Clinical Approach to Vomiting (Winston) Flashcards
(T/F) Vomiting is a diagnosis as well as a clinical sign
False, vomiting is a clinical sign, not a diagnosis
Vomiting is a _______________ reflex
central nervous system
(T/F) Coordinated closure of nasopharynx and glottis to protect the airway
True
Definition:
Is used when vomitus contains blood flecks, blood clots, or brown coffee ground-like material (digested blood)
Hematemesis
(serious problem)
Acute vomiting: _____ week in duration
< 1
Chronic vomiting: _______ week in duration
> 2-3
Causes of vomiting can be characterized as:
- Primary gastrointestinal (GI)
- Extra-GI/Systemic disorders
List GI Causes of ACUTE Vomiting:
- Dietary Related
- Acute gastritis or enteritis
- Drug-induced
- Viral enteritis
- Bacterial infection
- Parasites
- Gastric or intestinal obstruction
(T/F) It is okay to not look under a cat’s mouth that presents for vomiting
False, you need to complete oropharyngeal examination in every vomiting cat to look for a string wrapped around the base of the tongue
List Extra-GI Causes of ACUTE Vomiting:
- Motion sickness
- Vestibular disease
- Acute pancreatitis
- Acute kidney failure
- Acute hepatic failure
- Ketoacidotic diabetes mellitus
- Pyometra
- Prostatitis
- Peritonitis
- Drug-induced (e.g., cardiac glycosides, narcotics, chemotherapeutics)
- Sepsis
- CNS disorders (inflammation, edema)
What is necessary to rule out extra-GI disorders that cause vomiting prior to evaluating for primary GI disorders with contrast radiology, endoscopy, or exploratory laparotomy?
Laboratory Evaluations
The top extra-GI causes of vomiting (+/- diarrhea) are:
- Liver Failure
- Pancreatitis
- Kidney Failure
- HYPOadrenocorticism
But for cats, we need to add on…
- Hyperthyroidism
- Heartworm disease
Many vomiting animals do not have an acid-base disturbance but if they do, it is more commonly a ______________due to severe dehydration → poor tissue perfusion → subsequent lactic acidosis
metabolic acidosis
- LRS or plasmalyte (likely with additional KCl)
_____________________ is most likely to occur in dogs and cats with vomiting secondary to pyloric or proximal small bowel obstruction. Can also occur 2º to severe diffuse vomiting w/o obstruction
Metabolic alkalosis
- 0.9% saline supplemented with KCl
(T/F) If vomiting is severe or persistent enough to require antiemetics, you should also be simultaneously investigating the underlying cause
True
If the owner reports that the patient re-ingest the “vomitus”, consider _______________ and not ________________
regurgitation, vomiting
Stimulation of the afferent nerves in the ___________________ can be caused by diseases that result in inflammation, irritation, infection, or stretch of organs within the abdominal cavity
abdominal viscera
Stimulation of the _____________________ zone can be caused by noxious substances in the bloodstream that typically arises from either an organ-system failure, blood-borne toxin, or drug-induced
chemoreceptor trigger
Stimulation of the __________________ is primarily caused by motion sickness or disease of cranial nerve VIII
vestibular apparatus
Stimulation of the _________________ is medicated by psycho-social cues (e.g. stress) in people and will not be further considered here as a cause of vomiting in dogs and cats
cerebral cortex
___________________ is a good general-use anti-emetic in cats. In dogs, however, it is most effective for inhibiting abdominal visceral (and NOT chemoreceptor trigger zone) causes of vomiting
Ondansetron (Zofran)
___________________ works well in dogs to inhibit the chemoreceptor trigger zone causes of vomiting. In cats, however, it is NOT thought to inhibit any inputs to the vomiting center and instead functions as a prokinetic (promotes gastrointestinal motility).
Metoclopramide (Reglan)
Four drugs are used most commonly in dogs and cats for the control of vomiting, which one is this one?
- blocks dopamine (D2) receptors
Metoclopramide (Reglan)
- Chemoreceptor Trigger Zone (dogs)
Four drugs are used most commonly in dogs and cats for the control of vomiting, which one is this one?
- blocks serotonin (5-HT3) receptors
Ondansetron (Zofran)
- Abdominal Viscera (dog)
- Vomiting Center (cats)
Four drugs are used most commonly in dogs and cats for the control of vomiting, which one is this one?
- blocks neurokinin (NK1) receptors (substance P)
Maropitant (Cerenia)
- all of them both cats and dogs (Abd. Viscera, Chemo.trigger zone, Vestibular apparatus, vomiting center)
Four drugs are used most commonly in dogs and cats for the control of vomiting, which one is this one?
- blocks alpha-adrenergic (alpha1/alpha2) receptors (also blocks dopamine, histamine type-1 & muscarinic receptors
Chlorpromazine (Compazine)
- Chemoreceptor Trigger Zone (dogs & cats)
- Vomiting Center (dogs & cats)
