Clinical approach to vomiting

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
Last modified: Monday, 28 May 2012, 7:09 AM