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Small Animal Medicine II > Acute Vomiting > Flashcards

Acute Vomiting Flashcards

1
Q

Vomiting reflex:

A
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2
Q

What are 2 unique characteristics of vomiting?

A
  1. active abdominal contractions
  2. contains bile
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3
Q

What is acute vomiting? What 2 differentiations need to be made?

A

<10 days (7-14d)

  1. life-threatening vs. self-limiting
  2. systemic vs. GI disease
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4
Q

What are 7 important parts of a history in patients that are vomiting?

A
  1. duration and frequency of vomiting
  2. timing of vomiting in relation to eating or time of day
  3. contents
  4. dietary indiscretion
  5. appetite
  6. drug administration
  7. other clinical signs
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5
Q

What are 5 signs on physical examination seen in patients that are vomiting?

A
  1. dehydration - delayed CRT, tacky MM, skin tent, sunken eyes
  2. abdominal pain
  3. abnormal abdominal palpation - FB, mass, thickened stomach or intestines, organomegaly, fluid wave
  4. oral examination - string FB under tongue
  5. presence of systemic disease - icterus, encephalopathy, uremic breath, peripheral lymphadenopathy, bradycardia
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6
Q

What is acute gastritis? What are some possible causes?

A

sudden onset of vomiting related to gastric mucosal insult or inflammation

  • dietary indiscretion or intolerance
  • FB
  • drugs and toxins - NSAIDs, corticosteroids, heavy metals, antibiotics, plants, cleaners, bleach
  • systemic disease - uremia, liver disease, Addison’s
  • parasites - Ollulanus, Physaloptera
  • bacteria - toxins, Helicobacter
  • viruses
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7
Q

What are the 3 major GI differentials for vomiting?

A
  1. gastritis - dietary indiscretion (FB, table scraps, recent changes in diet), toxins (plants, chemicals), FB injures or irritates mucosa, drugs (antibiotics, NSAIDs)
  2. gastric FB
  3. hemorrhagic gastroenteritis
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8
Q

What are 6 major systemic differentials for vomiting?

A
  1. acute pancreatitis
  2. parvovirus
  3. renal failure
  4. endocrinopathies - Addison’s, DM, hyperthyroidism
  5. hepatobiliary disease
  6. toxins - grapes, raisins, xylitol, ethylene glycol
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9
Q

What are 4 findings that point to GI disease as a cause of acute vomiting? 2 systemic findings?

A

GI - masses or thickening palpated in GIT, significant diarrhea, otherwise normal, in association to eating

SYSTEMIC - ill prior, signs of systemic disease

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10
Q

What is the minimum database used for diagnosing self-limiting vomiting? What 2 things can be added?

A

PCV/TS - looking for signs of dehydration

  1. abdominal radiographs - r/o FB
  2. CBC/chem - r/o systemic disease and electrolyte/acid-base derangements
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11
Q

What are 3 parts to the minimum database for life-threatening vomiting?

A
  1. CBC/chem +/- UA
  2. abdominal radiographs and ultrasounds - look for FB, intestinal tract abnormalities, pancreatitis, GBM, organomegaly
  3. specific tests for systemic disease - PLI, basal cortisol
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12
Q

What are the most common biochemistry changes associated with acute vomiting? What else is seen?

A

hyponatremia + acidosis (decreased TCO2/HCO3) - typically mild, self-limiting, and due to dehydration

  • hypochloremia - loss of HCl
  • hypokalemia
  • alkalosis - increased TCO2/HCO3, severe loss of HCl, pyloric outflow tract obstruction
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13
Q

How can vomiting result in metabolic acidosis and alkalosis?

A

ACIDOSIS - dehydration, hypovolemia, increased lactic acid, loss of duodenal bicarbonate

ALKALOSIS - loss of H+ from stomach increases plasma HCO3, gastric outflow or proximal duodenal obstruction, hyponatremia, hypokalemia, hypochloremia (sever, persistent vomiting)

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14
Q

What biochemical changes are seen with possible systemic disease leading to vomiting?

A
  • renal disease = increased BUN/creatinine, inappropriate USG, acidosis
  • liver disease = increased ALT, ALP, Tbili
  • DM/DKA = hyperglycemia, glucosuria, ketonuria, acidosis
  • hypoadrenocorticism = hyponatremia, hyperkalemia, acidosis
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15
Q

What is the purpose of diagnostic imaging in cases of acute vomiting? What 2 are most commonly performed?

A

see if causes require surgery vs. supportive care

  1. abdominal radiographs - obstruction, radiopaque FB, peritoneal effusion
  2. abdominal U/S - FB, obstruction, intussusception, GBM, gastroenteritis, pancreatitis
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16
Q

How do patients with self-limiting vomiting most commonly present?

A
  • appear systemically healthy - BAR
  • minimal to no dehydration
  • cause likely to resolve without intervention

(gastroenteritis)

17
Q

How do patients with life-threatening vomiting most commonly present?

A
  • depressed
  • moderate to severe dehydration
  • persistent and severe vomiting
  • hematemesis
  • cause unlikely to resolve without aggressive supportive therapies
18
Q

What are 4 parts to treatment of life-threatening vomiting?

A
  1. IV fluid therapy
  2. antiemetics - Cerenia, Onsandestron +/- PPIs
  3. NPO - withhold food and water until vomiting decreases or stops
  4. remove FB via endoscopy or surgery
19
Q

What rates are recommended for hydrating patients with life-threatening vomiting?

A
  • estimated % dehydration (clinically detectable at 5%)
  • losses due to on going vomiting (estimate volume of vomitus)
  • maintenance - 60 mL/kg/day
20
Q

What electrolytes should be added to fluid therapy in patients presenting with life-threatening vomiting? How can acid-base derangement be treated?

A

potassium chloride (20 mEq/L) + isotonic crystalloids - LRS, 0.9% NaCl

if acidotic - LRS, alkalotic -.9% NaCl

21
Q

What 4 treatments are recommended for self-limiting vomiting?

A
  1. SQ fluids - LRS, 10-20 mL/kg/site
  2. NPO for 12 hours
  3. small frequent meals - highly digestible EN, i/d, RC GI (after resolution for 2-3 days add in usual diet over 3-5 days)
  4. antiemetics - r/o obstruction first!
22
Q

Dehydration:

A
23
Q

A patient with a history of acute vomiting over 4 days presents with the following CBC. What does this mean?

A

increased PCV/HCT = hemoconcentration, dehydration from vomiting

24
Q

A patient with a history of acute vomiting over 4 days presents with the following biochemistry panel. What does this mean?

A
  • high albumin - hemoconcentration
  • hyponatremia, hypokalemia, hypochloremia, high CO2 (equivalent to HCO3) = metabolic alkalosis - fluid pools in stomach due to gastric or duodenal outflow tract obstructions (FB?)
25
Q

What is occurring in this radiograph?

A
  • BLUE = FB in high duodenum
  • ORANGE = distended proximal duodenum
  • YELLOW = pylorus distended with fluid
  • caudal displacement of intestines

Small Animal Medicine II (57 decks)

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