Veterinary Clinical Medicine-I (General and Systemic)

CLINICAL APPROACH TO VOMITING

Clinical approach

• History: gagging, coughing, regurgitation, dysphagia
• Young unvaccinated animal- check for infectious diseases- parvo/CD vaccination/ travel/ medical problem/ medication/ NSAID
• Age of the animal - assess– weaning- vascular ring anomaly; projectile- gastric outflow obstruction
• Breed: GDVin deep chested dogs- Setter boxer, GSD; pyloric stenosis in brachycephalic breeds- boxer
• Check for Ingestion of toxins/ foreign bodies
• Rule out Systemic diseases/ metabolic diseases, polyuria/ polydipsia, weight loss- ketoacidosis, renal failure
• Assess vomiting episode: duration frequency, relationship with eating/ drinking, description of the vomitus
• Dietary clue:  type of diet, change- adverse reaction to food.
• Vomitus with fecal odour- low intestinal obstruction or SIBO
• Bile in vomitus- no pyloric obstruction
• Blood in vomitus: fresh bright red or digested blood that has coffee ground appearance- GI erosion / ulceration.
• Hematemesis- metabolic related ulcers uremia, NSAID, gastric neoplasms.
• Examination of  oral cavity: icteric mm, uremic breath, ulceration or linear foreign body around the base of the tongue.
• Fever- infectious/ inflammatory process.
• Bradycardia or cardia arrhythmia sign of metabolic disturbance
• Abdomen palpated for distension and tympany (GDV) effusion

Hematology

•  Neutrophilia with left shift- sepsis or inflammatory disease - pyometra                         

General treatment and management of vomiting animal

• To correct / remove the primary cause
• To control vomiting episode- alleviating further loss of fluid and electrolytes
• To correct fluid and electrolyte or acid- base disturbances.
• NPO (Nothing per os) for 24 hrs
• After 12 hrs offer small amount of water or ice cubes
• After 24 hrs if water is tolerated, introduce bland carbohydrate== cooked rice, lean minced beef, chicken, cottage cheese, baby food. Avoid diet high in fat/ protein
• Initially split total daily requirement into 3-4 small meals
• Fluid therapy- loss of sodium, potassium chloride; hypokalemia with metabolic acidosis
• PCV total protein - animal’ s dehydration status
• Anaemia- bleeding GI lesions, CRF
• Lipase/ amylase- pancreatitis - acute vomiting/ pain - plain radiograph are inconclusive
• Urinalysis: fractional excretion of sodium
• pH of vomitus - regurgitation - alkaline; vomitus- acidic
• ECG- hypoadrenocorticism vomiting is associated with bradycardia and signs of hypovolemic shock
• Radiography/ Endoscopy/ laparotomy
• Leukopenia (with or without left shift) gram-negative sepsis salmonella/ viral infection