Why Is This Patient Vomiting Cases Flashcards
Are there any questions you would ask the owners?
- What colour is the frothy vomit? How soon after eating breakfast? Did you hear retching / see abdominal effort when vomiting?
- Tends to scavenge – do you know if he’s eaten anything he shouldn’t have?
- Has he any smilar episodes in the past / has this happened before?
- Has she changed his food recently?
- Do you have other pets? Do thye have any similar signs?
How worried are you about Jefferson?
What is his problem list?
- How worried are you about Jefferson?
Not overly, vomiting but not ill, still BAR, normal faeces, less than 24hrs, can do some screening if the owner is really worries – conscious radiographs, bloods
- What is his problem list?
tense abdomen
vomiting (regurgitation?)
what are your main differentials for his problems (in order of most likely
- dietry indiscretion from scavenging / change of diet
- foreign body from scavenging – gastric or oesophageal
- oesophageal disease / megasophagus primary or secondary
- IBD / IBS if this has happened before
- Food intolerance
What is your plan for Jefferson?
- Send home with anti emetic – will help decide between dietry indiscretion (should feel better) and FB – will still vomit
- Possible bland diet – chicken and rice
- Tell owner to call in 24hours for update – come back in if still vomiting, however if vomiting resolves no need to come back unless concerned
Are there any questions you would ask the owners?
Does he scavenge? Are yu aware of anything hes eaten and shouldn’t have?
Has he had anything similar in the past? (pancreatitis etc)
Poor appetite – has he eaten anything? When did he last eat? What did he eat?
Do you have other pets? Do they show similar clinical signs?
How worried are you about Jackson?
What is his problem list?
How worried are you about Jackson?
Yes, vomiting and ill from it!acute u]onset, 4 days dehydration, 4 days vomiting
What is his problem list?
- vomiting
- Anorexia (4 days)
- No feces for 24hours
- Dull / lethargy / depressed
- Hypothermic + tachycardic (only slightly – probably due to the dehydration)
- Dehydration
- Tense – painful abdomen
- Tacky membranes
- Polydypsic
- Reluctance to walk
What are your main differentials?
- Foreign body
- pancreatitis
- Infectious / parasitic?
- Toxicity e.g lead poisoning
What is your plan?
- Hospitalised, IV fluids + dextrose, pain relief, - because its been 4 days, so dehydrated etc very poorly needs supportive therapy
- Initial bloods – routine biochem and haematology + ask for canine pancreatic lipase test (do this after the xays I you ant see anything on them)
- Take conscious xrays – probably very dull - screening for foreign body, megasophagus
- Offer bland meal of rice and chicken
- O tube
- However, if needs surgery for FB then starve
Are there any questions you would like to ask the Owner?
- When does she vomit – is it after meals or is it random? Is there abdominal effort / gagging / do you hear her? What consistency is the sick?
- Do any other pets have clinical signs in your house?
How worried are you?
What is the problem list?
How worried are you about Deirdre?
-yes as showing signs of systemic disease, not acute though so do have time to work through investigation
What is her problem list?
- Chronic history of polyphagia, weight loss,polydipsia
- Chronic vomiting – 3-4x per week
- Bcs 3/9 = underweight
- Heart murmur
- Tachycardia (could it be stress induced? Hyperthyroid?)
What are your main differentials?
- Hyperthyroid
- CKD
- Food intolerance (but doesn’t explain polydipsia)
- IBD
- CKD / liver failure / lungs – triaditis (gut, liver pancreas)
- Pancreatitis – chronic
- Diabetes mellitus
- lymphoma
- disautonomia
What is the plan?
- Full clinical exam – palpation of LNs and abdomen
- Urinalysis: dipstick and SG – rule out DM, urine creatinine – CKD
- Haematology and biochem including T4 – rule out hyperthyroid, look at liver parameters, systemic inflammation
- If urinalysis and bloods normal (very unlikely) then can do imaging to look for neoplasia / FB
Any questions for the owner?
- Has he been wormed before or after getting him?
- Have you got the worm from the car? Can you describe it
- Have you seen worms in his stools?
