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NAUSEA

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SUSPENSION - a kind of painful sensation in the epigastric region, chest, mouth, often preceding vomiting, and often accompanied by general weakness, sweating, hypersalivation, cooling of the limbs, pallor of the skin, lowering blood pressure.

Nausea occurs in many pathological conditions, including various intoxications, diseases of internal organs, the central nervous system, vestibular dysfunction (motor nausea), and metabolic disorders. It also happens psychogenic nausea with unpleasant visual and olfactory sensations in excitable individuals, sometimes as a manifestation of neurosis, psychosis.

The pathogenesis of nausea is associated with the excitation of the vomiting center, which is still insufficient for the formation of an act of vomiting, but already accompanied by anti-peristaltic contractions of the stomach, with which a feeling of nausea is associated. The basis of reflex nausea is the stimulation of the vagus nerve by impulses from mechanically or chemically irritated receptors of various reflexogenic zones. Such receptors contain the posterior pharyngeal wall, root of the tongue, gastrointestinal tract, liver, bile ducts and bladder, pancreas, serous membranes (peritoneum, pleura, pericardium), bronchi, kidneys, uterus with appendages. Gastric nausea occurs most often, often occurs with a weakening of the secretion of gastric juice, tone and motility of the stomach; comes after eating and is often associated with her character (fatty foods, alcohol, etc.).

Toxic nausea that occurs during poisoning, infections and intoxication, due to the excitation of chemoreceptors of the trigger zone in the bottom of the IV ventricle, which activate the vomiting center. The latter is also activated when the receptors of the vestibular apparatus are overexposed (with motion sickness, rotation on the carousel, diseases of the inner ear, Meniere's disease). In the origin of cerebral nausea, the increase in intracranial pressure due to cerebral edema or a disturbance of liquorodynamics during its tumors, traumatic brain injury, inflammation of the lining of the brain is of the greatest importance. Metabolic nausea (with hypovitaminosis, iron deficiency anemia , endocrine and other pathologies) is heterogeneous in pathogenesis and depends on the nature of the effects of impaired metabolism on various organs with activation of the vomiting center in some cases reflex, and in others - toxic or combined effects.

Being a nonspecific symptom of many diseases, nausea has a diagnostic value only in conjunction with other signs of the disease (for example, signs of peritoneal irritation in acute appendicitis). Certain specificity has a connection with nausea with some factors provoking it (eating, changing body position, etc.). The clinical history is collected in the same way as for vomiting. If the patient makes a complaint only about nausea that occurs, for example, every day, other signs of the disease should be identified by actively interviewing the patient, followed by a targeted examination. Thus, when other dyspeptic complaints associated with nausea are detected (belching, a feeling of heaviness in the epigastric region, etc.) and the association of nausea with food intake, diseases of the digestive organs (gastritis, cholecystitis , pancreatitis , gastric tumor, etc.) should be assumed examination; when nausea is combined with headache, sensitivity disorders or movements, a neurological examination is necessary, etc.

Symptomatic treatment is necessary when pronounced in patients with acutely developing pathological conditions (more often with vestibular dysfunction) and in cases where the treatment of the underlying disease is not effective enough. Neuroleptics have a pronounced central effect, especially thiethylperazine (torekan), which is prescribed in a dose of 6.5–13 mg (1–2 ml) intramuscularly, as well as ethaperazine. Close to them on the mechanism of action of metoclopramide (raglan, cerrucal) and sulpiride (eglonil, dogmatil). The drug of choice is aeron used 1 tablet sublingually (up to 3 times a day). Sometimes reflex nausea suppresses validol (menthol), anestezin in small doses.