vomiting (persons)

Question 1

Describe the vomiting reflex triggered by the vestibular system in dogs & cats

Answer 1

Motion sickness (vestibular system)
- dogs: triggers CRTZ and gives feedback directly to emetic center
- cats: direct feedback to emetic center

Question 2

Acute vs chronic v+ timeline

Answer 2

Acute: < 10 days
- after 14 days, begin to consider it chronic

Question 3

Acute gastritis

Answer 3

sudden onset of vomiting related to gastric mucosal insult or inflammation

Question 4

DDx for GI-caused V+

Answer 4

Gastritis - inflammation
- dietary indiscretion (FB, table scraps, recent change in diet)
- toxins
- ABX, NSAIDs

Gastric FB
Hemorrhagic gastroenteritis (HGE)

Question 5

DDx for systemically caused V+

Answer 5

Acute pancreatitis
Renal failure
Endorcine disorders
Hepatobiliary disease
Parvovirus
Toxins (grapes, raisins, xylitol, ethylene glycol)

Question 6

Most comon electrolyte abnormalities seen with mild versus severe vomiting

Answer 6

Mild v+: Mild metabolic acidosis

Severe v+: Severe metabolic alkalosis

Question 7

What causes metabolic acidosis in acute vomiting?

Answer 7

dehydration, hypovolemia, increased lactic acid; loss of duodenal bicarbonate

metabolic acidosis: low HCO3- –> leads to compensatory respiratory alkalosis response (hyperventilation // low PaCO2)
kidneys eliminate acids via H+ or by r eabsorbing HCO3-
pH directly related to HCO3-

Question 8

What causes metabolic alkalosis with severe vomiting?

Answer 8

loss of H+ from stomach –> increased plasma HCO3-; gastric outflow or proximal duodenal obstruction; severe, persistent v+

metabolic alkalosis: high HCO3-
kidneys eliminate acids via H+ or by r eabsorbing HCO3-
pH directly related to HCO3-

on CBC: CO2 represents bicarbonate (HCO3-)

Question 9

Atypical Addison’s Disease

Answer 9

deficient in cortisol, but no electrolyte abnormalities

difficult to diagnose (typical: hypo Na,K,Cl)

Question 10

Self-limiting V+ signs

Answer 10

appear systemically healthy, minimal-to-no dehydration, cause likely to resolve without intervention

Question 11

Life-threatening v+ signs

Answer 11

depressed, moderate-to-severe dehydration, persistent and severe vomiting, hematemesis, cause unlikely to resolve without aggressive supportive therapies

Question 12

DDx for GI-caused chronic gastritis in dogs and cats

Answer 12

• food hypersensitivity (lymphoplasmatic inflammation), parasitism (eosinophilic inflammation), heliobacter pylori,
• idiopathic (inflammation: lymphoplasmacytic; eosinophilic inflammation), IBD, steroid-responsive

Question 13

Gastroc Neoplasias

Answer 13

1. Adenocarcinoma
- lesser curvature of stomach
- most common in gastric neoplasia in dogs
- v+, weight loss to sevre emaciation, anorexia +/- hematemesis

2. Lymphoma
- stomach and SI
- large cell in dogs & cats = bad
- small cell form in cats can appear similar to IBD

Question 14

Patient presents for vomiting AND PU/PD. Top differentials?

Answer 14

renal disease, diabetes; hypercalcemia

Question 15

GI disease patients: how to tell this is the primary cause of v+

Answer 15

patient is clinically normal in between vomiting events

Question 16

How to tell that systemic disease = the primary cause of a patient’s v+

Answer 16

concurrent clinical signs

icteric: hepatobiliary dz

Question 17

Cats usually vomit due to primary __??__

Answer 17

GI Disease

primary IBD, lymphoma,

Question 18

Causes of vomiting

Answer 18

delayed gastric emptying, obstruction (pyloric or intestinal), gastric neoplasia