Exam 1 - Vomiting Patient Flashcards
what should you consider in a brachycephalic breed that is vomiting?
pyloric hypertrophy
what should you consider in an older cat that is vomiting?
hyperthyroidism
what differentials are you considering in a young animal with vomiting?
panleuk in kittens, parvo, parasites, & congenital disease
what differentials should you consider in a cattery/shelter with an outbreak of vomiting patients?
FeLV, FIV, FIP
what is the biggest difference between vomiting & regurgitation?
vomiting is an active process while regurgitation is a passive process
T/F: vomiting is not always caused by gi disease
true
why is an oral exam important in vomiting cats?
linear foreign bodies trapped at the tongue
why look at the patient’s skin, signs of pruritus, or signs of allergic dermatitis?
may point to food-responsive dermatitis
when is a more aggressive diagnostic plan warranted in a vomiting patient?
abdominal pain or other concerning findings on physical exam (abdominal mass, etc), intractable vomiting, biochemical abnormalities, depressed, hematemesis, & chronic disease refractory to diet
how is vomiting classified?
- duration of signs - acute or chronic
- likely cause - primary gi (GDV, gastric tumor, dietary indiscretion) or non-gi disease (systemic/secondary - addison’s, CKD, liver disease)
what are the 4 basic groups that fall under primary gi disease for patients with acute vomiting?
- dietary indiscretion/intolerance
- infectious/inflammatory - gastroenteritis, parvo, helminths
- obstruction - GDV, intussusception, FB
- gi ulceration - NSAIDS, gastric lymphoma, & mast cell tumors
what are the 6 main groups that fall under non-gi diseases that cause acute vomiting?
- acute pancreatitis
- endocrine - DKA, addison’s, & hyperthyroidism
- acute organ failure
- drugs/toxic plants
- CNS disease
- infectious/other - prostatitis, pyometra, peritonitis, & septicemia
what are the 5 main groups of primary gi disease that cause chronic vomiting?
- IBD/bilious vomiting
- gi neoplasia - adenocarcinoma, leiomyosarcoma, GIST, & mast cell tumor
- mechanical/functional obstruction - gastric FB, pyloric stenosis, & dysmotility
- gi ulceration
- infectious - parasitism, histoplasma, pythium, FeLV/FIV, & FIP
what are the 4 main groups of non-gi disease that cause chronic vomiting?
- chronic inflammation/infection - pancreatitis, prostatitis, pyelonephritis, cholangitis
- endocrine - addison’s & hyperthyroidism
- chronic organ failure
- HWD in cats
what should you do if you do an exploratory surgery and you find no obvious cause of the vomiting?
complete exam of the abdomen - get biopsies from stomach, duodenum, jejunum, ileun, mesenteric lymph node, liver, pancreas
what are the main components of treating vomiting?
identify & remove/treat offending agent
dietary restriction or modification
how is diet modification done in animals with acute vomiting?
short periods of dietary restriction while getting control of vomiting (be careful in cats)
once vomiting is controlled, give a highly digestible diet with high moisture in small frequent meals
how is diet modification done in animals with chronic vomiting?
highly digestible low fat diets in dogs, hypoallergenic, or novel protein
enteral feeding tubes may be needed to facilitate nutrition
what is the general therapeutic approach of symptomatic treatment for vomiting?
anti-emetics - if vomiting is intractable & mechanical obstruction is ruled out
anti-nausea drugs - not all anti-emetics eliminate nausea
other treatments - acid suppressants (upper gi bleed), NSAID toxicity (misoprostol), prokinetics for motility disorders, & appetite stimulants
what is the tmax of cerenia?
1-2 hours - rapidly absorbed
what animals have fda approval for using cerenia?
dogs over 4 months can get injectable SQ/IV or oral, dogs older than 2 months can have SQ or oral, & cats older than 4 months injectable SQ
what is cerenia an effective anti-emetic for?
CKD, chemotherapy (doxo & cisplatin), motion sickness in dogs, & emetic drugs (opioids, alpha 2s in cats, & emetogen - give minimum 2 hours prior)
give cerenia prior to pre-meds
T/F: cerenia can be ineffective against nausea depending on the emetogenic stimulus
true - nausea still present after alpha-2, opioid administration, & cisplatin
what is the mechanism of action of cerenia?
NK-1 antagonist - inhibits substance p in the central nervous system
what is the mechanism of action of ondansetron & dolasetron?
5HT3 antagonists - peripheral & central in the CRTZ, vomiting center, & abdominal viscera
when are 5HTs antagonists useful in vomiting patients?
best for acute chemotherapy-induced nausea & vomiting
what is a common side effect of ondansetron?
sedation
what is a disadvantage of ondansetron in terms of dosing?
poor bioavailability in dogs & cats so thrice daily dosing
what is the mechanism of action of metoclopramide?
dopamine-2 (low dose) & 5HT3 antagonist (high dose)
T/F: metoclopromide is effective in cats as an anti-emetic
false
what is metoclopromide useful for in vomiting patients?
visceral-induced vomiting such as parvo virus in dogs - may have some pro-motility effects
what drug has the largest indication of use in cats as an appetite stimulant?
mirtazipine
what is the mechanism of action of mirtazapine?
presynaptic a2-adrenergic receptor & post-synaptic 5HT3 & 5HT2 antagonist
anti-nausea, anti-emetic, pro-kinetic
what are the side effects associated with mirtazapine?
vocalization & nervousness
reduced frequency with liver & kidney disease
what are some differentials for chronic vomiting with gi bleeding, both gi & extra-gi?
gi - gi ulceration, NSAIDS, neoplasia, IBD
extra gi - addison’s, neoplasia (gastrinoma, pancreatic carcinoma), & liver failure
