TABLE 1
Anatomical structures related to CINV 5
Structure Activity
Vomiting
centre
Primary structure for coordinating nausea and vomiting;
a collection of neurons in the medulla oblongata
Chemoreceptor A specific location in the brain directly sensitive to agents
trigger zone
with known emetogenic potential
(CTZ)
Vagus nerve
Receives sensory information from abdominal organs
and an important source of stimuli to the CTZ and
vomiting centre
Nucleus tractus The main site for the termination of vagal afferents from
solitarius (NTS) the gut. Lies directly adjacent to the DMV and the AP
Dorsal motor
nucleus of the
vagus (DMV)
The area from which motor efferent signals from the
brain to abdomen originate
Area postrema Located on the caudal side of the fourth ventricle and is
(AP)
directly connected to the NTS and DMV that receive
emetic signals from the enterochromaffin cells
in the brain (Figure 1).
The central nervous system
plays a critical role in the
physiology of nausea and vomiting.
It serves as the primary site that
receives and processes a variety
of emetic stimuli and also has a
primary role in generating efferent
signals. These signals are sent to
a number of organs and tissues in
a process that eventually results
in vomiting. Specifically, signals
associated with luminal contents
are detected by vagal afferent
chemoreceptors in the mucosa
and relayed to the hindbrain by
a rapid and distinctive firing
pattern. Table 1 summarises the
anatomical structures related to
CINV.
It is now accepted that the
existence of a central vomiting
centre located in the medulla is
unlikely to exist as a discrete
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