Vomiting Flashcards
(31 cards)
primary GI causes of vomiting
- dietary indiscretion
- GI foreign body
- GI neoplasia
- pancreatitis
- infectious gastroenteropathy
- IBD
extra-GI causes of vomiting
- liver disease
- renal disease
- hyperthyroidism
- toxins
- Addison’s
- heartworm
is vomiting due to small bowel disease more common in dogs or cats
cats
dogs - diarrhea w/ small bowel disease
what are the two main pathways of the vomiting reflex
- humoral (blood borne) –> CRTZ
- neural –> vomiting center
what are the major visceral receptors
5HT3
substance P
located in the GIT, peritoneum, bile duct epithelium
is dopamine receptors more relevant for vomiting in dogs or cats
dogs - D2 receptors are a strong component of vomiting reflex
what vomiting-related drugs are used in dogs that are not effective in cats
- apomorphine - D2 agonist, induces vomiting
- metoclopramide - D2 antagonist, antiemetic
what components send input to the vomiting center
- cerebral cortex - anticipatory emesis
- vestibular nuclei - motion sickness
- CRTZ - blood borne
- pharynx & GIT - gastroenteritis
cat vs dog vestibular nuclei pathway
cats: direct input from vestibular nuclei to the vomiting center
dogs: vestibular nuclei feeds input to the CRTZ which sends info to the vomiting center
regurgitation vs vomiting
regurgitation:
- passive (no contractions)
- no prodromal nausea
- seconds to hours after meal
- undigested material
vomiting:
- active
- prodromal nausea
- minutes to hours after meal
- undigested or digested material
what are signs of severe disease in vomiting patients
- fever
- melena/hematochezia
- weakness
- anorexia < 48 hours
- abdominal pain
- vomiting of coffee grounds or frank blood
- pale, icteric, or muddy MM
- enlarged abdominal organs or peripheral LNs
diagnostics for acute vomiting
- PCV/TP
- glucose
- azostix
- USG
- abdominal radiographs
- +/- fecal float
- +/- resting cortisol
management of acute vomiting
- isotonic crystalloid fluids
- LF diet
- antiemetics
- broad spectrum Ab (young animals)
should vomiting animals be given gastric acid suppressants
only if worried about a GI bleed (iron deficiency anemia)
diagnostics for chronic vomiting
- minimum database
- fecal floatation
- serum T4
- serum B12/folate
- FeLV/FIV
- abdominal US/radiographs
- resting cortisol
- serum bile acids
- spec PLI
- liver aspirate/biopsy
- GI biopsy
pros and cons of endoscopy
pros: less invasive, can visualize the stomach, duodenum, proximal jejunum, and able to collect many punch biopsies
cons: can not collect full thickness biopsies,
pros and cons of laparotomy
pros: can get full thickness biopsies
cons: more invasive, only a single biopsy collected, have to use opioids (post op ileus)
gastritis
non specific inflammation of the stomach
what is a very common infectious cause of gastritis
helicobacter pylori
common GI bacteria in HEALTHY dogs/cats but can cause gastritis
diagnosis of H. pylori
gastric biopsy
histopath: lymphofollicular gastritis
treatment of H. pylori
triple therapy x2 weeks
- clarithromycin
- metronidazole
- PPI
can IBD affect the stomach
yes
when is the use of antiemetics indicated vs contraindicated
- intractable vomiting
- risk of aspiration pneumonia
- secondary acid-base or electrolyte derangements
contraindications:
- obstruction
- toxin ingestions
gastric acid suppressants
- PPIs (omeprazole, pantoprazole)
- H2 antagonists (famotidine)
