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1042 Vomiting, Chronic

Vomiting, Chronic Client Education
Sheet
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BASIC INFORMATION
○ Administration of potentially ulcerogenic
bowel disease, hepatic disease, pancreatitis,
drugs (e.g., NSAIDs, glucocorticoids) • Intraabdominal disorders (e.g., inflammatory
Definition ○ Possibility of foreign body ingestion food intolerance/allergy, foreign body, GI
• Active expulsion of stomach and sometimes ○ Use of dewormers or prophylactic parasites, neoplasia)
duodenal contents preceded by nausea and parasiticides
retching • If vomiting of undigested or partially digested Initial Database
• Intermittent or persistent vomiting for more food occurs 7-10 hours after ingestion, gastric CBC, serum biochemistry profile (including
than 7 days outflow obstruction or gastric hypomotility sodium and potassium), urinalysis, and fecal
• Chronic vomiting is a very common clini- is likely. exam are indicated for essentially all pets with
cal sign and can be associated with a wide chronic vomiting.
variety of gastrointestinal (GI) and non-GI PHYSICAL EXAM FINDINGS • Serum T 4 (adult cats)
disorders. A thorough physical exam is mandatory but • Abdominal imaging: radiographs and/or
may be unremarkable. Extra attention is war- ultrasound
Synonym ranted regarding • With hematemesis: check drug history,
Chronic emesis • Hydration status coagulation (p. 380)
• Mouth inspection (sublingual linear foreign
Epidemiology body in cats, ulcerations) Advanced or Confirmatory Testing
SPECIES, AGE, SEX • Abdominal palpation (abdominal mass, Additional diagnostics depend on results of
• Any animal can be affected; epidemiology thickened bowel loops) screening tests. Commonly indicated tests:
depends on the underlying cause. • Rectal exam (presence of melena or • ACTH stimulation test: hypoadrenocorti-
• Young animals are more likely to ingest hematochezia) cism
foreign bodies; older animals are more likely • Palpation of the neck for thyroid nodule • Canine or feline pancreatic lipase immu-
to have neoplastic disease, hyperthyroidism, (essential for cats > 6 years old) noreactivity or 1,2-O-dilauryl-rac-glycero-
kidney failure. Other findings may relate to cause of vomiting: 3-glutaric acid-(6′-methylresorufin) ester
• Small kidneys in animal with uremic (DGGR) study: pancreatic disease
GENETICS, BREED PREDISPOSITION vomiting • Serum folate and cobalamin: small intestinal
• Brachycephalic breeds: pyloric stenosis • Enlarged salivary glands in dog with phe- disease
• Airedale terrier: pancreatic carcinoma nobarbital responsive sialadenitis • Heartworm antigen testing (cats)
• Shar-pei, rottweiler, German shepherd: • Cutaneous nodules with mast cell–induced • In rare cases, GI contrast studies may be
inflammatory bowel disease (IBD) GI ulcers indicated to evaluate motility disorders or
gastric outflow obstruction.
RISK FACTORS Etiology and Pathophysiology • If tests fail to identify another cause for
Depends on cause of vomiting (e.g., use of • Stimulation of humoral (blood-borne sub- chronic vomiting, gastroduodenoscopy or
NSAIDs is risk factor for gastric ulcer; absent stances) or neural (especially by receptors exploratory celiotomy with GI and hepatic
prophylaxis risk factor for parasites) located throughout the GI tract) pathways biopsies is indicated.
can lead to activation of the vomiting center.
CONTAGION AND ZOONOSIS • Certain drugs, uremic toxins, and electrolyte, TREATMENT
Zoonotic potential of Helicobacter heilmannii osmolar, or acid-base disorders can activate
and Helicobacter felis is unclear. the chemoreceptor trigger zone and cause Treatment Overview
vomiting. Goals are supportive treatment (if needed) and
ASSOCIATED DISORDERS correction of the underlying cause.
Hypochloremic metabolic alkalosis, dehydration DIAGNOSIS
and hypovolemia, metabolic acidosis, weight Chronic Treatment
loss Diagnostic Overview • Address any identified underlying disease or
Differentiation of systemic causes from GI disorder, as appropriate.
Clinical Presentation causes begins with history and physical exam. • If the patient seems otherwise healthy and
DISEASE FORMS/SUBTYPES Routine blood and urine tests and abdominal initial database fails to identify abnormalities,
Vomiting animals may appear healthy or may imaging (radiographs and/or ultrasonogra- dietary therapy alone can be attempted. If the
have signs of systemic disease (e.g., icterus, phy) are warranted. If a cause is not found, response is insufficient, further diagnostics
dehydration, depression). specific tests (e.g., ACTH stimulation/resting are necessary, followed by specific treatment
cortisol in dogs, serum T 4 in adult cats) should based on results.
HISTORY, CHIEF COMPLAINT be considered. Prophylactic broad-spectrum ○ Dietary manipulations (often low-fat,
• It is important to differentiate vomiting from deworming and diet trial are usually indicated. hypoallergenic diets containing a single
dysphagia and regurgitation. Ultimately, failing a conclusive diagnosis from and novel source of protein)
○ Vomiting involves forceful retching and these measures, the proximal GI tract is assessed • Antiemetics (e.g., maropitant 1 mg/kg SQ
abdominal contraction and may produce endoscopically and histologically. or 2 mg/kg PO q 24h, maximum duration
bile-stained contents. of 5 days, or metoclopramide 0.2-0.4 mg/
• Important questions Differential Diagnosis kg SQ q 8h) can be used empirically after
○ Description of vomiting (active retch), A detailed differential diagnosis is provided the presence of a foreign body is ruled out,
time in relation to food intake, character on p. 1294. but it does not substitute for addressing
of the vomitus (e.g., possible hematemesis) • Extraabdominal disorders (e.g., uremia, the cause of vomiting. Metoclopramide
○ Diet history, including effect of various hypoadrenocorticism, hyperthyroidism, can cause lethargy and restlessness, especially
diets on clinical signs heartworm infection [cats]) in cats.

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