Chronic Vomiting Flashcards
Where is the primary issue located with regurgitation vs vomiting?
Regurgitation- esophageal disease
Vomiting- problem in abdomen
What is the best questions to ask an owner to determine if a problem is vomiting vs regurgitation?
Presence of abdominal contractions, bile present, can owners tell its going to happen beforehand, any nausea or salivation
- otherwise how vomit looks is not a good indicator
What additional history questions are good to ask in vomiting cases?
Does the vomiting occur at a certain time of day? (biliary vomitous syndrome more likely to occur in morning on empty stomach)
Does the pet eat things it shouldn’t?
Is the pet given any medications or supplements?
Is the pet given any extra food in addition to their normal diet?
What does the vomit look like- blood or coffee ground appearance?
In chronic vomiting cases, what are the main two categories of diseases that may be responsible?
Primary GI disease or extra-GI/systemic
What are some primary GI disease that can cause chronic vomiting in cats?
- Neoplasia- lymphoma (large cell has worst prognosis), adenocarcinoma, mast cell
- Inflammatory bowel disease (steroid or food responsive)
- parasites (roundworms, physaloptra, hookworms)
- chronic foreign body (stomach FB intermittently blocks pylorus)
- idiopathic gastritis
Why is antibiotic responsive IBD not commonly a differential for chronic vomiting?
They often also have chronic diarrhea in these cases
Why are whipworms not a differential for chronic vomiting in a cat?
Tend to affect the large colon and cause diarrhea moreso than vomiting
- also somewhat rare in cats compared to dogs
What are some extra GI/ systemic causes of chronic vomiting in cats?
- chronic kidney disease (poor appetite)
- hyperthyroidism
- chronic pancreatitis (poor appetite)
- hepatobiliary disease (poor appetite)
- hypercalcemia (causes dysmotility of GI tract)
What are differentials for chronic vomiting that are seen more often in dogs than cats?
Bilious vomiting syndrome, pyloric stenosis (common in brachycephalics), Addisons disease
What are some differentials for weight loss despite a normal appetite in cats?
Metabolic:
Hyperthyroidism
Diabetes mellitus (rare to cause vomiting)
Enteropathy:
-IBD
-Neoplasia (lymphoma)
-parasitism
Exocrine pancreatic insufficiency (usually have diarrhea, sometimes vomiting if pancreatitis is present)
How low does albumin have to be in order for effusion to be present?
<1.5-2
What values will change on the bloodwork of a patient with protein losing enteropathy?
Decreased albumin and globulin (similar ratio of loss) and cholesterol
In a case of protein losing enteropathy, what are some good first steps for treatment?
Hypoallergenic diet trial
- consider performing in stable patients
- strict hydrolyzed or novel protein diet for 3 weeks
If doesn’t help, consider imaging for foreign body/neoplasia
- if abnormalities are seen, consider biopsies
What are the advantages and disadvantages to using endoscopy vs surgery to take biopsies?
Endoscopy- less invasive, can only get into the stomach, duodenum, and ileum, can only a sample of the mucosa/submucosa
Surgery- can take full thickness biopsies and can access all portions of the small intestine, but it is more invasive with more potential complications
If starting steroids for a case of steroid responsive IBD, what dose should you start at? How quickly should you taper?
Start at 2 mg/kg/day
- recheck in 2 weeks (evaluate clinical signs, weight, and blood chemistry to assess plasma proteins)
- once clinical signs are well controlled and albumin is within normal range for at least 2 weeks, start a prednisolone taper
- taper prednisolone by 25% every 2-3 weeks to lowest effective dose (recheck clinical signs and albumin prior to each taper)
