Gastric contents are propelled into the esophagus when there is relaxation of the gastric fundus and gastroesophageal sphincter followed by a rapid increase in intraabdominal pressure produced by contraction of the abdominal and diaphragmatic musculature. Increased intrathoracic pressure results in further movement of the material to the mouth. Reflex elevation of the soft palate and closure of the glottis protect the nasopharynx and trachea and complete the act of vomiting. Vomiting is controlled by two brainstem areas, the vomiting center and chemoreceptor trigger zone. Activation of the chemoreceptor trigger zone results in impulses to the vomiting center, which controls the physical act of vomiting.
Section 3. Common Patient Presentations