nausea

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Classification according to ICD-10
R11 Nausea and vomiting
ICD-10 online (WHO version 2019)

Nausea or nausea (Latin nausea , late Greek ἡ ναῦτία nautía "seasickness", too ancient Greek ἡ ναῦς naus "ship") is a disorder that is also referred to as a "queasy" feeling in the stomach area and nausea . But it can also occur as a community feeling that can not be localized ( coenesthesia ) or as a combination of both, i. H. as a feeling in the epigastric region and as a common feeling (general nausea). Physiologically, it can occur as a protective function after the ingestion of harmful substances or as a symptom of an illness. Sometimes the nausea goes away after vomiting.

causes

In addition to poisoning and the ingestion of spoiled food, the causes of nausea are a variety of mental disorders , illnesses, etc. a. the gastrointestinal tract , the brain , the heart , the kidneys , the liver and the pancreas , as well as traumatic brain injuries in question. Also severe pain, pregnancy, unusual stimuli of the balance organ - e.g. B. during a sea voyage - as well as psychological influences such as fear, disgust or excitement can trigger nausea. Likewise, anesthesia or surgery due to nausea and vomiting ( postoperative nausea and vomiting ). It is also a common side effect of various drugs, in particular cytostatics for the treatment of tumor diseases ( chemotherapy-induced nausea and vomiting ; CINV) and at the beginning of opioid therapy, but also after radiation therapy ( radiotherapy-induced nausea and vomiting ; RINV). In addition, abrupt discontinuation of various medications (e.g. antidepressants such as citalopram ) can cause nausea as one of the temporary withdrawal symptoms. Nausea can also be triggered by irritation in the head and neck area.

Pathophysiology

Both the central and the vegetative nervous system can be involved in the development of nausea . The vomiting center lies in the reticular formation in the elongated medulla ( medulla oblongata ).

Motion sickness (motion sickness)

Nausea and vomiting can occur in the context of kinetoses . These are motion sickness such as seasickness, feeling unwell when driving, elevator or air travel. Passengers are more affected than the driver. The most effective triggers are rhythmic movements without a view of the horizon 12–24 times per minute. Kinetoses often begin with tiredness, yawning and lack of concentration. Then, in addition to nausea, cold sweats, paleness and salivation occur. Effective drugs are scopolamine or H1 antihistamines ( diphenhydramine or cinnarizine).

Psychogenesis

As a disorder that cannot be localized, nausea often represents a vegetative exhaustion reaction , which can be understood as the failure of the activity stages (alarm reaction and resistance stage) within the general adjustment syndrome . Nausea, as a rejection of feelings of hunger, can be viewed as a mood in which one's appetite is lost. Colloquially, this mood is described as "sucks". The actual vomiting often represents a regressive refuge. It represents an excorpration as an immature stage of identification in the oral phase or in a symbiotic relationship . On the communicative level of the anaclitic-diatrophic equation , "vomiting" represents in the sense of Self-cleaning is often a correction of previous bad postures. It is often a question of cleaning the ego ( catharsis ) and getting rid of wrong interpersonal arrangements that were once "swallowed", cf. also the figure above. In pediatrics , nausea often represents a disorder of internalization in relation to the mother or the carer. Identification goes hand in hand with both internalizations and externalizations . Nausea should be understood more as an externalization process.

Therapy (antiemesis)

Treatment of the underlying disease and the omission or removal of the nausea stimulus and a quiet environment make sense. Medicines that produce nausea as an adverse effect should be checked for their necessity. For some causes, such as tumors, infections, inflammations, pharmacological or surgical interventions may be necessary. Symptomatic therapy is sufficient in many cases, e.g. B. by taking anti- emetics and antihistamines or herbal remedies ( ginger , fennel , but also cannabis ). The latter is used, for example, in palliative medicine , as well as - in small doses in off-label use - certain neuroleptics such as haloperidol . The serotonin inhibitor ondansetron is often used for chemotherapy- related nausea . Medicines effective for opioid nausea include metoclopramide , haloperidol, droperidol , dimenhydrinate, and tropisetron . In the case of nausea due to the accumulation of food in the stomach (gastrostasis), the prokinetics used are metoclopramide, alizapride , domperidone and erythromycin , and dimenhydrinate and / or haloperidol for occlusion of the gastrointestinal tract (gastrointestinal obstruction ). Corticosteroids (such as dexamethasone ) alone or in combination with dimenhydrinate and / or levopromazine also have an antiemetic effect on the central nervous system . Also benzodiazepines (eg, lorazepam ), cannabinoids , and NK-1 receptor antagonist ( aprepitant ) are applicable substances for nausea. If the cause is psychogenic , psychotherapy can be helpful.

