Projectile vomiting without nausea is a forceful expulsion of stomach contents without the usual preceding sensation of sickness. This presentation differs from typical vomiting and can signal an underlying medical issue.
Understanding the Specific Symptom
Projectile vomiting is the forceful and sudden expulsion of stomach contents, often traveling a significant distance. Unlike regular vomiting, it occurs without the usual preceding sensation of nausea or stomach discomfort. The absence of nausea is a key differentiating factor, as it suggests a different physiological mechanism at play compared to common vomiting triggers.
Causes in Infants and Children
In infants and young children, projectile vomiting without nausea can indicate several conditions. A common cause is pyloric stenosis, a thickening and narrowing of the pylorus, the muscular valve connecting the stomach to the small intestine.
Pyloric stenosis typically manifests in infants between 3 and 6 weeks of age, though it can occur up to 6 months. The thickened muscle prevents food from passing properly, leading to forceful, non-bilious vomiting, often immediately after feeding. Affected infants often remain hungry and eager to feed again. This condition can lead to dehydration and weight loss if not addressed.
Other causes in infants and children include certain infections. Meningitis, an inflammation of the membranes surrounding the brain and spinal cord, can present with vomiting, fever, and irritability. Severe gastroenteritis, while typically associated with nausea, can sometimes cause forceful vomiting. Less common causes include:
Certain food allergies
Other infections like ear infections or pneumonia
Intestinal obstructions
Potential Causes in Adults
In older children and adults, causes of projectile vomiting without nausea often differ from those in infants. Conditions that increase intracranial pressure are a primary category. These include brain tumors, hydrocephalus (an accumulation of cerebrospinal fluid in the brain), or severe headaches like migraines.
The mechanism involves activation of the chemoreceptor trigger zone in the brainstem, which initiates vomiting without nausea. Head injuries can also lead to elevated intracranial pressure and subsequent projectile vomiting. Less common causes include certain gastrointestinal issues, such as severe food poisoning or some types of intestinal obstruction.
When to Seek Medical Care
Prompt medical evaluation is important when experiencing projectile vomiting without nausea, especially in infants. Signs of dehydration are a concern and include:
Decreased urination (fewer than six wet diapers per day in infants)
Dry mouth and lips
Lack of tears when crying
A sunken soft spot on an infant’s head or sunken eyes
For adults: thirst, headache, fatigue, and decreased urine output
Additional signs indicating a need for immediate medical attention include fever, a stiff neck, or a severe headache, as these can suggest a neurological issue. Changes in consciousness or behavior, such as unusual drowsiness or irritability, also warrant urgent care. Any instance of blood in the vomit or persistent vomiting that prevents fluid intake requires immediate medical consultation.
Diagnostic Approaches
Diagnosing the cause of projectile vomiting without nausea begins with a medical history and physical examination. A healthcare professional will inquire about the vomiting’s onset, frequency, characteristics, and any associated symptoms. During the physical exam, especially in infants, the abdomen may be palpated for an “olive-shaped” mass characteristic of pyloric stenosis, or wavelike contractions may be observed.
Further diagnostic tests are often needed to identify the underlying condition. For suspected pyloric stenosis, an abdominal ultrasound is the standard imaging. If increased intracranial pressure is suspected, imaging studies like a CT scan or MRI of the brain may be performed. Blood tests are also commonly ordered to assess for dehydration and electrolyte imbalances. These investigations aim to pinpoint the specific cause to guide appropriate management.