Small Animal Practice

Veterinary Teaching Hospital

Airlangga University

DifferentialDiagnose

Vomit

• Vomiting is the forceful expulsion of stomach contents through the mouth, caused by humoralstimulation of the chemoreceptor trigger zone (CRTZ) or neural stimulation of the emetic center.

• The act of vomiting is composed of three phases:

– Nausea

– Retching

– Expulsion of proximal duodenal and gastric contents.

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Vestibular apparatusCerebral cortex

CRTZ

Uremic toxins, Hepatotoxins, Endotoxins

Anxiety, Stress Motion

Emetic center

Toxins, cell necrosis, inflammation,

distension, chemotherapy, radiation

[D, C1, H, A, S, E]

[S1, A, G, N]

[D, S4, C2, M]

[C1, H]

[S, N]

D; D2-DopaminergicC1; M1-CholinergicC2; M2-CholinergicA; α2-AdrenergicS1; 5-HT1A-SerotonergicS3; 5-HT3-SerotonergicS4; 5-HT4-SerotonergicH; H1-HistaminergicE; ENKµδ-EnkaphalinergicN; Neuropkinin-1 antagonistG; Glucokorticoid receptorM; Motilin

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Acute Vomit

• Dietary

– Dietary indiscretion*

– Dietary intolerance*

– Sudden change in diet*

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Acute Vomit

• Gastrointestinal disease– Colitis*– Constipation/obstipation*– Foreign body*– Gastric dilatation/volvulus*– Gastric or duodenal ulceration*– Gastritis/enteritis*– Haemorrhagic gastroenteritis*– Infection [Bacterial*; Parasites*; Viral*]– Inflammatory bowel disease*– Intestinal volvulus– Intussusception– Neoplasia*

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Acute Vomit

• Endocrine disease

– Diabetic ketoacidosis*

– Hypoadrenocorticism (Dog)

• Miscellaneous conditions

– Central nervous system disease

– Diaphragmatic hernia

– Motion sickness

– Psychogenic

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Acute Vomit

• Metabolic/systemic disease– Hypercalcaemia/hypocalcaemia– Hyperkalaemia/hypokalaemia*– Hyperthermia*– Liver disease* – Pancreatitis*– Peritonitis*– Prostatitis*– Pyometra* (Dog)– Renal disease* – Septicaemia*– Urinary obstruction*– Vestibular disease*

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Acute Vomit

• Drugs/toxins– Acetazolamide

– Adder bite

– Allopurinol

– Alpha-2 agonists

– Aminophylline

– Amphotericin B

– Apomorphine

– Aspirin

– Atipamezole

– Atropine

• Drugs/toxins– Batteries

– Benzalkonium chloride

– Bethanechol

– Blue-green algae

– Borax

– Bromocriptine

– Calcium edetate

– Carbimazole

– Carboplatin

– Cardiac glycosides

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Acute Vomit

• Drugs/toxins– Cephalexin

– Chlorambucil

– Chloramphenicol

– Chlorphenamine

– Clomipramine

– Colchicine

– Cotoneaster

– Cyclophosphamide

– Cyclosporin

– Cytarabine

• Drugs/toxins– Daffodil

– Dichlorophen

– Diclofenac sodium

– Dinoprost tromethamine

– Dopamine

– Doxorubicin

– Doxycycline

– Dieffenbachia

– Ethylene glycol

– Erythryomycin

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Acute Vomit

• Drugs/toxins– Glipizide

– Glucocorticoids

– Glyphosphate

– Honeysuckle

– Horse chestnut

– Hydralazine

– Ibuprofen

– Indomethacin

– Ipecacuanha

– Iron/iron salts

• Drugs/toxins– Ivermectin

– Ketoconazole

– Laburnum

– Lead

– Levamisole

– Lignocaine

– Loperamide

– Medetomidine

– Melphalan

– Metaldehyde

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Acute Vomit

• Drugs/toxins– Methimazole

– Metronidazole

– Mexiletine

– Misoprostol

– Mistletoe

– Mitotane

– Naproxen

– Nicotinamide

– Nitroscanate

– NPK fertilisers

• Drugs/toxins– NSAIDs

– Paracetamol

– Paraquat

– Penicillamine

– Pentoxifylline

– Petroleum distillates

– Phenoxy acid herbicides

– Phenytoin

– Pimobendan

– Piperazine

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Acute Vomit

• Drugs/toxins– Plastic explosives

– Poinsettia

– Potassium bromide

– Procainamide

– Propantheline bromide

– Pyracantha

– Pyrethrin/pyrethroids

– Pyridostigmine

– Rhododendron

– Rowan

• Drugs/toxins– Salt

– Selective serotonin reuptake inhibitors

– Sildenafil

– Sotalol

– Strychnine

– Sulphasalazine

– Terfenadine

– Tetracycline

– Theobromine

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Acute Vomit

• Drugs/toxins

– Theophylline

– Tricyclic antidepressants

– Trimethoprim/sulphonamide

– Ursodeoxycholic acid

– Vitamin D rodenticides

– Xylazine

– Yew

– Zinc

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Chronic Vomit

• Gastrointestinal– Bacterial overgrowth

– Colitis*

– Constipation/obstipation*

– Enterogastric reflux

– Gastric motility disorders*

– Gastric or duodenal ulceration*

– Gastritis/enteritis*

– Infection [Bacterial; Fungal; Parasites*; Viral]

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Chronic Vomit

• Gastrointestinal

– Inflammatory bowel disease [Eosinophilic; Lymphocytic; Lymphoplasmacytic; Mixed]

– Irritable bowel syndrome

– Neoplasia*

– Obstruction [Foreign body*; Inflammatory bowel disease (gastritis or enteritis); Intussusception*; Neoplasia*; Pyloric stenosis]

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Chronic Vomit

• Endocrine disease

– Diabetes mellitus*

– Hyperthyroidism* (Cat)

– Hypoadrenocorticism (Dog)

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Chronic Vomit

• Metabolic/systemic disease– Heartworm disease

– Hypercalcaemia/hypocalcaemia

– Hyperkalaemia/hypokalaemia

– Liver disease*

– Pancreatitis*

– Prostatitis

– Pyometra* (Dog)

– Renal disease*

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Chronic Vomit

• Miscellaneous conditions

– Abdominal neoplasia

– Diaphragmatic hernia

– Sialadenitis

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