Individual evidence

  1. ↑ a b Nausea, stomach, and general exhaustion. In: Thure von Uexküll : Basic questions of psychosomatic medicine. Rowohlt Taschenbuch, Reinbek bei Hamburg 1963, p. 195.
  2. ↑ a b Nausea as a result of the unsuccessful provision = special case of a mood . In: Thure von Uexküll: Basic questions of psychosomatic medicine. Rowohlt Taschenbuch, Reinbek bei Hamburg 1963, pp. 173, 176.
  3. ↑ Community Feelings. In: Hermann Rein , Max Schneider : Introduction to the human physiology. 15th edition. Springer, Berlin 1964, p. 674 ff.
  4. ↑ K. Jordan, C. Sippel, HJ Schmoll: Guidelines for antiemetic treatment of chemotherapy-induced nausea and vomiting: past, present, and future recommendations. In: Oncologist . 2007 Sep; 12 (9), pp. 1143-1150. Review. PMID 17914084
  5. ^ Claudia Bausewein , Susanne Roller, Raymond Voltz (eds.): Guide to Palliative Care. Palliative Medicine and Hospice Care Elsevier Munich, 5th edition 2015, p. 109. ISBN 978-3-437-23313-5
  6. ↑ PC Feyer, E. Maranzano, A. Molassiotis, F. Roila, RA Clark-Snow, K. Jordan; MASCC / ESMO: Radiotherapy-induced nausea and vomiting (RINV): MASCC / ESMO guideline for antiemetics in radiotherapy: update 2009. In: Support Care Cancer. 2011 Mar; 19 Suppl 1, pp. S5-14. Epub 2010 Aug 10. PMID 20697746
  7. ^ T Jelinek: course book travel medicine: advice, prophylaxis, traveling with illnesses. Georg Thieme Verlag 2012 Stuttgart, New York, ISBN 978-3-13-150851-5
  8. ↑ A. Koch, I. Cascorbi, M. Westhofen, Manuel Dafotakis, p Klapa, JP Kuhtz-Busch Beck: The neurophysiology and treatment of motion sickness. In: Deutsches Ärzteblatt International. Volume 115, pp. 687-696. doi: 10.3238 / arztebl.2018.0687
  9. ↑ Thure von Uexküll: Investigations into the phenomenon of 'moods' with an analysis of the nausea after apomorphic administration of various sizes. In: Zeitschr. clin. Med. 149, 132 (1952).
  10. ↑ Nausea. In: Thure von Uexküll et al. (Ed.): Psychosomatic medicine. 3. Edition. Urban & Schwarzenberg, Munich 1986, ISBN 3-541-08843-5 , pp. 6, 86, 91, 536, 544, 546, 732, 774, 1298.
  11. ^ Excorporation. In: Stavros Mentzos : Neurotic Conflict Processing. Introduction to the psychoanalytic theory of neuroses, taking into account more recent perspectives. Fischer-Taschenbuch, Frankfurt 1992, ISBN 3-596-42239-6 , p. 46 f.
  12. ↑ anaclitic-diatrophic equation. In: Wolfgang Loch : On the theory, technology and therapy of psychoanalysis . (Conditio humana). S. Fischer, 1972, ISBN 3-10-844801-3 , p. 262.
  13. ↑ internalization. In: Sven Olaf Hoffmann , G. Hochapfel: theory of neuroses, psychotherapeutic and psychosomatic medicine. Compact textbook. 6th edition. Schattauer, Stuttgart 2003, ISBN 3-7945-1960-4 , pp. 17-22, especially p. 20.
  14. ↑ Catharsis. In: Peter R. Hofstätter (Ed.): Psychology . The Fischer Lexikon, Fischer-Taschenbuch, Frankfurt am Main 1972, ISBN 3-436-01159-2 , pp. 18, 273, 274, 319.
  15. ↑ Catharsis. In: Philip G. Zimbardo , Richard J. Gerrig: Psychology . Pearson, Hallbergmoos near Munich 2008, ISBN 978-3-8273-7275-8 , p. 601.
  16. ^ A b Claudia Bausewein , Susanne Roller, Raymond Voltz (eds.): Guide to Palliative Care. Palliative Medicine and Hospice Care. 5th edition. Elsevier, Munich 2015, p. 159. ISBN 978-3-437-23313-5 .
  17. ^ Pharmawiki: Dopamine antagonists .
  18. ↑ See Katri Elina Clemens, Eberhard Klaschik: Nausea, vomiting and constipation in the palliative situation. Dtsch Arztebl 2007; 104 (5): A-269 / B-240 / C-235.
  19. ↑ Cf. Deutsche Apothekerzeitung: Antiemesis: preventing cytostatic-induced vomiting .
  20. ↑ Pharmaceutical newspaper: Aprepitant combats nausea after administration of cytostatics . 2003.

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