Vomiting and diarrhea

Common symptoms that can occur for a variety of reasons are vomiting and diarrhea (diarrhea).

Causes of the vomiting and diarrhea

First of all, these symptoms are manifested by food poisoning or food toxoinfections, [1] affecting the GI tract, as well as bacterial intestinal infections, [2] in which all patients have practical abdominal pain, diarrhea and vomiting.

For example, vomiting against a background of subfebrile temperature and watery yellow diarrhea with mucus can be either symptoms of enterogenic escherichiosis, the causative agent of which is the bacterium Escherichia coli - Escherichia coli, [3] or symptoms of salmonellosis, which develops when infected with bacteria of the genus Salmonella. [4]

When the mucous membranes of the large intestine are invaded by bacteria of the genus Shigella, the symptoms of dysentery (shigellosis) occur: green diarrhea and vomiting with high fever and cramping abdominal pain. [5], [6]

Vomiting, diarrhea and fever (up to +39°C) with abdominal pain are symptoms of gastrointestinal infection by Yersinia enterocolitica bacteria and the development of acute intestinal yersiniosis. [7]

Nausea, abdominal pain, vomiting and diarrhea in an adult occur in case of exacerbation of gastritis, inflammation of the pancreas - pancreatitis, inflammation of the appendix vermiformis - acute phlegmonous appendicitis. [8]

Most cases of vomiting and diarrhea in pregnancy are due to the same causes, more information - Intestinal infection in pregnancy

Nausea, vomiting, and diarrhea can be nitrate and nitrite poisoning, [9], [10] occur with radiation damage to the intestines [11] or are side effects of certain medications, including magnesium sulfate, antibiotics, proton pump inhibitors (which reduce acid secretion in the stomach), antacids (heartburn medications), SSRI antidepressants, and others.

When the whole body is exposed to high doses of ionizing radiation (radiation), diarrhea, vomiting, and headache with marked dizziness and general weakness are observed. [12]

In addition, diarrhea, vomiting, and weakness after eating (with bouts of dizziness and cold sweats) accompany dumping syndrome (rapid gastric emptying), which is most commonly seen after removal of all or part of the stomach (gastrectomy) for peptic ulcer disease, [13] but can also occur in the presence of functional dyspepsia. [14]

Vomiting and diarrhea in a child can be signs of bacterial intestinal infections in children, at an early age as a result of overeating, and can also be symptoms of viral gastroenteritis or rotavirus enteritis, often called intestinal flu. Rotavirus infection, that is, rotavirus of the Reoviridae family, is transmitted by the fecal-oral route and, when infected, damages the cells lining the small intestine mucosa, resulting in watery diarrhea, vomiting, and intestinal cramps. [15], [16] A similar clinical picture is given by noroviruses. [17]

And vomiting and fever without diarrhea in children may be associated with acute tonsillitis (sore throat) of bacterial origin, in particular caused by Streptococcus pneumoniae. [18] For details, see Vomiting and fever in a child without diarrhea.

Also read:

• Vomiting with diarrhea in a child without fever
• Vomiting without fever and diarrhea in a child

When abdominal pain and diarrhea without vomiting, you should suspect helminthiasis - a worm infestation or infection with parasitic worms such as intestinal eel, ascarids, echinococcus tapeworm, etc. [19], [20]

At the same time, nausea and vomiting without diarrhea and fever can occur due to problems not related to the gastrointestinal tract, and appear in cases:

• concussion resulting from the traumatic brain injury; [21]
• Bacterial or viral meningitis; [22]
• caused by bacteria of the genus Legionella legionellosis; [23]
• Labyrinthitis (inflammation of the inner ear) - combined with dizziness, ringing and pain in the ear; [24]
• autonomic crises;
• migraines; [25]
• Adrenal insufficiency - Addison's disease. [26]

Bile vomiting and diarrhea / yellow vomiting and diarrhea can be with any intestinal infection or poisoning when vomiting continues and the stomach is empty.

In addition, the cause may be related to an open pyloric sphincter in alcohol poisoning, gastroenteritis, gastroesophageal reflux disease (GERD), biliary tract disease, or pancreatic disease. Vomiting bile may indicate sliding esophageal hernia - a hernia of the esophageal opening (hiatus oesophageus) of the diaphragm. [27]

Stomach flu, food poisoning, or acute gastroenterocolitis may cause vomiting of bile, diarrhea, and fever.

And foamy vomiting and diarrhea can be caused by stomach diseases, abuse of fatty and acidic foods, and alcohol.

