One of the most common problems for which patients are presented to me is that of chronic vomiting. There are a myriad of causes and treatments available. So, this week I wanted to dedicate some bandwidth to sharing more information about this common clinical problem. I hope you find the post helpful – happy reading!
What is chronic vomiting?
Vomiting is actually a protective mechanism of the body. It’s an intricately coordinated process of expelling ingesta from the stomach and sometimes the duodenum (the first part of the small intestine) – this can be helpful when a pet ingests toxic or noxious substances. Vomiting is controlled by a specific area of the brain called the emetic center in the medulla oblongata. Stimuli from various parts of the body, including the intestinal tract, can trigger a unique cascade of events that trigger the emetic center to initiate vomiting. Chronic vomiting is defined as vomiting that has occurred for more than one week.
What causes it?
There are many potential causes of chronic vomiting in dogs and cats. I like to initially categorize the causes as either:
- Related to the gastrointestinal tract
- Everything else
The list of primary gastrointestinal tract causes of chronic vomiting includes problems like inflammatory bowel disease, food allergies, intestinal cancers, and infectious diseases (i.e.: parasites, fungal disease likes histoplasmosis).
It’s important to remember there are many possible inducers of chronic vomiting outside of the gastrointestinal tract too. These include:
- Kidney disease (i.e.: chronic kidney disease)
- Liver and gall bladder disease (i.e.: gall bladder mucocele, copper storage disease, chronic hepatitis, cholangitis)
- Hypoadrenocorticism (Addison’s disease)
- Hyperthyroidism
- Chronic pancreatitis
How is chronic vomiting diagnosed?
It’s relatively easy to diagnosis chronic vomiting – remember, the simple definition is vomiting that has been going on for more than one week. What is more challenging to figure out is what’s causes the chronic vomiting in the first place. As you read earlier, there are a lot of potential causes, so we try to progress through the diagnostic process logically, performing non-invasive tests before minimally invasive and invasive ones. Recommended tests may include:
- Complete blood count
- Serum biochemical profile
- Urinalysis
- Urine culture
- ACTH stimulation test to screen for hypoadrenocorticism (Addison’s disease
- Food elimination trial to diagnose food allergies
- GI profile to screen for B vitamin deficiencies (that provide information about the health of the gastrointestinal tract) and pancreatic abnormalities
- Fecal analysis to look for intestinal parasites
- Fungal testing
- Liver function testing
- Thyroid hormone screening
- Diagnostic imaging (i.e.: chest radiographs/x-rays, abdominal radiographs/x-rays, abdominal sonography)
- Biopsies (i.e.: gastrointestinal, liver)
Pet owners may find it helpful to partner with a board-certified veterinary internal medicine specialist to develop a logical and cost-effective diagnostic plan.
How is chronic vomiting treated?
Effectively treating chronic vomiting requires identifying the underlying cause. It’s imperative to thoroughly investigate potential causes so your pet can be treated properly. Understandably, chronic kidney disease is treated very differently than Addison’s disease. Undeniably, successful management depends on an accurate diagnosis on
Sometimes for various reasons, families elect not to pursue definitive diagnostic testing. Rather they elect empirical or best guess treatment. In many circumstances, this course of action is actually successful. But in others, it isn’t. That’s when pet owners tend to become frustrated because they’re pet isn’t getting better. So, here’s what families need to understand and accept about empirical therapy for chronic vomiting:
- Empirical treatment success can’t be guaranteed
- If empirical treatment isn’t successful, we won’t know why because we don’t have a definitive diagnosis
- Pursuing definitive diagnostic testing can be much more challenging after attempting empirical therapy
Pet owners may find it helpful to consult with a board-certified veterinary internal medicine specialist before making a decision about empirical therapy.
The take-away message about chronic vomiting in dogs and cats…
Chronic vomiting is relatively common in dogs and cats. There are many potential causes, so a thorough diagnostic investigation is imperative. With accurate diagnoses, veterinarians can develop appropriate treatment plans to help pets hopefully lead more healthful lives.
To find a board-certified veterinary internal medicine specialist, please visit the American College of Veterinary Internal Medicine.
Wishing you wet-nosed kisses,
CriticalCareDVM
