| Definition: Chronic Vomiting | | | | - Gastric |
| - Acute vomiting that fails to respond to | | | | - Small intestinal |
| appropriate symptomatic therapy | | | | - Colonic |
| - Untreated vomiting that persists longer than two | | | | - Secondary GI |
| weeks | | | | - Systemic illness that affects GI function |
| - Consistent | | | | Chronic Vomiting: |
| - Intermittent or episodic | | | | Diagnostic Steps |
| Approach to Vomiting | | | | - CBC, biochemistry profile, UA |
| - Primary GI | | | | - Fecal |
| - Gastric | | | | - Survey abdominal radiographs |
| - Small intestinal | | | | - Cats: |
| - Colonic | | | | - T4 if over 6 yrs, FeLV, FIV |
| - Secondary GI | | | | - occult heartworm test |
| - Systemic illness that affects GI function | | | | - Elimination diet |
| Secondary GI Causes of Vomiting | | | | - Endoscopy |
| SYSTEM | | | | - Abdominal ultrasound |
| - Kidneys | | | | - Barium series |
| - Liver | | | | - Laparatomy |
| - Exocrine pancreas | | | | Approach to Chronic Vomiting |
| - Endocrine pancreas | | | | CBC, biochemistry profile, UA, fecal |
| - Adrenals | | | | Survey abdominal radiographs |
| - Peritoneum | | | | Cats: T4 if over 6 yrs, FeLV, FIV (occult |
| - CNS | | | | heartworm test) |
| - Thyroid | | | | Mild Signs: |
| - Uterus | | | | - Elimination diet |
| - Systemic infection | | | | Significant Clinical Signs: |
| Disease: | | | | - Endoscopy |
| - Renal failure | | | | - Abdominal ultrasound |
| - Hepatic disease | | | | - Barium series |
| - Pancreatitis | | | | - Laparotomy |
| - DKA | | | | Overview: |
| - Addison's | | | | Gastric Causes of Chronic Vomiting |
| - Peritonitis | | | | - Chronic gastritis |
| - Cerebral or vestibular disease | | | | - Lymphocytic/plasmacytic |
| - Hyperthyroidism | | | | - Eosinophilic |
| - Pyometra | | | | - Associated with GHLOs |
| - Sepsis | | | | - Parasitic |
| Overview: | | | | - Reflux gastritis |
| Gastric Causes of Chronic Vomiting | | | | - Gastric foreign body |
| - Chronic gastritis | | | | - Gastric ulceration |
| - Lymphocytic/plasmacytic | | | | - Gastric motility disorders |
| - Eosinophilic | | | | - Gastric neoplasia |
| - Associated with GHLOs | | | | Chronic Gastritis |
| - Parasitic | | | | Classified by etiology, breed, and/or |
| - Reflux gastritis | | | | histopathology |
| - Gastric foreign body | | | | Types of Chronic Gastritis |
| - Gastric ulceration | | | | - Lymphocytic/plasmacytic gastritis (Chronic |
| - Gastric motility disorders | | | | non-specific gastritis, IBD) |
| - Gastric neoplasia | | | | - Eosinophilic gastritis |
| Overview: | | | | - Granulomatous gastritis |
| Intestinal Causes of Chronic Vomiting | | | | - Atrophic gastritis |
| - Inflammatory bowel disease (IBD) | | | | - Gastritis associated with GHLOs |
| - Intestinal neoplasia | | | | - Parasitic gastritis |
| - Duodenal ulcers | | | | - Reflux gastritis |
| - Fungal enteritis | | | | Etiopathogenesis of Chronic Lymphocytic |
| - Chronic intussusception | | | | Plasmacytic Gastritis |
| - Foreign bodies | | | | - Non-specific reaction to many insults |
| - Colitis | | | | - Either wall defects allow antigen absorption from |
| Chronic Vomiting: History | | | | stomach stimulating immune response OR |
| - Characterize vomiting | | | | breakdown in immune tolerance (auto-immune |
| - Onset | | | | gastritis) |
| - Duration | | | | - Mucosal damage allows back-diffusion of acid |
| - Frequency | | | | - Gastric inflammation compromises motility, |
| - Progression | | | | secretions and plasma proteins lost into lumen |
| - Relationship to eating | | | | Chronic Lymphocytic/Plasmacytic Gastritis: Clinical |
| - Specific features (blood, foreign material, | | | | Features |
| undigested food, projectile, etc.) | | | | - Persistent intermittent vomiting exacerbated by |
| - Response to changes in diet or feeding schedule, | | | | eating |
| medication, other changes | | | | - Diarrhea occurs if animal has concurrent IBD of |
| Associated clinical signs- | | | | intestines |
| - Appetite changes | | | | - PE, CBC, chemistries, UA, fecal, and survey |
| - Weight loss | | | | radiographs - typically NAF |
| - Diarrhea | | | | Chronic Lymphocytic/Plasmacytic Gastritis: |
| - Changes in attitude (lethargy) | | | | Diagnosis |
| - PU/PD | | | | - Obtain endoscopic biopsies or full-thickness |
| - Cough, tachypnea, dyspnea | | | | biopsies by laparotomy |
| - Other | | | | - Infiltration of the gastric mucosa predominantly |
| - Potential exposures prior to onset: | | | | with lymphocytes and plasma cells |
| - Medications | | | | - Mucosa may be normal thickness (simple |
| - Plants | | | | gastritis), increased (hypertrophic), or decreased |
| - Toxins | | | | (atrophic) |
| - Garbage | | | | Note: Mucosal hypertrophy can cause outflow |
| - Potential foreign bodies | | | | obstruction |
| - Other sick animals | | | | Chronic Lymphocytic/Plasmacytic Gastritis: |
| - Dietary history | | | | Treatment |
| - Deworming history | | | | PRIMARY THERAPY |
| - Vaccination status | | | | - +/- NPO or "no food" for 24-48 hours |
| - Past medical history | | | | - Multiple small daily meals |
| - Past surgical history | | | | - Easily digested diet (i/d) |
| Approach to Vomiting: | | | | - Novel protein diet (e.g. |
| - Primary GI | | | | |