9.5.1: Intestinal causes of vomiting

Question 1

Signs of nausea

Answer 1

• Hypersalivation
• Lethargy
• Anorexia
• Lip-smacking
• Burping

Question 2

What factors could affect the CRTZ and therefore cause vomiting?

Answer 2

Question 3

What factors could affect the vomiting centre in the brain and therefore cause vomiting?

Answer 3

Question 4

What factors could affect the vestibular apparatus and therefore cause vomiting?

Answer 4

Question 5

What factors could affect / locations could be affected with regards to peripheral recetors, therefore causing vomiting?

Answer 5

Question 6

1-10

Answer 6

Question 7

11-20

Answer 7

Question 8

21-30

Answer 8

Question 9

Key questions to help you work out if the patient is vomiting?

Answer 9

• What does the patient look like at the time i.e. are they nauseous, showing abdominal effort and hypersalivation?
• How long does it take?
• What do they bring up?
• When does it happen?
• Is there any discernible reason why this happens?

Question 10

How would you localise vomiting to neuro disease related to the vomiting centre?

Answer 10

Perform a neurological exam

Question 11

How would you localise vomiting to the vestibular appartus?

Answer 11

• Perform a clinical (+ neuro) exam

Question 12

How would you localise vomiting as being caused by the CRTZ?

Answer 12

• Will see blood derangements -> biochemistry
• Toxin history

Question 13

How would you localise vomiting as being caused by peripheral receptors?

Answer 13

• Look for inflammation/ distension of organs
• Clinical exam + imaging (ultrasound, radiography)

Question 14

True/false: if vomiting is intestinal in origin, you would expect to see major abnormalities on bloods that specifically relate to this.

Answer 14

False
With intestinal causes of vomiting, often have normal or non-specific findings on bloods

Question 15

1

Answer 15

Question 16

2

Answer 16

Question 16

3

Answer 16

Question 16

4

Answer 16

Question 16

5

Answer 16

Question 17

Acute intestinal vomiting - differentials

Answer 17

• Trauma / obstruction e.g. FB, intussusception
• Toxin e.g. dietary indiscretion, drugs (NSAIDs, steroids, antibiotics, chemotherapy)
• Inflammatory (=acute enteritis) - may be immune mediated or infectious
• Acute pancreatitis, diabetic ketoacidosis will also cause sudden onset vomiting

Question 18

Causes of acute enteritis - immune mediated

Answer 18

• Dietary indiscretion
• Idiopathic (lymphocytic plasmacytic / eosinophilic gastroenteritis)

Question 19

Causes of acute enteritis - infectious

Answer 19

• Bacterial: salmonella, campylobacter, clostridia, E. coli
• Viral: parvovirus / feline panleucopenia, coronavirus, distemper, rotavirus, enteroviruses, astroviruses and others
• Protozoal: isospora, cryptosporidium, giardia, tritrichomonas in cats
• Parasitic: Toxocara canis / cati, taenia, trichuris, uncinaria, dipylydium
• Fungal unlikely

Question 20

Toxins that cause vomiting

Answer 20

• Ethylene glycol (antifreeze)
• Raisins or grapes
• Theobromine (chocolate)
• Heavy metal / lead
• Daffodils, ivy, bluebells, lilies
• Conkers and acorns
• Amanita phalloides
• Adder bites, toads
• Luminous necklaces