Identifying the cause of acute vomiting in dogs: It matters for treatment and outcome (Sponsored by IDEXX)
With a vomiting dog, it is critical to distinguish between pancreatitis and nonspecific gastroenteritis. This is because the standard-of-care treatment of pancreatitis is no longer identical to treatment of nonspecific gastroenteritis. Accurate diagnosis will guide you to the best treatment plan for your patient.
Jörg M. Steiner, MedVet, DrMed.Vet, PhD, DACVIM-SA, DECVIM-CA, AGAF
VOMITING IS COMMONLY observed in dogs. In fact, isolated vomiting episodes that are clinically insignificant are quite common. Most pet owners
are aware of this and rarely present their dog to a veterinarian for such an isolated vomiting episode. However, when the
dog has several vomiting episodes or there is a noticeable decline in the dog's overall health, veterinary care that involves
both diagnosis and treatment is important.
Diagnosis: Basic and rapid tests make a difference
Many patients with acute-onset vomiting have an acute gastroenteritis for which the exact etiology is rarely ascertained.
However, some vomiting patients have acute hepatic disease, acute renal failure, a foreign body, or pancreatitis. Thus, you
must make a basic diagnostic effort to differentiate the causes of acute vomiting. Some of the most important steps you can
take when evaluating dogs with acute vomiting are to
Obtain preliminary measurements for basic parameters (i.e. PCV, total solids, blood urea nitrogen [test strip], and blood glucose)
Collect a baseline blood sample for more comprehensive and specific analysis, including a CBC, a serum chemistry profile with
electrolytes, a canine pancreas-specific lipase test (Spec cPL® Test; IDEXX Laboratories), and perhaps other tests depending
on the specific patient
Collect a baseline urine sample for complete urinalysis
Obtain abdominal radiographs to identify evidence of gastrointestinal obstruction.
Contrasting treatment protocols for pancreatitis and nonspecific gastroenteritis in dogs
If in-house clinical pathology testing is available, run a CBC and a serum chemistry profile immediately. These results will
help to rule out renal failure, acute hepatic disease, hypoadrenocorticism, and many other potential causes of acute vomiting.
However, it is just as important to exclude pancreatitis as an underlying cause of the clinical signs, and this can be achieved
by running an in-clinic canine pancreas-specific lipase test (SNAP® cPL™ Test; IDEXX Laboratories). Many veterinarians believe
that this step is not important because the treatment of acute gastroenteritis and pancreatitis is considered to be the same.
However, during the past 20 years, the treatment of pancreatitis in dogs has changed dramatically, and the current state-of-the-art
treatment of pancreatitis no longer resembles that of nonspecific gastrointestinal upset in dogs (see Table). 1
Deciding between discharge and hospitalization
Assessing the severity of pancreatitis in dogs is also of concern. Many studies have demonstrated that no reliable means for
routinely assessing the severity of pancreatitis in dogs is available.2 It is also well-recognized that patients with severe pancreatitis and the risk of life-threatening complications might not
display clinical signs commensurate with the severity of their disease, and their condition may deteriorate dramatically over
a short period of time. It may be perfectly safe to discharge a patient with acute vomiting due to acute nonspecific gastroenteritis
that is not dehydrated and that feels well. On the other hand, a patient with acute vomiting caused by acute pancreatitis
should be monitored more closely in the clinic to avoid severe complications and death. It is just as crucial to differentiate
a patient with acute vomiting caused by pancreatitis from a patient with acute vomiting as a result of nonspecific gastroenteritis
as it is to differentiate a patient with acute vomiting caused by hypoadrenocorticism. Such differentiation can be quickly
and easily achieved by the Spec cPL and SNAP cPL tests.