- Have you noticed anything else unusual in the 4 days?
- Did you keep him on the same diet as before?
- Have you seen him eat anything he shouldn’t?
Are you worried?
What is the problem list?
How worried are you about Buster?
- No worried, doesn’t seem poorly with the worms, not pot bellied, will need worming and monitoring but still BAR and eating. Salivation / quietness after each time he has been in the car – motion sickness?
What is his problem list? All sudden onset
- Vomitied worm
- Yellow soft stools, no weaned so should be brown
- Quiet and subdued – only in consult, worried / nauseus from car?
What are the main differentials?
- Has worms – most likely T.canis (transmammary and transplacental)
- Motion sickness
- Dietry intolerance
What is your plan?
- Weigh puppy
- worming regime: every 2 weeks until weaned, then monthly until 6 months, then every 3 months fro there on in
- treat with fenbendizole
- discuss vaccines, flea / ectoparasite control
- discusss diet – shouldn’t be feeding cereal and milk
- worm first, then ask them to bring him in in 48 hours and make sure hes not been sick again and is his usual self – unless in the car and assume motion sickness, vaccinate in 2 days when you are sure hes not systemically ill and vomiting
What questions would you ask?
- Any other cats showing signs?
- Is he a hunter / scavenger?
- Have they had a change in diet / environment / new stresses?
- Are the vaccinations and worming up to date?
What is your problem list?
- Anorexia 3-4 days
- Vomit?
- Tense / painful abdomen
- Firm faeces in colon – constipation
- Dehydration (prolonged skin tent) Dry, tachy mucus membranes
- Fluidy abdomen
- Not as playful, lethargy, dull – 4 days
- Hypothermic and tachycardic
- Poor peripheral pulses
What are the differentials?
- Foreign body
- Pancreatitis
- Infectious (others will probably have signs) – giardia (but would have diarrhoea), aprvo, corona, salmonella,
- Dietry indescresion
How worried are you?
What action do you take?
How worried are you about Pepper?
- Very worried – not eating / drinking for 4 days, very poorly
What action would you like to take next?
- Hospitalise, take baseline bloods for haematology and biochem, then IV fluids, then radiograph +/- ultrasonography, then place o tube whilst still sedated and give parenternal nutrition.
Are you worried?
What are the problems?
- How worried are you about Bella?
Yes, would like to admit for supportive care and diagnostic investigations. Been vomiting a lot for 3 days!
- Problem
Vomiting 3days but 5-6x daily = a lot!
Anorexic 2 days
Not wanting to walk or stand for long (weakness)
Tacky mucuous membranes
Dehydration (skin tenting)
Hypothermic
Tense / painful abdomen
Borderline tachycardia (poss due to the dehydration?)
What are the differentials?
- Foreign body
- Pancreatitis
- Intusseption
- Acute kidney / liver failure or gall bladder inflammation
- Parasitic / Viral / bacterial infection of GI tract
- Pyo – NO BECAUSE NEUTERED
What is the plan?
- Hospitalise
- Baseline bloods
- Radiographs =/- ultrasound
- IVFT (IV fluid therapy)
- Dependant on bloods / radiographs – put o tube / naso-oesophageal tube
What questions would you ask?
- Same signs in the other dogs?
- Does she scavenge?
- Has she got a history of vomiting / similar signs before?
- Is she polydipsic / drinking more?
How worried are you?
What are the problems?
How worried are you about Misty?
Quite worried, female entire and pyometra is a serious condition
What is her problem list?
- Urinary incontinence
- Food aversion
- Skin tent – dehydrated
- Vomit – 5x in last 24hours
- Congested mm – darker colour
- Dental tartar and gingivitis
- Lethargic
- Painful abdomen
- pyrexic
What are the main differentials?
- Pyometra
- Pancreatitis
- Foreign body
- Dental disease – she does have these, but may have caused her to go off her food
- Kidney failure
- Liver failure
What is your plan?
Straight in for ultrasound of uterus
- If nothing found, can then further other diagnostics such as radiographs and bloods, follow up ultrasound on kidneys / liver
- IVFT
- If pyo – AB’s and surgery to remove uterus
