Vomiting Flashcards
The following describes what?
A reflex
Forceful expulsion of stomach contents through the mouth
One of the most common presentations of illness in our patients
Self limiting vs. debilitating
Vomiting!
What are the 3 phases of vomiting?
Nausea
Retching
Expulsion
What clinical signs are associated with the first phase of vomiting (nausea aka prodromal phase)?
Ptyalism
- Hiding*
- Seeking attention*
- Yawning*
- Shivering*
- Tachycardia*
- Pallor*
What clinical signs are associated with the second phase of vomiting (retching)?
Abdominal mm, chest wall and diaphragm all contract without any expulsion of gastric contents
Retrograde contraction –> duodenal contents into stomach
Deep inspiratory movements
Respiratory center is inhibited
What clinical signs are associated with the third phase of vomiting (forceful expulsion)?
Stomach DOES NOT actively expel!!
**Stomach, esophagus, and sphincters relaxed during vomiting!!
Force that expels arise from the contraction of the diaphragm and abdominal mm
What is the pathway for vomiting?
Stimuli –> afferent pathways (sensory and central); higher brain; vestibular apparatus (motion sickness); CRTZ –> emetic center –> efferent motor signals = VOMIT TME!
Explain the physiology of vomiting.
Activation of chemoreceptors and mechanoreceptors
Stimulation of visceral afferent receptors (5-HT3; NK-1)
Direct stimulation of the cerebral cortex and limbic system -fear, stress, trauma
Vestibular system stimulation (M-1 cholinergic; H1-histaminergic)
CRTZ (Chemoreceptor Trigger Zone)
-stimulated by vestibular system
-many receptors
-free nerve endings bathed in CSF -lacks BBB –> stimulated by ‘emetogens’
How does motion sickness (“kinetosis”) induce vomiting?
inner ear/labyrinth stimulation –> dopamine and serotonin released from CRTZ activation –> Ach released from emetic center
How do drugs such as chemo agents induce vomiting?
5-HT3 serotonergic receptors and CRTZ
How does intestinal inflammation induce vomiting?
- direct afferent input to vomiting center
- many causes of GI dz; pancreatitis
How do opioids induce vomiting?
-stimulation of CRTZ, increased vestibular sensitivity, gastric stasis, or impaired intestinal motility and constipation
How do toxins induce vomiting?
-CRTZ permeable and initiates NT cascade
How does uremia induce vomiting?
- decreased gastric clearance –> ulcers and gastritis (PPI, H2-antag)
- toxins cross BBB –> stimulate central and peripheral receptors
- activates CRTZ via D2-dopaminergic receptors
T/F When a client tells you their pet never eats anything that they shouldn’t you should believe them bc they know their pets best.
False. People don’t know shit.
What clinical signs do we see with vomiting?
vomiting lethargy inappetence \+/- diarrhea \+/- wt loss systemic signs of illness respiration changes if aspiration has occurred
There are some major things to note when performing physical exam with a dog that’s vomiting. What are they?
- dehydration- skin, eyes
- abdominal pain
- abdominal distension
- palpable foreign material
- thickened intestines
- constipation (bc straining so much in litter box they make themselves vomit)
- normal
- ptyalism
- mental status (toxins, CNS dz)
- respiratory status-can change
- diarrhea (do a rectal!)
- **look under the tongue!!
- wt loss
- signs of systemic illness
Diagnostics are sorta the same as always but what’s something additional that’s unique with regards to vomiting?
Baseline cortisol is an extra aspect of diagnostic workup to look into as well as coagulation profile (i.e. if hematemesis or protein losing nephropathy)
T/F DO NOT make initial recommendations based on owner finances.
True
What is your protocol when patient is NOT systemically ill and is acutely vomiting?
Symptomatic therapy; few days of diet and medications then wean onto normal diet
What is your protocol when patient IS systemically ill and is acutely vomiting?
Symptomatic therapy; lab evaluation and imaging
What is your protocol when patient is NOT systemically ill and is chronically vomiting?
Symptomatic therapy; food trial at least 2 -3 wks; +/- Medication trials
What is your protocol when patient IS systemically ill and is chronically vomiting?
Symptomatic therapy; lab evaluation and imaging; +/- biopsy
What are the basics to know about PCV/TS?
PCV= estimate of RBC decreased= anemia increased= dehydration
TS= total solids= serum proteins- mostly Alb and globulins, as well as fibrinogen and other proteins decreased= low protein increased= dehydration, some advanced inflammatory dz and neoplasia
What are some basics to know about Blood glucose?
BG= blood glucose decreased= hypoglycemia from various cause increased= possibly DM
On many glucometers –> affected red cell count
decreased= artificially w polycythemia
increased= dehydration
Serum chemistry rules out what ?
kidney, liver and electrolyte concerns
Urinalysis helps rule out what?
UTI and UTO; indicators of other systemic dz
Fecal tests help rule out what?
Parasites
Coags help rule out what?
if hematemesis or other signs of bleeding are present
When would we perform a baseline cortisol?
to rule out Addison’s or support pursuing ACTH stim
