Causes

Nausea and vomiting result when the vomiting centre in the brain is activated. Causes typically
involve disorders of the digestive tract or the brain, or ingested substances.
Common causes
The most common causes of nausea and vomiting are
- Gastroenteritis (infection of the digestive tract)
- Drugs
- Toxins

Nausea and vomiting commonly occur with any dysfunction of the digestive tract but are
particularly common with gastroenteritis). A less common digestive tract disorder is obstruction of
the intestine, which causes vomiting because food and fluids back up into the stomach because of
the obstruction. Many other abdominal disorders that cause vomiting also cause significant
abdominal pain. In such disorders (for example, appendicitis or pancreatitis), it is typically the pain
rather than the vomiting that causes people to seek medical care.
Many drugs, including alcohol, opioid analgesics (such as morphine), and chemotherapy drugs,
can cause nausea and vomiting. Toxins, such as lead or those found in some foods and plants,
can cause severe nausea and vomiting.
Less common causes
Less common causes of nausea and vomiting include
Brain or central nervous system disorders
Motion sickness
Metabolic changes or bodywide (systemic) illness
Psychologic disorders
Cyclic vomiting syndrome

The vomiting center also can be activated by certain brain or central nervous system disorders,
including infections (such as meningitis and encephalitis), migraines, and disorders that increase
pressure inside the skull (intracranial pressure). Disorders that increase intracranial pressure
include brain tumors, brain hemorrhage, and severe head injuries.
The balance organs of the inner ear (vestibular apparatus) are connected to the vomiting center.
This connection is why some people become nauseated by the movement of a boat, car, or
airplane and by certain disorders of the inner ear (such as labyrinthitis and positional vertigo).

Nausea and vomiting may also occur when there are metabolic changes in the body, such as
during early pregnancy, or when people have diabetes that is severely out of control or severe liver
failure or kidney failure.
Psychologic problems also can cause nausea and vomiting (known as functional or psychogenic
vomiting). Such vomiting may be intentional. For instance, people who have bulimia make
themselves vomit to lose weight. Or it may be unintentional. For instance, children who are afraid of
going to school vomit as a response to their psychologic distress.
Cyclic vomiting syndrome is an uncommon disorder in which people have severe attacks of
vomiting (or sometimes only nausea) at varying intervals. People feel normal between attacks.
Although it usually starts in childhood, it sometimes lasts until adulthood. Cyclic vomiting that
begins in adulthood is often due to chronic marijuana use.

The vomiting centre of the brain

The fourth ventricle of the brain hosts the vomiting centre. The floor of the fourth ventricle contains
an area called the chemoreceptor trigger zone (CTZ). It is also called the area postrema. When the
CTZ is stimulated, vomiting may occur.
The CTZ contains receptors for dopamine, serotonin, opioids, acetylcholine and the
neurotransmitter substance P. When stimulated, each of these receptors gives rise to pathways
leading to vomiting and nausea. Present in high concentrations in the vomiting centre, Substance P
seems to be involved in the final common pathways that give rise to vomiting.
Inputs to the vomiting centre in the brain
The CTZ in the brain is stimulated by various inputs from different parts of the body and this leads
to vomiting. Some of the inputs to the CTZ include:

Inputs from the vestibular system of the inner ear. These travel via the eighth cranial
nerve or the vestibulocochlear nerve and are involved in motion sickness causing nausea and
vomiting. There is an abundance of the H1 type of histamine receptors in this system that can be
suppressed by the H1 type of antihistaminics to control vomiting induced by motion sickness.

The tenth cranial nerve or the vagus nerve carries signals to the CTZ when the back
of the throat or pharynx is irritated or stimulated. This is called the gag reflex.

The nervous system around the gut or the enteric nervous system also transmits
signals to the brain via the vagus nerve. It is via this system that radiation therapy, chemotherapy
and gastroenteritis activate the 5-HT3 receptors leading to vomiting.

Dopamine receptors are activated by stress and several psychiatric conditions,

leading to vomiting.
The process of vomiting
The process of vomiting involves several phases and steps. These include:


Stimulation of the CTZ leading to activation of the motor, parasympathetic and
sympathetic nervous system

Stimulation of the parasympathetic nervous system leading to increased salivation

Deep breathing preceding the actual vomiting to protect the lungs from aspiration

Heaving or retching before the actual vomiting

Relaxation of the pyloric sphincter that guards the lower end of the stomach to bring
up content from the gut

The pressure within the abdomen rises and the pressure within the chest or thorax
is lowered. The abdominal muscles contract to expel the contents of the stomach

Activation of the sympathetic nervous system leads to sweating, palpitation and

rapid heart rate