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Vomiting in dogs is very common and can result from a variety of causes, from simple gastritis to complex diseases systems of another organization. Not only is it very painful for the dog and the owner, it also provides a challenge for the veterinarian. This article explains the multiple causes of vomiting in dogs, including allergic reactions, and the range of treatment options available.
What is vomiting?
Vomiting is the expulsion of food,fluids or debris from the stomach or small intestine due to coordinated movements of the gastrointestinal system, musculoskeletal and nervous systems. It is important to differentiate regurgitation, which is a passive process rather than a coordinated effort like vomiting.
Regurgitation is a sign of disease in the esophagus, such as obstructions (foreign bodies, such as a stick, bone or toy, or a stricture), esophagitis (inflammation of the esophagus) or megaesophagus (dilatation of thedue to the weakening of the smooth muscle of the esophagus). The main difference between regurgitation and vomiting is that regurgitation is effortless, while vomiting is accompanied by strong abdominal contractions.
How can I tell vomiting and regurgitation of the other?
Sometimes it is not easy to do. Generally, if it occurs immediately after eating, it is more likely to be regurgitation (although vomiting may also occur at the time). If the content of the discharged materialseems to be completely undigested food, it also supports regurgitation. If the presence of bile can be confirmed, however, it is more likely to be vomiting.
Causes of vomiting
The most common causes of vomiting are dietary related, either by overeating (bulimia, for example, eating too rich or spoiled food) which causes acute (sudden) vomiting or allergic reactions (food allergies) can cause chronic (long and intermittent)vomiting.
However, there are many other causes resulting either from himself the gastrointestinal tract (stomach and small intestine) or secondary to disease elsewhere in the body (eg liver or kidney ). Within the stomach, possible causes include:
1. Gastritis (inflammatory)
2. Ulceration of the stomach
3. Stomach Cancer
4. Obstruction (foreign bodies, telescoping of intestine)
5. Hiatal hernia (stomach hernia part throughdiaphragm)
Possible causes of the bowel include:
1. Infectious diseases (eg parvovirus)
2. Worms
3. Inflammatory bowel
4. Bowel cancer
Secondary causes of vomiting that are caused by disease elsewhere in the body include:
1. Pancreatitis (infection or inflammation of the pancreas)
2. Peritonitis (infection of the abdominal cavity)
3. Hepatitis (liver inflammation)
4. Renal
5. Pyometra (infection ofuterus)
6. Hormonal deficiencies or excesses (eg, Addison disease, diabetes mellitus, sepsis, calcium imbalance)
Other possible causes that do not fit into the above categories are drug reactions (eg digoxin, chemotherapy drugs, NSAIDs) and neurological disorders.
Treatment of vomiting
Vomiting is a symptom, not a disease in itself. Whether or not treatment is appropriate depends on individual circumstances. If the dog is vomiting thatoccasionally, is bright and otherwise normal to examination, treatment is probably not necessary. Some dogs with sensitive digestive systems will vomit once or twice a month, regardless of any treatment, and if they are otherwise well this should be ignored.
For cases of acute vomiting, the first step should always be to starve the dog for 24 hours (while keeping plenty of water available ad lib). After the period of starvation, the dog should be offered small portions of food very bland,such as chicken and boiled rice for a few days. Meals should be fed as smaller portions several times a day rather than one larger meal.
While treating the symptom itself often improve patients' attitudes and comfort, there is no substitute for a good diagnosis of the underlying cause, and certain medications can be harmful if given blindly (eg give metoclopromide a dog with a gastric or intestinal obstruction). While cases of acute vomiting and severe requireimmediate treatment, the dogs can quickly become dehydrated, develop electrolyte imbalances and aspiration pneumonia otherwise.
Managing dog vomiting
There are 2 goals when dealing with a vomiting dog:
1. Identify the underlying cause
2. Stop the vomiting in a safe and effective
In many cases, anti emetic therapy (the technical term for vomiting is emesis, and therefore the drugs used to treat it are called anti emetics) is instigatedimmediately, while the cause is under construction.
