  • Liver failure

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