Vomiting in Companion Animals

Approach to Vomiting in Companion Animals

• This presentation covers approaches to understanding and treating vomiting in companion animals.
• Key learning objectives include constructing differential diagnoses, choosing appropriate diagnostics, determining medical and surgical interventions, assessing prognosis, considering welfare implications, and developing disease prevention strategies.

What is Vomiting?

• Vomiting is an active process involving several stages.
• Nausea: Pro-dromal signs like depression, shivering, hiding, yawning, lip-licking, increased salivation, and swallowing.
• Retching: Forceful contraction of abdominal muscles and diaphragm.
• Expulsion: Pressure changes force gastric content to the esophagus and mouth, as the material passes through the pharynx, respiration is inhibited, and the nasopharynx and glottis close to prevent aspiration.

What is Regurgitation?

• Regurgitation is a normal, voluntary process.
• Expulsion of material from the pharynx or esophagus.
• It does not involve nausea or retching; it's the effortless return of recently ingested food.

Why Do Patients Vomit?

• Vomiting can stem from various causes classified as either gastrointestinal or extra-gastrointestinal conditions.
• Gastrointestinal causes include conditions within the stomach (gastritis, gastric ulcers, neoplasia, motility disorders), small intestine (inflammation, foreign bodies, intussusception, infections, neoplasia), and large intestine (inflammation, obstipation, neoplasia).
• Extra-gastrointestinal conditions involve issues like metabolic/endocrine disorders (diabetic ketoacidosis, hypoadrenocorticism, renal disease, hepatic disease), toxins/drugs, abdominal disorders (pancreatitis, peritonitis, hepatobiliary disease, pyometra), or neurological disorders (vestibular disease, pain, smell, trauma, encephalitis).

Gastrointestinal Conditions

• Gastric: Gastritis, gastric ulceration, neoplasia, motility disorders, GDV, foreign body, pyloric stenosis, hiatal hernia.
• Small intestine: Inflammation (IBD), neoplasia, foreign body, intussusception, infection.
• Large intestine: Inflammation (IBD/Colitis), obstipation, infection, neoplasia.

Extra-Gastrointestinal Conditions

• Metabolic/endocrine: Diabetic ketoacidosis, hypoadrenocorticism, renal disease, hepatic disease, endotoxaemia, electrolyte disorders, hyperthyroidism.
• Toxins/drugs: NSAIDs, antibiotics, cyclosporin, methimazole, chemotherapy, poisons.
• Abdominal: Pancreatitis, peritonitis, neoplasia, hepatobiliary disease, pyometra.
• Neurological: Vestibular, pain, smell, trauma, encephalitis

Investigation of Vomiting

• History: Acute versus chronic, GI versus extra-GI,duration, frequency, severity, emesis contents, toxin/drug exposure, scavenging/foreign body, faecal consistency, demeanour, weight loss, appetite, changes in diet, thirst, urination, and pain.
• Physical examination: Look for specific signs (painful, bloated, icterus, solid structure, head tilt) and serious signs (pyrexia, tachycardia, weak pulses, dehydration).
• Diagnostic plan: Laboratory testing (PCV/total solids, glucose, urea/creatinine, electrolytes, urine, specific gravity, dipstick), imaging (X-ray, ultrasound), cytology/histopathology, surgical exploration, infectious disease testing.

Laboratory Work

• Minimum database includes PCV/total solids, glucose, urea/creatinine, electrolytes, and urine.
• Further testing (full haematology, biochemistry, coagulation testing, cortisol, bile acids, total T4, CPLI, fPLI) is done depending on the findings.
• Infectious disease testing can include stool examinations for parvovirus and FeLV.

Radiography & Ultrasound

• Imaging plays a vital role in identifying underlying conditions, including the gastrointestinal tract and surrounding organs.

Endoscopy

• Used to visualize the gastric tract for foreign bodies, ulcers, neoplasia, and inflammation.

Surgical Exploration

• Indications for surgical intervention may include gastric/intestinal foreign body, gastrointestinal neoplasia, GDV, abdominal neoplasia, septic peritonitis, or pyometra.

Treatment

• Acute Vomiting: Symptomatic treatment with anti-emetics (maropitant, metoclopramide, ondansetron), analgesia (opioids, tramadol, lidocaine), gastric protectants, and intravenous fluids (Hartmann's solution, sodium chloride, colloids).
• Chronic Vomiting: Disease-specific therapy tailored to the underlying condition, might include surgery, dietary changes, chemotherapy, and treatment for extra-GI conditions.

Preventative Measures

• Implement disease prevention strategies tailored to the individual pet's needs and risk factors.

Summary

• Determine if vomiting or regurgitation, acute or chronic, gastrointestinal or extra-gastrointestinal.
• Comprehensive investigation is crucial.
• Symptomatic treatment may be necessary but requires careful monitoring.

This quiz explores the mechanisms and treatment approaches related to vomiting in companion animals. It covers differential diagnoses, diagnostic choices, and both medical and surgical interventions. Understanding the implications for animal welfare and prevention strategies is also emphasized.