Vomiting

Question 1

primary GI causes of vomiting

Answer 1

• dietary indiscretion
• GI foreign body
• GI neoplasia
• pancreatitis
• infectious gastroenteropathy
• IBD

Question 2

extra-GI causes of vomiting

Answer 2

• liver disease
• renal disease
• hyperthyroidism
• toxins
• Addison’s
• heartworm

Question 3

is vomiting due to small bowel disease more common in dogs or cats

Answer 3

cats

dogs - diarrhea w/ small bowel disease

Question 4

what are the two main pathways of the vomiting reflex

Answer 4

1. humoral (blood borne) –> CRTZ
2. neural –> vomiting center

Question 5

what are the major visceral receptors

Answer 5

5HT3
substance P

located in the GIT, peritoneum, bile duct epithelium

Question 6

is dopamine receptors more relevant for vomiting in dogs or cats

Answer 6

dogs - D2 receptors are a strong component of vomiting reflex

Question 7

what vomiting-related drugs are used in dogs that are not effective in cats

Answer 7

1. apomorphine - D2 agonist, induces vomiting
2. metoclopramide - D2 antagonist, antiemetic

Question 8

what components send input to the vomiting center

Answer 8

1. cerebral cortex - anticipatory emesis
2. vestibular nuclei - motion sickness
3. CRTZ - blood borne
4. pharynx & GIT - gastroenteritis

Question 9

cat vs dog vestibular nuclei pathway

Answer 9

cats: direct input from vestibular nuclei to the vomiting center

dogs: vestibular nuclei feeds input to the CRTZ which sends info to the vomiting center

Question 10

regurgitation vs vomiting

Answer 10

regurgitation:
- passive (no contractions)
- no prodromal nausea
- seconds to hours after meal
- undigested material

vomiting:
- active
- prodromal nausea
- minutes to hours after meal
- undigested or digested material

Question 11

what are signs of severe disease in vomiting patients

Answer 11

• fever
• melena/hematochezia
• weakness
• anorexia < 48 hours
• abdominal pain
• vomiting of coffee grounds or frank blood
• pale, icteric, or muddy MM
• enlarged abdominal organs or peripheral LNs

Question 12

diagnostics for acute vomiting

Answer 12

1. PCV/TP
2. glucose
3. azostix
4. USG
5. abdominal radiographs
6. +/- fecal float
7. +/- resting cortisol

Question 13

management of acute vomiting

Answer 13

1. isotonic crystalloid fluids
2. LF diet
3. antiemetics
4. broad spectrum Ab (young animals)

Question 14

should vomiting animals be given gastric acid suppressants

Answer 14

only if worried about a GI bleed (iron deficiency anemia)

Question 15

diagnostics for chronic vomiting

Answer 15

1. minimum database
2. fecal floatation
3. serum T4
4. serum B12/folate
5. FeLV/FIV
6. abdominal US/radiographs
7. resting cortisol
8. serum bile acids
9. spec PLI
10. liver aspirate/biopsy
11. GI biopsy

Question 16

pros and cons of endoscopy

Answer 16

pros: less invasive, can visualize the stomach, duodenum, proximal jejunum, and able to collect many punch biopsies

cons: can not collect full thickness biopsies,

Question 17

pros and cons of laparotomy

Answer 17

pros: can get full thickness biopsies

cons: more invasive, only a single biopsy collected, have to use opioids (post op ileus)

Question 18

gastritis

Answer 18

non specific inflammation of the stomach

Question 19

what is a very common infectious cause of gastritis

Answer 19

helicobacter pylori

common GI bacteria in HEALTHY dogs/cats but can cause gastritis

Question 20

diagnosis of H. pylori

Answer 20

gastric biopsy

histopath: lymphofollicular gastritis

Question 21

treatment of H. pylori

Answer 21

triple therapy x2 weeks
- clarithromycin
- metronidazole
- PPI

Question 22

can IBD affect the stomach

Answer 22

yes

Question 23

when is the use of antiemetics indicated vs contraindicated

Answer 23

1. intractable vomiting
2. risk of aspiration pneumonia
3. secondary acid-base or electrolyte derangements

contraindications:
- obstruction
- toxin ingestions

Question 24

gastric acid suppressants

Answer 24

• PPIs (omeprazole, pantoprazole)
• H2 antagonists (famotidine)

Question 25

what are problems with H2 blockers

Answer 25

• tachyphylaxis - develops tolerance within 1 week
• less effetive/potent than PPIs
• CYP450 inhibitors - affects metabolism of other drugs

Question 26

administration considerations for PPIs

Answer 26

requires acidic environment to work - administer 30m min prior to a meal

do not give prior to sucralfate (also needs acidic environment)

must taper before stopping

Question 27

prostaglandin E1 analogues

Answer 27

misoprostol

increases muscoal blood flow and mucus production

decreases gastric acid secretion

less common in vet med

Question 28

metoclopramide

Answer 28

antiemetic + weak prokinetic
- 5HT3 antagonist
- D2 antagonist
- 5HT4 agonist

do not use as antiemetic in cats
does not work on colon (constipation)

administer as CRI

Question 29

ondansetron

Answer 29

potent antiemetic
- 5HT3 antagonist

IV or SQ

Question 30

diphenhydramine

Answer 30

motion sickness antiemetic in DOGS only
- vestibular nuclei
- histamine H1 antagonist

does not work in cats

Question 31

maropitant

Answer 31

antiemetic in dogs and cats
- NK1 antagonist

good for opioid induced vomiting, motion sickness, anesthetic sparing

does NOT resolve nausea, only stops vomiting