A veterinarian start by taking a complete history, focusing in particular on the normal diet, recent medication, vaccination status and description of symptoms. He or she must first ensure that the dog is actually vomiting and not regurgitating, which has a different set of causes. It is also important to obtain a graphical depiction of the discharged material, and whether it contained bile, fresh blood or whatseems to be coffee granules (partly digested blood).
The next step is a complete clinical examination, including carefully feeling the abdomen, taking the rectal temperature of dogs and assessing the hydration status. Once this is complete, a veterinarian will have a little narrowed down the list of differential diagnoses in mind. If the dog is not dehydrated, posture, bright, and the two vital parameters and feeling the abdomen were normal, the veterinarian will often (and rightly) make apresumptive diagnosis of gastritis, gastroenteritis or diarrhea is present too, and prescribing antibiotics to combat bacterial infection likely. The owner is then likely to be sent home with instructions to starve the dog for 24hrs and give bland food for a few days, along with antibiotics. The owner is responsible to monitor the dog closely, and return immediately if signs of deterioration, or 2 to 3 days later for a routine checkup.
If there are findings inclinical history or physical examination that relate to then trigger additional tests are necessary. The first of these tests is generally blood for hematology and biochemistry profiles. Urine and faeces May also be analyzed, it is for bad bacteria or parasites. Further laboratory tests may be necessary in certain circumstances, such as tests of stimulation of bile acid if liver dysfunction is suspected or a test stimulus to ACTH in search of adrenal disease.
The next stepof the work up involves imaging. The most useful is abdominal radiography (radiography), but ultrasonography and endoscopy can also be very important. Radiography and endoscopy both have to be performed under general anesthesia, while ultrasonography can be made aware. If imaging does not reveal the underlying cause biopsies may then be taken either guided by endoscopy or exploratory surgery. Histopathology of these samples (the study of tissue microscopically) can give vitalclues to the cause, especially in differentiating between inflammation and cancer.
The final diagnostic option is the therapeutic trial. If the dog is better on the medication prescribed, then it must have been some kind of disease that responds to this drug. According to this logic, dewormers, antibiotics or an exclusion diet trial may be chosen.
Drugs used to treat vomiting
1. Guardians of the stomach and antacids
These drugs are usefulwhen gastric ulcer is suspected. Examples include acts (sucralfate as a bandage on the wound), H2 antagonists (reduce acid production) and omeprazole (also reduces acidity).
2. Metoclopromide
The drug blocks a neurotransmitter in the brain called dopamine, which prevents the activation of the vomiting center in the brain (known as the trigger zone chemoreceptor). This is only partially effective in doing so, however, and has the additional effect of increasing forward motilityintestine. This means it should never be given to dogs that might have a stomach or intestinal obstruction. It can also cause mental changes such as hyperactivity and disorientation.
3. Phenothiazines (eg Acepromazine, ACP)
They are effective in blocking dopamine receptors indicated above, in addition to other receptors involved in the vomiting reflex. They are generally used when metoclopromide failed, but also have undesirable side effects such as low blood pressure andsedation.
4. Antihistamines
Histamine receptors are also present in the trigger zone chemoreceptor, part of the brain that controls the vomiting reflex. Antihistamines are effective in blocking the vomiting is due to motion sickness, but are useless against other causes.
5. Domperidone
Domperidone has a similar action to metoclopromide in that it blocks dopamine receptors and secondarily blocks serotonin receptors, but not the effects of promotilitymetoclopromide. However, side effects include enlargement of the vulva and the possible effects on fertility.
6. Maropitant
This is a new drug that is a neurokinin 1 (NK1) receptor antagonist. It can be administered orally or by injection, and is extremely effective in stopping vomiting by working both on the vomiting center in the brain and stomach. It is considered so effective in stopping vomiting that veterinarians must ensure to properly investigate potentially hazardousunderlying causes, which could be masked fatally by this drug.
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