What is Emesis: Types, Causes, Treatments, Complications, Phases

Emesis, is the involuntary, forceful expulsion of the contents of an individual’s stomach through the mouth and at times through the nose. It is also known as vomiting or throwing up. In this article we will know about the causes, types, diagnosis and treatment procedures for emesis.

Emesis or vomiting can be caused by a number of conditions and may be present as a specific response to ailments like poisoning or gastritis or as an elevated intracranial pressure to excessive exposure to ionizing radiation etc. Nausea is a symptom experienced in emesis which is actually the feeling that an individual is about to vomit or throw up. Emesis may at times lead to some complications which may be dangerous and require immediate treatments.

There are various ways to treat emesis which may include antiemetics, intravenous fluids etc. We will talk more about the complications, types, diagnosis and treatment procedures in the later part of our article. However, before that let us know about the contents which may be thrown out during the process of emesis.

• Usually, emesis due to gastritis includes the gastric secretions and they are highly acidic in nature.
• Fresh blood may sometimes come out in a process of emesis and is known as blood vomiting.
• Bile can also come out in emesis which occurs in case of severe emesis where there is a duodenal contraction.

Emesis occurs in two phases. One is the Retching phase and other is the Expulsive phase.

1. Retching phase of emesis: This is the first phase of the emesis where nothing expels out but the patient may be experiencing violent hiccups. Here the abdominal muscles undergo a few rounds of coordinated contractions together with the diaphragm, and the muscles used in inspiration of the respiration process.
2. Expulsive phase of emesis: This is the next phase in the act of emesis. Here in this phase there forms an intense pressure in the stomach which is brought about by enormous shifts in both the diaphragm as well as the abdomen. This may last for some time and then all of a sudden, the pressure may be released when the upper oesophageal sphincter is relaxed and thus results in the expulsion of gastric contents.

Below are some of the noted complications with emesis.

• Dehydration and Imbalance of Electrolyte: Dehydration is one of the serious complications with emesis or vomiting. Emesis may lead to depletion in the water content of the body and may also alter the electrolyte status. Emesis due to gastritis leads to direct loss of acids or protons and chloride.
• Choking, aspiration pneumonia etc. due to emesis: Emesis can be seriously dangerous in case the gastric content enters the respiratory tract. The person may choke and may meet with a condition of an aspiration pneumonia that can be dangerous.
• Destruction of the tooth enamel due to continuous emesis: It is also known that sometimes emesis can cause a destruction of the tooth enamel because of the acidity of the contents thrown out. There are also chances of ill oral health as the tissues of the gums may also be degraded by the process of emesis.
• Erosion of oesophagus or tears in oesophageal mucosa: One more complications of emesis can be that continuous and repeated emesis may cause erosions to the oesophagus or also may at times cause small tears in the oesophageal mucosa.

Following are some of the types of emesis.

1. Delayed Emesis: This is a type of emesis which mostly occurs after 2-5 days of the administration of a chemotherapy drug known as Cisplatin in about 60% of the patients undergoing the treatment. Such types of emesis are quite difficult to treat with standard antiemetic drugs and may require a combination therapy of oral dexamethasone and oral metoclopramide.
2. Anticipatory Emesis: Anticipatory emesis is one type of emesis that is conditioned by the severity and duration of previous reactions to chemotherapy.
3. Cyclic Emesis: One more type of emesis is known as the Cyclic emesis. Here there is an uncontrollable vomiting and this process of emesis occurs mostly in every 2-3 months. Migraine may be the cause of such a type of emesis.
4. Projectile Emesis: This is one more type of emesis which actually refers to the process of throwing up of gastric contents with a great force. It throws up the contents at such a force that sometimes some materials also exist via the person’s nose.

As mentioned earlier that there are various causes of emesis, here we will be taking a look on some of the most common causes.

• Emesis may occur due to stimulation of the sensory nerve endings in the GI tract and the pharynx which may be due to medications/drugs.
• Emesis may also occur due to endogeneous emetic substances produced because of the radiation damage or any disease.
• Disturbance of the vestibular apparatus may also cause emesis.
• Stimuli to the sensory nerves of the heart and viscera may cause emesis.
• An increase in the intracranial pressure, nauseating smells, disgusting experiences etc can also cause emesis.
• Sometimes emesis and nausea occurs due to PONV or post operative nausea and vomiting as a result of the surgery and general anesthesia.
• Emotional stress also causes emesis.

Emesis can be mostly treated by Antiemetics. Let us look below to know more about this.

This is a drug which is known to be effective against emesis and nausea. These are the medications mostly used to treat motion sickness and the side effects of medications like Chemotherapy. There are various classes of the antiemetic drugs. Let us look at them below.

• Muscarinic Receptor Antagonists or Anticholinergics for Treating Emesis: This class of the antiemetic drug is mainly used to prevent motion sickness. There may be side effects of anticholinergics like, it may cause hallucinations when taken in large dose and also may lead to blurry vision, dry mouth etc and also can affect the pulse rate.
• H1 Antihistamines: This class of antiemetic drugs is mainly for motion sickness and also have an additional anticholinergic action. There may be side effects of this class of antiemetics like drowsiness and loss of coordination.
• Antidopaminergic Drugs: Such class of antiemetic drug are mostly used as antipsychotic agents. Apart from this, they also have antimuscarinic action.
• Corticosteroids to Treat Emesis: It is one more class of antiemetic drug which can be used in treating emesis.
• Benzodiazepines to Treat Emesis: These are the class of antiemetics which are good for anticipatory nausea and emesis before cancer therapy. They are also used for treating vestibular disorders.
• 5-HT3 receptor antagonists: This is one of the most effective treatments available for treating and preventing serious emesis occurring due to cancer chemotherapy. It is known that about 85%of patients achieve complete control on emesis with this drug.

There are some effective home remedies available for emesis which is discussed below.

• Ginger: Being good for the digestive system, ginger works as a natural antiemetic for preventing emesis. You can try ginger tea with a little honey or even eat fresh slices of ginger for the effective results.
• Rice Water: Rice water is beneficial in reducing the act of emesis, especially those which are caused due to gastritis. Just boil one cup of rice in one and half cup of water and strain the solution for drinking the rice water.
• Mint: Mint is also known to be effective in treating emesis. You can prepare mint tea and take for the best benefits. Add mint leaves in one and half cup of boiling water and allow it to steep and strain the water. Then drink the mint tea for the best benefits.
• Cinnamon: Cinnamon or Dalchini is also known to be helpful in calming the stomach and also treat nausea and emesis. You can add one and half teaspoon of cinnamon powder in boiling water and allow it to steep for few minutes and then strain the water before drinking it. However, this home remedy may not be suitable for the pregnant women
• Vinegar: One more home remedy for emesis, upset stomach etc. is vinegar. It calms the stomach and helps detoxification. You can simply mix one tablespoon of apple cider vinegar and on tablespoon of honey in a glass of water and drink it. You can repeat it as many time required.
• Fennel: It is also known that fennel seeds are effective in digestion and ease nausea. Because of the antimicrobial properties, fennel can be used in treating emesis. Simply chewing fennel seeds would help.
• Clove: Chewing some cloves or taking tea made of few cloves can be effective in treating emesis or vomiting.
• Cumin: One of the best home remedies for treating emesis is cumin. It is mostly effective when emesis or nausea is caused due to digestive problems. You can mix one and half tablespoon of cumin seeds in warm water and drink it for the essential results.

So, above we talked about the act of emesis, its types, causes, complications along with the treatments and home remedies. In case of any emergency due to emesis, or nausea kindly talk to a medical professional and take the effective treatments.