Acute vomiting – diagnostic approach
The first step in the approach to the acutely vomiting dog is to determine that vomiting and not regurgitation is present.
Vomiting is associated with signs of nausea (depression, salivation, and frequent swallowing,) that is followed by abdominal
contractions prior to the expulsion of material. Regurgitation is associated with esophageal disorders and occurs passively,
usually associated with increased intrathoracic pressure that may be caused by excitement, activity, or changes in body position.
Once you have determined the dog is vomiting rather than regurgitating,, the next step is to determine if a self-limiting
or life threatening problem is present. This assessment is crucial and must be based on a thorough history, careful physical
examination, clinical experience and judgment, and a sound understanding of the differential diagnosis of acute vomiting.
Dogs with acute pancreatitis can present with both types of vomiting. Animals should be considered to have a potential life-threatening
problem if some of the following are present: Moderate or severe abdominal pain, lethargy, dehydration or pyrexia, enlarged
distended bowel, frequent and severe diarrhea, hematemesis, frequent vomiting or increasing frequency of vomiting, signs of
systemic disease, or puppies with an incomplete vaccination history. If a clear distinction cannot be reached, it is better
to error on the cautious side and consider a potential life-threatening problem.
Dogs with a self-limiting problem require minimal diagnostic testing and symptomatic treatment, and often cease vomiting within
12-24 hours of initial presentation. A minimum data base for animals with self-limiting vomiting should include determination
of packed cell volume and total solids, zinc sulfate fecal flotation, and digital rectal examination. Some common causes include
acute gastritis or enteritis, dietary indiscretion, drug administration, toxin ingestion, foreign body ingestion, parasites,
and coronavirus. Reclassification to life-threatening status may be indicated if an animal initially assessed as having self-limiting
acute vomiting continues to vomit despite appropriate symptomatic therapy.
Life-threatening cases of acute vomiting require an in-depth diagnostic evaluation, vigorous symptomatic management, and often
specific therapy directed at the underlying cause. The initial minimum data base for life-threatening acute vomiting includes
a complete blood count, biochemical profile with amylase and lipase, urinalysis, zinc sulfate fecal flotation, and survey
abdominal radiographs. After the initial evaluation, additional diagnostic studies may be indicated in some instances, such
as upper GI endoscopy, upper GI barium series, abdominal ultrasonography, ACTH response testing, or surgical exploration of
the abdomen. Some common causes include acute gastritis, dietary indiscretion, hookworms, foreign body obstruction, intussusception,
parvovirus, distemper, HGE, acute renal failure, acute liver failure, hypoadrenalcorticism, diabetes mellitus, and pyometra.