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Retching

April 12, 2024

Retching (also known as dry heaving) is the reverse movement (retroperistalsis) of the stomach and esophagus without vomiting.[1] It can be caused by bad smells or choking, or by withdrawal from certain medications, or after vomiting has completed. Retching can also occur as a result of an emotional response or from stress, which produces the same physical reaction. The function is thought to be mixing gastric contents with intestinal refluxate in order to buffer the former and give it momentum in preparation of vomiting.[2] Treatments include medication and correction of the fluid and electrolyte balance.

Physiology edit

The retching phase is characterized by a series of violent spasmodic abdomino-thoracic contractions with the glottis closed. During this time, the inspiratory (inhalatory) movements of the chest wall and diaphragm are opposed by the expiratory contractions of the abdominal musculature. At the same time, movements of the stomach and its contents take place. Whereas a patient will complain of disagreeable sensations during nausea, speech is not possible during retching. The characteristic movements furnish a ready diagnostic sign of the retching phase. Schindler (1937)[3] studied retching on two occasions during gastroscopy and noted that longitudinal folds appeared in the previously smooth antrum, thickened quickly, came together and completely closed the antrum.[4] Retching involves a deep inspiration against a closed glottis. This, along with contraction of the abdomen, leads to a pressure difference between the abdominal and thoracic cavities. As a result, the stomach and gastric contents are displaced upwards toward the thoracic cavity.[5]

Retching comprises a rhythmically alternating (about once per second) elevation and descension of the entire pharyngolaryngo-esophago-gastric apparatus in synchrony with the movement of the diaphragm. The function of retching may be to mix gastric contents with intestinal refluxate to buffer gastric contents before gastroesophageal reflux and to impart a momentum to the gastric contents before vomiting. Airway protection during retching is accomplished by glottal closure during retches and constriction of the upper esophageal sphincter between retches.[2]

Versus vomiting edit

Vomiting (the expulsion of gastric contents) is usually preceded by retching, but retching and vomiting can occur separately[6] and involve different sets of muscles.[7] During a retch, thoracic pressure is decreased and abdominal pressure is increased, which may serve to position gastric contents and overcome esophageal resistance.[6] Conversely, a vomit occurs with increased thoracic and abdominal pressure. Retches and vomits are commonly lumped together in behavioral analyses and consequently the neural controls for these processes are not well delineated.[8]

Treatments edit

The treatments for significant retching include correction of fluid and electrolyte balance, nutritional support and medications like phenothiazines (such as Compazine and Phenergan), 5-HT3 antagonist (such as Zofran), dopamine receptor antagonists (such as Reglan), antihistamines (Antivert, and Dramamine, Benadryl) and anticholinergics (scopolamine). Alternative approaches are also available. The best-studied alternative therapy is perhaps the use of acupressure for pregnancy-related nausea and vomiting.[citation needed] Wristbands with acupressure buttons are commercially available. An implanted device with attached electrodes into the gastric wall can be an option for patients with refractory nausea and vomiting.[9]

See also edit

References edit

  1. ^ "Vomiting and Nausea". eMedicine. February 12, 2012.
  2. ^ a b Lang, IM; Dana, N; Medda, BK; Shaker, R (September 2002). "Mechanisms of airway protection during retching, vomiting, and swallowing". American Journal of Physiology. Gastrointestinal and Liver Physiology. 283 (3): G529-36. doi:10.1152/ajpgi.00062.2002. PMID 12181164.
  3. ^ Schindler, R (1937). Gastroscopy. Chicago: University of Chicago Press. p. 145.
  4. ^ Keet, AD (1998). "Nausea, Retching, and Vomiting". The Pyloric Sphincteric Cylinder in Health and Disease. PLiG. p. 122.
  5. ^ Berne, Robert M.; Matthew N. Levy (2004). Physiology. Elsevier Mosby. p. 557. ISBN 0-323-03390-3.
  6. ^ a b Andrews, PL; Davis, CJ; Bingham, S; Davidson, HI; Hawthorn, J; Maskell, L (February 1990). "The abdominal visceral innervation and the emetic reflex: pathways, pharmacology, and plasticity". Canadian Journal of Physiology and Pharmacology. 68 (2): 325–45. doi:10.1139/y90-047. PMID 2178756.
  7. ^ Grelot, L; Miller, AD (1994). "Vomiting - Its Ins and Outs". News in Physiological Sciences. 9 (3): 142–147.
  8. ^ Horn, Charles (11 October 2007). "Why is the neurobiology of nausea and vomiting so important?". Appetite. 50 (2–3): 430–434. doi:10.1016/j.appet.2007.09.015. PMC 2274963. PMID 17996982. nihmsid: NIHMS42868.
  9. ^ Porter, Ryan F.; Gyawali, C. Prakash. "Nausea and Vomiting". Patient Education & Resource Center. American College of Gastroenterology.

