Podcast
Questions and Answers
What is a common indication for surgical exploration?
What is a common indication for surgical exploration?
Which of the following is NOT a component of symptomatic therapy for vomiting?
Which of the following is NOT a component of symptomatic therapy for vomiting?
Which anti-emetic is often used to manage vomiting related to motion sickness?
Which anti-emetic is often used to manage vomiting related to motion sickness?
What fluid type is commonly used in intravenous therapy for dehydration?
What fluid type is commonly used in intravenous therapy for dehydration?
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Which medication is considered an opioid for analgesia?
Which medication is considered an opioid for analgesia?
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Which gastrointestinal condition does NOT typically lead to vomiting?
Which gastrointestinal condition does NOT typically lead to vomiting?
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What is a common cause of vomiting related to metabolic/endocrine disorders?
What is a common cause of vomiting related to metabolic/endocrine disorders?
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Which extra-gastrointestinal condition is associated with trauma?
Which extra-gastrointestinal condition is associated with trauma?
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Which of the following is a complication of small intestinal conditions?
Which of the following is a complication of small intestinal conditions?
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Which of the following is NOT a diagnostic plan component for investigating vomiting?
Which of the following is NOT a diagnostic plan component for investigating vomiting?
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What can renal disease cause that relates to gastrointestinal symptoms?
What can renal disease cause that relates to gastrointestinal symptoms?
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What physical examination sign could indicate dehydration?
What physical examination sign could indicate dehydration?
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Which condition is most likely to cause abdominal disorders in relation to toxins or drugs?
Which condition is most likely to cause abdominal disorders in relation to toxins or drugs?
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Which of the following gastrointestinal conditions involves neoplasia?
Which of the following gastrointestinal conditions involves neoplasia?
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Which laboratory work parameters can indicate azotaemia?
Which laboratory work parameters can indicate azotaemia?
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What is a possible consequence of not considering a patient's signalment in history taking?
What is a possible consequence of not considering a patient's signalment in history taking?
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What type of history is essential when investigating vomiting?
What type of history is essential when investigating vomiting?
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What does the presence of hyperglycaemia in laboratory results indicate?
What does the presence of hyperglycaemia in laboratory results indicate?
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Which of these is a primary source of vomiting due to gastrointestinal conditions?
Which of these is a primary source of vomiting due to gastrointestinal conditions?
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In what situation is endoscopy most likely contraindicated?
In what situation is endoscopy most likely contraindicated?
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Which form of testing is indicated for assessing gastrointestinal diseases?
Which form of testing is indicated for assessing gastrointestinal diseases?
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What common pitfall occurs when evaluating a patient's appetite during history taking?
What common pitfall occurs when evaluating a patient's appetite during history taking?
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Which of the following is a hallmark of a painful patient during physical examination?
Which of the following is a hallmark of a painful patient during physical examination?
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What is the initial phase of vomiting characterized by pro-dromal signs such as depression and lip-licking?
What is the initial phase of vomiting characterized by pro-dromal signs such as depression and lip-licking?
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During vomiting, what physiological response occurs to prevent aspiration as the material passes through the pharynx?
During vomiting, what physiological response occurs to prevent aspiration as the material passes through the pharynx?
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Which structure receives input from the vestibular nucleus to trigger vomiting?
Which structure receives input from the vestibular nucleus to trigger vomiting?
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What differentiates regurgitation from vomiting?
What differentiates regurgitation from vomiting?
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Which of the following is NOT a potential reason for a patient to vomit?
Which of the following is NOT a potential reason for a patient to vomit?
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Which of the following is a potential medical intervention for managing vomiting?
Which of the following is a potential medical intervention for managing vomiting?
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What should be prioritized when creating a differential diagnosis list based on vomiting?
What should be prioritized when creating a differential diagnosis list based on vomiting?
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What is a welfare implication of treatment options for vomiting in companion animals?
What is a welfare implication of treatment options for vomiting in companion animals?
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Study Notes
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.
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Description
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.