Pathogenesis

Being a protective reaction of the organism, in physiological sense vomiting is the actual expulsion of the contents of the stomach and small intestine, the mechanism of which is caused by contractions of the intestine and abdominal wall muscles. Activation of the vomiting center, which is located in the medulla oblongata, occurs by stimuli or indirectly after exposure from the gastrointestinal region, as well as from the cerebral cortex and thalamus, the vestibular area, and the vomiting chemoreceptor trigger zone (CTZ) located on the dorsal surface of the medulla oblongata. This zone has receptors (histamine H1, acetylcholine M1, serotonin 5-HT3, dopamine DA2, neurokinin NK1) and receives afferent signals from autonomic neurons of the enteric nervous system (ENS), transmitting them to the vomiting center. And from this center, the response impulses that induce the gag reflex go through the efferent branches of the V, VII, IX, X and XII cranial nerves to the upper parts of the gastrointestinal tract, through the vagus and sympathetic nerves to the lower parts of the GI tract and through the spinal nerves to the diaphragm and abdominal wall muscles.

In intestinal bacterial infections, endotoxins released by bacteria (Escherichia coli, salmonella, etc.) entering the GI tract not only have a toxic effect on enterocytes - epithelial cells of the small and large intestine - with their damage, but also enter the bloodstream - with the production of antibodies (IgA, IgG, IgM) and the development of an immune response.

And in viral gastroenteritis, the pathogenesis of diarrhea is explained by the penetration of viruses into the cytoplasm and endoplasmic network of cells lining the intestinal epithelium and their multiplication. As a result of colonization of the intestinal epithelium there is destruction of plasma membranes of columnar (caemic) enterocytes and microvilli on their apical surface, which negatively affects the wall digestion and water absorption - with liquefaction of intestinal contents and stool.

Forms

Conventionally distinguish several types of vomiting and diarrhea.

Water diarrhea and vomiting are characteristic of viral infections, particularly rotavirus infection.

Watery diarrhea without vomiting or fever is seen in food allergies, carbohydrate intolerance in adults and lactase deficiency in children, [28] and in congenital short bowel syndrome in children. [29]

In cases of poisonous mushroom poisoning, gastrointestinal bleeding and dysentery, there is vomiting and diarrhea of blood.

Yellow diarrhea, vomiting, intestinal cramps, and fever most often indicate an intestinal infection of a bacterial nature.

White diarrhea and vomiting may be due to cholera (whose causative agent is the bacterium Vibrio cholerae) [30] or mercury poisoning. [31]

When you have diarrhea and vomiting at sea, the first suspicion is food toxicity, although it may be signs of jellyfish burn. [32]

And diarrhea and vomiting in a child at sea can appear, among other things, as signs of acclimatization in children. [33]

Diagnostics of the vomiting and diarrhea

To determine the specific disease causing these symptoms, in addition to anamnesis, tests may be required, including general and biochemical blood tests, serum bacterial examination and serologic testing, stool analysis (with bacterial examination, detection of helminth eggs and rotavirus antigen); if meningitis is suspected, laboratory examination of liquor.

In difficult cases, instrumental diagnostics is used: gastroscopy, ultrasound or CT scan of the abdominal cavity and pelvic organs.

The true cause of vomiting and diarrhea - taking into account their nature and the presence/absence of other symptoms, as well as the results of laboratory tests - helps to identify the differential diagnosis.

Treatment of the vomiting and diarrhea

How do I stop vomiting and diarrhea? Immediately take the medications prescribed by for vomiting and diarrhea.

Intestinal adsorbents (enterosorbents) activated charcoal, Carbolong, Polysorb, Sorbex, Enterosgel, Atoxyl, Smectu, etc.; Loperamide (Imodium) and other tablets for diarrhea, as well as tablets for vomiting are used.

In diarrhea of infectious etiology is used Enterofuryl (Nifuroxazid) - an antimicrobial agent in capsules and in the form of suspension; Chlorquinaldol (tablets), etc.

Bacterial intestinal infection requires antibiotic therapy, for more information see. - Antibiotics for intestinal infection

Full details are in the materials:

• Treatment of food poisoning
• Treatment of dysentery
• Salmonellosis treatment
• Treatment of abdominal pain and diarrhea: pills, folk remedies
• Treatment of vomiting and abdominal pain in adults and children
• What to do when a child has diarrhea?

The main problem with vomiting and diarrhea is dehydration due to loss of fluid, salts and minerals, so it is mandatory to take drugs to restore water-electrolyte balance: isotonic sodium chloride solution, Regidron, Ringer-Lokka solution, Gastrolit, Isolit.

Drug therapy can be supplemented by herbal treatment with the use of erect lupa, veronica, forest wheatgrass, serpentine, horse sorrel, calendula, willow-leaved tea. See: Traditional remedies for diarrhea

What to eat for vomiting and diarrhea / what you can eat for vomiting and diarrhea:

• Diet in poisoning: general rules
• Nutrition and diet in food poisoning
• Diet for intestinal infection
• Diarrhea diet

For details on what to drink for vomiting and diarrhea, see - Drinks for diarrhea