April 12, 2024
retching, also, known, heaving, reverse, movement, retroperistalsis, stomach, esophagus, without, vomiting, caused, smells, choking, withdrawal, from, certain, medications, after, vomiting, completed, also, occur, result, emotional, response, from, stress, whi. Retching also known as dry heaving is the reverse movement retroperistalsis of the stomach and esophagus without vomiting 1 It can be caused by bad smells or choking or by withdrawal from certain medications or after vomiting has completed Retching can also occur as a result of an emotional response or from stress which produces the same physical reaction The function is thought to be mixing gastric contents with intestinal refluxate in order to buffer the former and give it momentum in preparation of vomiting 2 Treatments include medication and correction of the fluid and electrolyte balance RetchingSpecialtyGastroenterology Contents 1 Physiology 2 Versus vomiting 3 Treatments 4 See also 5 ReferencesPhysiology editThe retching phase is characterized by a series of violent spasmodic abdomino thoracic contractions with the glottis closed During this time the inspiratory inhalatory movements of the chest wall and diaphragm are opposed by the expiratory contractions of the abdominal musculature At the same time movements of the stomach and its contents take place Whereas a patient will complain of disagreeable sensations during nausea speech is not possible during retching The characteristic movements furnish a ready diagnostic sign of the retching phase Schindler 1937 3 studied retching on two occasions during gastroscopy and noted that longitudinal folds appeared in the previously smooth antrum thickened quickly came together and completely closed the antrum 4 Retching involves a deep inspiration against a closed glottis This along with contraction of the abdomen leads to a pressure difference between the abdominal and thoracic cavities As a result the stomach and gastric contents are displaced upwards toward the thoracic cavity 5 Retching comprises a rhythmically alternating about once per second elevation and descension of the entire pharyngolaryngo esophago gastric apparatus in synchrony with the movement of the diaphragm The function of retching may be to mix gastric contents with intestinal refluxate to buffer gastric contents before gastroesophageal reflux and to impart a momentum to the gastric contents before vomiting Airway protection during retching is accomplished by glottal closure during retches and constriction of the upper esophageal sphincter between retches 2 Versus vomiting editVomiting the expulsion of gastric contents is usually preceded by retching but retching and vomiting can occur separately 6 and involve different sets of muscles 7 During a retch thoracic pressure is decreased and abdominal pressure is increased which may serve to position gastric contents and overcome esophageal resistance 6 Conversely a vomit occurs with increased thoracic and abdominal pressure Retches and vomits are commonly lumped together in behavioral analyses and consequently the neural controls for these processes are not well delineated 8 Treatments editThe treatments for significant retching include correction of fluid and electrolyte balance nutritional support and medications like phenothiazines such as Compazine and Phenergan 5 HT3 antagonist such as Zofran dopamine receptor antagonists such as Reglan antihistamines Antivert and Dramamine Benadryl and anticholinergics scopolamine Alternative approaches are also available The best studied alternative therapy is perhaps the use of acupressure for pregnancy related nausea and vomiting citation needed Wristbands with acupressure buttons are commercially available An implanted device with attached electrodes into the gastric wall can be an option for patients with refractory nausea and vomiting 9 See also editPharyngeal reflex the gag reflex Regurgitation digestion VomitingReferences edit Vomiting and Nausea eMedicine February 12 2012 a b Lang IM Dana N Medda BK Shaker R September 2002 Mechanisms of airway protection during retching vomiting and swallowing American Journal of Physiology Gastrointestinal and Liver Physiology 283 3 G529 36 doi 10 1152 ajpgi 00062 2002 PMID 12181164 Schindler R 1937 Gastroscopy Chicago University of Chicago Press p 145 Keet AD 1998 Nausea Retching and Vomiting The Pyloric Sphincteric Cylinder in Health and Disease PLiG p 122 Berne Robert M Matthew N Levy 2004 Physiology Elsevier Mosby p 557 ISBN 0 323 03390 3 a b Andrews PL Davis CJ Bingham S Davidson HI Hawthorn J Maskell L February 1990 The abdominal visceral innervation and the emetic reflex pathways pharmacology and plasticity Canadian Journal of Physiology and Pharmacology 68 2 325 45 doi 10 1139 y90 047 PMID 2178756 Grelot L Miller AD 1994 Vomiting Its Ins and Outs News in Physiological Sciences 9 3 142 147 Horn Charles 11 October 2007 Why is the neurobiology of nausea and vomiting so important Appetite 50 2 3 430 434 doi 10 1016 j appet 2007 09 015 PMC 2274963 PMID 17996982 nihmsid NIHMS42868 Porter Ryan F Gyawali C Prakash Nausea and Vomiting Patient Education amp Resource Center American College of Gastroenterology Retrieved from https en wikipedia org w index php title Retching amp oldid 1217575110, wikipedia, wiki, book, books, library,

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