Veterinary Medicine - February 2008 - (Page MV2) MANAGING Participants VOMITING: Examining the physiology, common causes, and control in dogs and cats. Moderator Michael Leib, DVM, MS, DACVIM Albert E. Jergens, DVM, PhD, DACVIM Kenneth Simpson, BVMS, PhD, DACVIM, DECVIM David Twedt, DVM, DACVIM David Williams, MA, VETMB, PhD, DACVIM, DECVIM Virginia Tech Blacksburg, Va. Iowa State University Ames, Iowa Cornell University Ithaca, N.Y. Colorado State University Fort Collins, Colo. University of Illinois Urbana, Ill. Sponsor’s note: The objective of this roundtable discussion is to share the current clinical, medical, and scienti c understanding of vomiting and its physiology, cause, and control in companion animal medicine. Due to the paucity of FDAapproved products, the discussion includes the extra-label use of human pharmaceuticals. Physiology and causes of vomiting Dr. Michael Leib: Let’s start by discussing the physiology of vomiting, including the role and importance of the central and peripheral pathways. Dr. Albert E. Jergens: Simplistically, we can subdivide the pathophysiology of vomiting by cause: 1. Blood-borne toxins or metabolites that stimulate the chemoreceptor trigger zone 2. Input from the central nervous system 3. Stimuli that trigger responses from the vestibular system 4. Visceral vagal nerves, which send a erent signals from abdominal parenchyma in response to distention, irritation, or in ammation. The spectrum of clinical cases I see includes vomiting from dietary causes, pancreatitis, inammatory bowel disease, and liver disease in dogs and cats. I also see chemoreceptor trigger zoneinduced vomiting from drugs, blood-borne toxins, or problems secondary to metabolic disturbances (e.g., uremia or hyperbilirubinemia). In my Topics discussed: • The pathophysiology of vomiting • The importance of the central and peripheral pathways • Common causes and conditions that induce vomiting • The role of the chemoreceptor trigger zone • The diagnostic workup of a vomiting patient • Treatment for vomiting patients • Use of antiemetic therapy • Changes in nutrition and diet 2 ©2008 Pfizer Animal Health. All rights reserved. The recommendations discussed by these experts are based on their own expertise and experience. Pfizer Animal Health does not recommend the extra-label use of Cerenia (maropitant). Cover illustration by Ryan Kramer.
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