Vomiting

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.

Diagnosis

Differential diagnosis

• Acute gastritis .
• Gastric foreign body .
• Pyloric outflow obstruction .
• Gastric dilatation/volvulus .
• Neoplasia .
• Chronic gastritis .
• Hemorrhagic gastroenteritis .
• Parasitism.
• Gastric ulceration associated with toxemia, drugs (eg NSAIDs), neoplasia, uremia.
• Gastric polyps.
• Canine coronavirus .
• Canine distemper .
• Canine parvovirus .
• Pyloric stenosis.
• Hiatal hernia.
• Chronic hypertrophic pyloric gastropathy.

• Obstruction :
• • Foreign body .
  • Intussusception .
  • Neoplasia .
• Parvovirus .
• Ileus .
• Colitis .
• Inflammatory bowel disease .
• Constipation .
• Extraintestinal pressure on GI tract, eg pregnancy , splenomegaly.
• Motility disorders, eg dysautonomia .

Abdominal

• Pancreatitis .
• Pancreatic neoplasia.
• Prostatic infection.
• Peritonitis .
• Hepatobilary disease.
• Splenic disease, eg torsion.
• Metritis.

Metabolic

• Endocrine disease:
  • Hypoadrenocorticism .
  • Ketoacidotic diabetes mellitus .
  • Hypercalcemia .
• Toxemia:
  • Pyometra .
  • Renal failure , hepatic failure .
  • Drugs, eg erthyromycin .
  • Exogenous toxins, eg lead .

• Motion sickness and vestibular disease.
• Central nervous system diseases, eg neoplasia, infection, inflammation.
• Side-effect of some drugs, eg antineoplastic agents , cardiac glycosides .
• Ingestion of toxins.

Sequelae

Prognosis

• If vomiting episodes are acute and of short duration, they may be self-limited and are frequently treated with symptomatic therapy.
• See specific diseases.

Sources

Publications

Refereed papers

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

Other sources of information

• Approach to the management of emesis in dogs: Current guidelines to 'best practice'. (2007) European Emesis Council supported 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).