Chronic Vomiting in Dogs
Dr. Bari Spielman
Obtaining a complete medical history, and performing a thorough physical examination are necessary in order to create an appropriate diagnostic plan for the vomiting patient.
A complete blood count (CBC) evaluates the presence of infection, inflammation, anemia, etc.
A biochemical profile evaluates kidney, liver, and pancreas function, as well as electrolyte, protein, and blood sugar levels.
A urinalysis helps evaluate the kidneys and hydration status of the patient.
Multiple fecal examinations are important to rule out gastrointestinal parasites as a cause of vomiting.
Abdominal radiographs (X-rays) evaluate the abdominal organs, and may detect the presence of fluid, a foreign body, tumor or structural abnormality.
Chest X-rays are an important part of the diagnostic work up if cancer is suspected, in order to look for metastasis (spread) to the lungs.
Your veterinarian may recommend additional tests to insure optimal medical care. These are selected on a case-by-case basis.
An abdominal ultrasound evaluates the abdominal organs and helps assess the presence of tumors, thickening of the walls of the intestine, foreign bodies, etc.
An ACTH stimulation test may be recommended to rule out hypoadrenocorticism (Addison's disease) if certain electrolyte abnormalities are seen on the biochemistry profile.
Bile acids assays may be performed if liver disease is suspected.
A blood lead test may be indicated in the vomiting patient when there has been possible lead exposure, if material compatible with lead chips is seen on the abdominal x-rays, or if there are changes in the blood count suspicious of lead poisoning.
An upper gastrointestinal (GI) barium (dye) series may be considered in those cases where the initial tests do not confirm a diagnosis, especially if vomiting persists. Barium is administered and sequential x-rays are taken to watch its passage through out the intestines. It is also sometimes viewed under video x-rays, especially when motility disorders are suspected.
Gastroduodenoscopy (upper GI endoscopy) is often of benefit in the chronically vomiting patient. It involves the passage of a flexible viewing scope into the stomach and duodenum. It facilitates the removal of foreign bodies in the stomach, helps detect the presence of tumors and ulcers, and allows samples to be taken for culture and biopsy.
If other diagnostic tests fail to reveal a cause, or if surgical correction is required for the chronic vomiting, then an exploratory laparotomy is performed.
Your veterinarian may recommend one or more of the diagnostic tests described above. It is difficult to treat the patient with chronic vomiting symptomatically. It is very important with chronic vomiting that an underlying cause be identified, so that specific therapy can be instituted.
While diagnostic testing is underway the following nonspecific (symptomatic) treatments may be tried in some pets. These treatments may reduce the severity of symptoms or provide temporary relief for your pet. However, nonspecific therapy is not a substitute for definitive treatment of the underlying disease responsible for your pet's condition.
Withholding food and water for several hours allows the GI tract to rest. Gradual reintroduction of small amounts of bland food is instituted after the fast, and should be continued for several days to ensure the vomiting does not return.
Antiemetics (drugs that stop vomiting) should be used with caution. It is best to identify and treat the underlying cause of vomiting, but in selected cases these drugs may be recommended.
Antacids (drugs that decrease acid production by the stomach) such as Tagamet (cimetidine), Pepcid (famotidine), or Zantac (ranitidine) may be of benefit in some cases.
Gastrointestinal protectants and adsorbents, which are medications that protect or sooth, may coat an irritated intestinal lining and bind noxious or harmful agents. They include such drugs as Pepto-Bismol, Kaopectate, etc.
Specific therapy for chronic vomiting is highly variable and depends on the underlying cause. It may involve the administration of medications, changes in diet, and surgery.