Chronic Vomiting Flashcards
Describe the difference between vomiting and regurgitation
vomiting – active abdominal contractions, may contain bile, and pt may have nausea or salivation (vomiting makes u think of abdominal disease)
regurgitation – passive (makes u think more of esophageal dz)
what are 5 differentials for PRIMARY GI chronic vomiting?
- inflammatory bowel disease (SR, FR, or SIBO/AR)
- Neoplasia (lymphoma or gastric adenocarcinoma)
- parasites (ascarids/round worms, physaloptera, hookworms)
- idiopathic gastritis
- chronic gastric foreign body
what are 5 extra-GI / systemic differentials for chronic vomiting?
- hyperthyroidism
- chronic pancreatitis
- hepatobiliary disease
- chronic kidney disease
- hypercalcemia
what are differentials for weight loss with a NORMAL appetite?
- enteropathy – IBD, neoplasia, parasites
- exocrine pancreatic insufficiency
- metabolic – hyperthyroidism, diabetes mellitus
what would be a good diagnostic plan for a patient with chronic vomiting?
- rule out systemic disease 1st – CBC/Chem/UA, and T4
- rule out parasites – zinc sulfate fecal
- ultrasound – identify neoplasia, IBD, and foreign bodies
- diet trial – rule out food responsive IBD
when BOTH the albumin and the globulins are low on the CBC, what are potential causes?
protein-losing enteropathy
hemorrhage
if the globulins were normal or increased, you’d think more protein-losing nephropathy or liver failure.
When ruling out food-responsive IBD, what diet do you place the patient o and for how long?
strict hydrolyzed or novel protein for 3 weeks.
A patient comes to you 7% dehydrated, anorexic, and has a been vomiting for 14 days on and off. This patients mentation is dull. The owners mention that they did place the dog on new food 2 months ago. Would it be an appropriate next step to recommend a diet trial to rule out food-responsive IBD?
no – food trials are only recommended in stable patients.
At what value does a panhypoproteinemia need to go below in order for life-threatening effusion to occur?
< 1.5
If you perform an ultrasound on a dog that presented for chronic vomiting and you find a thickened portion of the muscularis. What is your concern and how would you further diagnose the problem?
cancer or IBD
you could differentiate by doing a biopsy – surgical or endoscopic.
What is the benefit of surgical biopsy over endoscopic?
surgical provides a full-thickness biopsy and you can have access to all portions of the small intestines.
endoscopic biopsies are technically less invasive (& therefore less risk) but they only biopsy the mucosa and +/- the submucosa AND they only provide access to the stomach, duodenum, and ileum.
What histopathology finding is consistent with steroid-responsive inflammatory bowel disease?
lymphoplasmacytic enteritis/gastritis
if there were eosinophils, then it would more likely have been parasites or food-responsive inflammatory bowel disease
what is the treatment for inflammatory bowel disease that is NOT food-responsive or parasitic?
prednisone (immunosuppressive dose) and then recheck in 2 weeks.
during recheck, looking for resolution of clinical signs, gaining weight, blood chemistry normal (Albumin in normal range), and plasma proteins normal.
one those clinical signs are well-controlled and the bloodwork looks normal for TWO weeks, then you can slowly start to taper the pred dose by 25% every 2-3 weeks until you get to the lowest effective dose.
What are side effects of prednisone?
- Diabetes mellitus (monitor BG)
- skin fragility
- weight gain
- polyphagia
- PU/PD
- increased risk of infection
what long-acting steroid is tolerated better by cats than prednisolone?
budesonide
