Chronic Vomiting Flashcards
Describe the difference between vomiting and regurgitation
vomiting – active abdominal contractions, may contain bile, and pt may have nausea or salivation (vomiting makes u think of abdominal disease)
regurgitation – passive (makes u think more of esophageal dz)
what are 5 differentials for PRIMARY GI chronic vomiting?
- inflammatory bowel disease (SR, FR, or SIBO/AR)
- Neoplasia (lymphoma or gastric adenocarcinoma)
- parasites (ascarids/round worms, physaloptera, hookworms)
- idiopathic gastritis
- chronic gastric foreign body
what are 5 extra-GI / systemic differentials for chronic vomiting?
- hyperthyroidism
- chronic pancreatitis
- hepatobiliary disease
- chronic kidney disease
- hypercalcemia
what are differentials for weight loss with a NORMAL appetite?
- enteropathy – IBD, neoplasia, parasites
- exocrine pancreatic insufficiency
- metabolic – hyperthyroidism, diabetes mellitus
what would be a good diagnostic plan for a patient with chronic vomiting?
- rule out systemic disease 1st – CBC/Chem/UA, and T4
- rule out parasites – zinc sulfate fecal
- ultrasound – identify neoplasia, IBD, and foreign bodies
- diet trial – rule out food responsive IBD
when BOTH the albumin and the globulins are low on the CBC, what are potential causes?
protein-losing enteropathy
hemorrhage
if the globulins were normal or increased, you’d think more protein-losing nephropathy or liver failure.
When ruling out food-responsive IBD, what diet do you place the patient o and for how long?
strict hydrolyzed or novel protein for 3 weeks.
A patient comes to you 7% dehydrated, anorexic, and has a been vomiting for 14 days on and off. This patients mentation is dull. The owners mention that they did place the dog on new food 2 months ago. Would it be an appropriate next step to recommend a diet trial to rule out food-responsive IBD?
no – food trials are only recommended in stable patients.
At what value does a panhypoproteinemia need to go below in order for life-threatening effusion to occur?
< 1.5
If you perform an ultrasound on a dog that presented for chronic vomiting and you find a thickened portion of the muscularis. What is your concern and how would you further diagnose the problem?
cancer or IBD
you could differentiate by doing a biopsy – surgical or endoscopic.
What is the benefit of surgical biopsy over endoscopic?
surgical provides a full-thickness biopsy and you can have access to all portions of the small intestines.
endoscopic biopsies are technically less invasive (& therefore less risk) but they only biopsy the mucosa and +/- the submucosa AND they only provide access to the stomach, duodenum, and ileum.
What histopathology finding is consistent with steroid-responsive inflammatory bowel disease?
lymphoplasmacytic enteritis/gastritis
if there were eosinophils, then it would more likely have been parasites or food-responsive inflammatory bowel disease
what is the treatment for inflammatory bowel disease that is NOT food-responsive or parasitic?
prednisone (immunosuppressive dose) and then recheck in 2 weeks.
during recheck, looking for resolution of clinical signs, gaining weight, blood chemistry normal (Albumin in normal range), and plasma proteins normal.
one those clinical signs are well-controlled and the bloodwork looks normal for TWO weeks, then you can slowly start to taper the pred dose by 25% every 2-3 weeks until you get to the lowest effective dose.
What are side effects of prednisone?
- Diabetes mellitus (monitor BG)
- skin fragility
- weight gain
- polyphagia
- PU/PD
- increased risk of infection
what long-acting steroid is tolerated better by cats than prednisolone?
budesonide
When should you consider adding secondary immunosuppressants?
consider if inflammatory bowel disease is not well controlled with prednisone alone or if the patient cannot tolerate steroids long-term.
what are the 2 secondary immunosuppressants available?
- chloambucil
- cyclosporine
if you start a patient on immunosuppressants PRIOR to getting a definitive diagnosis, what are potential consequences of this?
difficulty interpreting future biopsies if needed and if its something like histoplasmosis, and you are immunpsuppressing and you’ll worsen it.
What are components of supportive care for individuals with inflammatory bowel disease?
- Antiemetics (cerenia_ – NK-1 receptor antagonist that inhibits binding of substance P
- Ondansetron (5-HT3 receptor antagonist, binds on the vagal nerve and the CRTZ)
these can be used together.
what is the treatment for small cell GI lymphoma that is causing chronic vomiting?
pred + chlorambucil
what test would you recommend if IBD could not be differentiated from small cell lymphoma on histopathology?
PARR (PCR test)
what are causes of chronic vomiting that are MORE likely in dogs that in cats?
dietary indiscretion
bilious vomiting syndrome
pyloric hypertrophy
hypoadrenocorticism (addisons)
