ISSN 2398-2969      

Vomiting

icanis

Introduction

  • Clinical sign NOT a diagnosis therefore try to identify cause.
  • Differentiate between regurgitation, retching and true vomiting.
  • Cause: primary gastrointestinal or other abdominal conditions, secondary to systemic or metabolic disease or drug toxicity, secondary to neurological disease (cerebral or vestibular).
  • Diagnosis: biochemistry, urinalysis, radiography and ultrasonography, endoscopy all useful aids.
  • Treatment: depends on cause.
    Follow the diagnostic tree for Vomiting Vomiting.

Pathogenesis

Etiology

  • Visceral stimulation of vomiting center.
  • Central stimulation of vomiting center.
  • Vestibular stimulation of vomiting center.
  • Stimulation of chemoreceptor trigger zone (CRTZ).

Predisposing factors

General
  • Most often acute vomiting of uncertain cause; the majority of acute presentations are self-limiting.
  • A routine fecal exam for parasites Fecal analysis: parasites should be performed in all animals with GI signs.

Pathophysiology

  • The act of vomiting can be divided into three components: nausea, retching and vomiting.
Visceral stimulation
  • Distension of visceral organ/inflammation of visceral mucosa → neural stimulation (via sympathetic and vagal nerves) of vomiting center, located in the medulla oblongata of the brain.
CRTZ stimulation
  • Inflammation in CNS → increased intracranial pressure → stimulate chemoreceptor trigger zone (CRTZ) in brain → dopamine release from neurones → stimulation of vomiting center.
  • Toxins, toxic substances - uremia, ketoacidosis, drugs such as xylazine, morphine.
Vestibular stimulation
  • Irregular motion → disturbance in semi-circular canals → stimulation of vomiting center.
  • Labyrinthitis.
Vomiting
  • Dehydration.
  • Potassium depletion:
    • Minor loss in vomitus.
    • Urinary losses as kidney tries to maintain blood volume in face of dehydration and loss of gastric acid.
  • Acid base imbalances Acid base imbalance - usually metabolic acidosis. (Alkalosis suggests pyloric outflow obstruction with predominant loss of gastric acid.)

Timecourse

  • See specific conditions.

Diagnosis

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Treatment

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Elwood C M (2003) Investigation and differential diagnosis of vomiting in the dog. In Practice 25 (7), 374-386 VetMedResource.
  • Delles E K (1992) Chronic vomiting in the dog. Waltham Focus (2), 14-19 VetMedResource.

Other sources of information

  • Approach to the management of emesis in dogs: Current guidelines to 'best practice'. (2007)European Emesis Councilsupported by Pfizer Animal Health.
  • Twedt D C (2000)Vomiting. In:Textbook of Veterinary Internal Medicine.5th edn. Eds: S J Ettinger & E C Feldman. Philadelphia: W B Saunders Co. pp 119-121.
  • BSAVA Manual of Canine & Feline Gastroenterology(1996) D Thomas, J W Simpson & E Hall (Eds).

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