Functional Vomiting

　　Due to the complex and diverse etiology of functional vomiting, the duration and intensity of its occurrence and persistence vary, and the age of onset is different, the impact on the body is very different. Mild cases have no effect, only transient discomfort. Long-term chronic functional vomiting can lead to peptic esophagitis, hypovolemia, hypokalemia, hyponatremia, alkalosis, and other metabolic disorders. Further, anemia, malnutrition, and growth and development stasis may occur.

　　Acute conditions can cause electrolyte and water balance disorders, shock, aspiration, asphyxia,诱发arrhythmia, and even death. Those caused by surgical reasons can also lead to serious consequences such as gastrointestinal perforation, diffuse peritonitis, shock, sepsis, and others. Children with poor motor nerve function are also prone to aspiration after functional vomiting and need to be highly vigilant.

　　1. Digestive system

　　Pharyngeal irritation (such as artificial stimulation), acute gastroenteritis, chronic gastritis, active phase of peptic ulcer, acute gastrointestinal perforation, pyloric stenosis, massive hemorrhage, gastric mucosal prolapse, acute gastric dilatation, gastric volvulus, acute enteritis, acute appendicitis, mechanical intestinal obstruction, acute hemorrhagic necrotic enteritis, acute hepatitis, chronic active hepatitis, liver cirrhosis in the late stage, acute and chronic cholecystitis, cholelithiasis, bile duct ascaridiasis, acute pancreatitis, acute peritonitis, and others.

　　2. Other systems

　　Urogenital system diseases: ureteral stones, acute pyelonephritis, acute pelvic inflammatory disease, rupture of ectopic pregnancy, and others.

　　3. Cardiovascular diseases

　　Myocardial infarction, congestive heart failure, and other diseases; eye and ear diseases, including glaucoma and refractive errors, and others.

　　For nervous vomiting, although the symptoms may have lasted for several weeks or months, patients usually do not have weight loss, dehydration, or objective clinical abnormalities. However, for patients with severe psychological disorders, including eating disorders, malnutrition and metabolic disorders may occur due to persistent vomiting. Vomiting does not occur after anticipated physiological activities, such as vomiting when thinking about food, which may be related to eating. In patients with eating disorders, vomiting is self-induced.

　　To clarify the psychiatric cause of vomiting, it is necessary to elucidate the behavioral characteristics that cause vomiting, which may not be possible in terms of time. Patients may have a personal and family history of functional nausea and vomiting, which can serve as a pattern of existing symptoms. When encouraging patients to describe the background of vomiting episodes, they can associate the occurrence of vomiting with stress and claim that vomiting will recur and worsen during similar stress periods, but patients still do not admit that vomiting is related to mental tension.

　　Functional vomiting is caused by the non-random contraction of abdominal muscles and the relaxation of the lower esophageal sphincter, resulting in the forceful expulsion of gastric contents. To prevent functional vomiting after a loop colostomy, it is necessary to proceed in the direction of peristalsis, consistent with the direction of colonic peristalsis, and to reinforce the suture with 2 to 3 stitches at the proximal end of the anastomosis, suture the seromuscular layer to make the peristalsis direction more consistent. If the distal ileum is anastomosed to the proximal colon and the proximal ileum to the distal colon, the two anastomotic orifices should be about 5 cm apart to prevent reflux.

　　If the lesion does not cause complete obstruction of the intestinal lumen, it is a major mistake to seal the distal ileum and perform an end-to-side anastomosis of the proximal ileum at the site of the colon lesion. Because as the lesion progresses to complete obstruction, the secretion of intestinal mucosal secretions between the sealed orifice and the lesion increases, gradually expands, and can rupture to form peritonitis, which is a surgical error.

　　1. X-ray Examination:Abdominal X-ray shows dilated intestinal tract (intestinal obstruction near the site of the lesion).

　　2. Small Bowel Imaging:It shows that barium enters the distal intestinal tract through the anastomosis and some of it passes through the narrow part to enter the proximal intestinal tract, and then it is pushed into the distal anastomosis by peristalsis or moves backward to the anastomotic site by retroperistalsis.

　　3. Type B Ultrasound:The original colon lesion site and the proximal expanded intestinal tract can be palpated.

　　Functional vomiting is caused by the forceful expulsion of stomach contents due to the non-voluntary contraction of the abdominal muscles and the relaxation of the lower esophageal sphincter. Therefore, it is necessary to pay attention to eating in small portions and more frequent meals, choose light and easily digestible foods, supplement some high-quality proteins and essential amino acids, supplement potassium chloride and alkaline foods, and avoid lying down within half an hour after a meal, and avoid excessive activity.

　　Regardless of the etiology, the physician should ensure that the patient understands their discomfort and will try to alleviate their symptoms, avoiding the use of expressions such as 'Everything is normal' or 'This is an emotional issue'. Short-term use of antiemetics as symptomatic treatment may be tried, and long-term treatment should include supportive therapy, regular follow-up, which can help patients solve potential problems at this time. Drug treatment is mainly to improve vomiting symptoms, including anticholinergic drugs, antihistamines, antipsychotics, and prokinetic drugs.