Veterinary Medicine - February 2008 - (Page MV6) MANAGING VOMITING Dr. David Williams diagnostics. For example, if you suspect that the patient may have a gastrointestinal foreign body, abdominal radiographs would be the next step. If you suspect pancreatitis, then you might evaluate the patient with other diagnostics, such as a pancreatic lipase immunoreactivity test and ultrasonography. Simpson: I agree that a minimum database is really important. Systemic illness and vomiting associated with acute renal failure and leptospirosis is reasonably common in our practice. In these patients, measuring urine speci c gravity and serum creatinine up front helps rule out renal involvement and helps us determine whether to pursue other causes of vomiting. “How the food is introduced is probably more important than what the patient eats.” Twedt: Make sure the animal truly is vomiting and not regurgitating, gagging, or coughing, which would take your workup in a di erent direction. As for the physical exam and history, I always ask about polydipsia and polyuria and the character of the stools. Does the animal have mucousy stools, which might re ect an animal that is vomiting from colitis? Most veterinarians probably see the animals with acute mild self-limiting disease, but you have to make sure you don’t miss more complex or critical disorders. Simpson: Try to determine if it is a happy, healthy vomiter with no alarm bells or warning signs. These cases are treated symptomatically and require a minimal workup (e.g., parasite check). If they are not happy and healthy or if there are alarm bells, then they need a more comprehensive workup. Williams: A lot of this is classical conventional veterinary medicine: the signalment, the history, the physical examination, getting a feel for whether it’s self-limiting or whether the patient requires additional workup at this stage. 6 Leib: What are the most common causes of the vomiting in that type of patient? Jergens: I emphasize three big categories: dietary indiscretion, parasites, and infectious disease. From an infectious disease standpoint, I don’t have a feeling for what the prevalence of acute viral enteropathies or gastropathies are in the dog or cat. Furthermore, we can rule those out quickly with a client interview, a vaccine history, dietary trial, and routine anthelmintic therapy. Leib: Let’s move on to that acute patient that, as Dr. Simpson says, “presents alarm bells.” Perhaps that animal has a greater degree of dehydration, abdominal pain, or concurrent diarrhea. Maybe there isn’t a clear history of dietary indiscretion. What is our diagnostic workup in those patients? Williams: A classic minimum database: a complete blood count, serum chemistry panel, urinalysis, and fecal examination. Twedt: Your clinical ndings would direct you into further Treatment Leib: Let’s start with animals that have a mild, self-limiting case of vomiting. How should we manage these patients? Jergens: If the deworming history is vague or nonexistent, I might deworm that patient with a broadspectrum anthelmintic. Recently I’ve had several young animals in which I suspected an adverse food reaction . I don’t know whether it is intolerance or dietary sensitivity, but I try to nd an appropriate elimination diet that meets the patient’s nutritional requirements. If they are on a general commercial diet, I move them to a commercial diet that’s suitable for gastrointestinal disorders. Twedt: Yes, I agree. When prescribing a diet, it is usually a commercial formulation. A premade preparation is easier for the client than cooking diets, such as rice and boiled chicken. Leib: So these diets are the moderately fat-restricted, low- ber,
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