Diagnostic Approach to Chronic Vomiting
Chronic vomiting is defined as intermittent or continuous vomiting for at least 7 days. The first step is to determine if the client is observing vomiting or regurgitation. Vomiting is associated with such signs as depression; salivation; frequent swallowing; and in cats, vocalization. These signs are followed by abdominal contractions before expulsion of the food. In contrast, regurgitation is associated with esophageal disorders and occurs passively. The first most obvious step in the workup is a dietary history. Vomiting may be caused by dietary changes, foreign bodies, toxins (eg, houseplants), excessive hair, poor-quality diets, or ingestion of such things as "road kill." Abnormalities may or may not be found on the physical examination, and this seminar discusses the more subtle findings that are easily overlooked and often associated with early onset of underlying medical causes of vomiting. Survey radiographs are useful in most cases to rule out foreign bodies. In many cases, specialized diagnostic testing, such as barium series, endoscopic examination and biopsy, or laparotomy is needed to make a definitive diagnosis. This article presents the pros and cons of endoscopic examination, the procedure itself, practice tips on how to get the most out of the procedure, and how to get a better biopsy. For example, if gross abnormalities are found, multiple biopsies of lesions should be obtained. If gross abnormalities are not found, biopsies of standard regions should be obtained (cardia, greater curvature, angularis incisura, antrum, pylorus, and duodenum). One sample should be placed in a rapid urease test to look for Helicobacter species.
COMMENTARY: Chronic vomiting is one of those client complaints that make many veterinarians just cringe because there can be so many causes. In this seminar, the author lists 22 (!) of the most common causes but saves the day with a practice-oriented diagnostic approach. The discussion on the pros and cons of laparotomy vs endoscopy is particularly helpful.
Diagnostic approach to chronic vomiting. Leib MS. Proc Navc 2007 pp 440-442.