What is vomiting?
Vomiting is the forceful expulsion of stomach contents through the mouth.
What is the difference between vomiting and regurgitation?
In regurgitation, the food that is expelled comes from the mouth or esophagus, versus the stomach. Vomiting involves the forceful contraction of stomach muscles; regurgitation does not. Both vomiting and regurgitation can occur right after eating or drinking, or up to several hours later.
If my dog is vomiting, when should I call my veterinarian?
If your dog is bright and alert, and only vomits once, it is probably not necessary to call your veterinarian. Many dogs will vomit after eating grass, for instance. If your dog vomits more than once or appears sick, call your veterinarian. Your veterinarian will ask you a series of questions to determine how severe the vomiting is. It will be helpful for your veterinarian to know when the vomiting started, how many times your dog has vomited, what the vomit looks like, and if your dog is uncomfortable. It is especially important that you call your veterinarian immediately if:
•There is blood in the vomit
•Your dog acts like he wants to vomit, but nothing is expelled
•Your dog appears bloated or has a swollen abdomen
•You suspect your dog may have eaten something toxic or poisonous
•Your dog has a fever or is depressed
•Your dog's gums are pale or yellow
•Your dog is a puppy or has not received all his vaccinations
•Your dog appears to be in pain
•Your dog also has diarrhea
Do not give your dog any medications, including over-the-counter human medications unless advised by your veterinarian to do so.How is the cause of vomiting diagnosed?
There are many causes of vomiting (See Table 1: Causes, Diagnosis and Treatment of Vomiting in Dogs). It is important to determine the cause so the appropriate treatment can be given. Your veterinarian will combine information from you, the physical exam, and possibly laboratory and other diagnostic tests to determine the cause of the vomiting.
When dogs and cats vomit, their abdominal muscles contract very strongly multiple times before the food is actually ejected from the mouth. It may appear as though the whole body is involved in the effort. Often they will go through this process several times in a row.
Onset of symptoms – How suddenly the symptoms appeared is a good clue to what the cause of the vomiting may be. If the symptoms appeared suddenly, the condition is called "acute". If the symptoms remain over a long period of time (weeks), the vomiting is called "chronic".
Appearance of vomit – Distinguish vomiting from regurgitation (expelling food that has not yet reached the stomach), whether the vomit contains food or just fluid, color of vomit, presence of blood or bile in the vomit.
Degree of nausea – As shown by such signs as licking or smacking of lips, drooling, swallowing, or gulping. Timing of vomiting in relation to meals or drinking should also be noted.
Severity – How often the vomiting occurs and whether it is projectile.
Presence of other signs – Fever, pain, dehydration, urinary changes, depression, weakness, diarrhea, or weight loss. Vomiting is often caused by diseases not directly related to conditions of the digestive tract, such as hepatitis, pancreatitis, diabetes, and kidney disease.
Medical History – Your veterinarian will ask about your dog's medical history including vaccinations, what type of wormer the dog has received and how often, contact with other dogs, diet, any access to garbage or toxins, and any medications. The more information you can offer, the easier it will be to make a diagnosis.
Physical examination – Your veterinarian will do a complete physical exam including taking your dog's weight and temperature, checking the heart and respiration, looking in the mouth, palpating the abdomen, checking for dehydration, and performing a rectal exam.
Laboratory and diagnostic tests – In some cases of vomiting, your veterinarian will recommend a fecal flotation. This is a test to check for parasites such as intestinal worms or Giardia. If a bacterial infection is suspected, a fecal culture and sensitivity are performed. In cases of certain viral diseases, such as parvovirus, other tests on the feces may aid in the diagnosis.
If the dog is showing signs of illness, a complete blood count and chemistry panel are often recommended. Special blood tests may also be conducted if certain diseases are suspected.
Radiographs (x-rays) are appropriate if a tumor, foreign body, or anatomical problem is suspected. Other diagnostic imaging such as a barium study or ultrasound may also be helpful. Examinations using an endoscope or colonoscopy may be indicated.
For some diseases, the only way to make an accurate diagnosis is to obtain a surgical biopsy and have it examined microscopically.
How is vomiting treated?
Because there are so many causes of vomiting, the treatment will vary (See Table 1: Causes, Diagnosis and Treatment of Vomiting in Dogs).
In many cases of vomiting in dogs, it is recommended to withhold food for at least 24 hours, and provide small amounts of water frequently. Then, a bland diet such as boiled hamburger and rice is offered in small amounts. If the vomiting does not recur, the dog is slowly switched back to his normal diet or a special diet over the course of several days.
For some cases of vomiting, it may be necessary to modify the diet permanently. Special foods may need to be given as a way to avoid certain ingredients, add fiber to the diet, decrease the fat intake, or increase digestibility.
If intestinal worms are present, the appropriate wormer will be prescribed. Few wormers kill every kind of intestinal worm, so it is very important that the appropriate wormer be selected. In most cases, it is necessary to repeat the wormer one or more times over several weeks or months. It is also important to try to remove the worm eggs from the environment. The fecal flotation test looks for worm eggs, and if no eggs are being produced, the test could be negative even though adult worms or larvae could be present. For this reason, in some cases, even if the fecal flotation test is negative, a wormer may still be prescribed.
If dehydration is present, it is usually necessary to give the animal intravenous or subcutaneous fluids. Oral fluids are often inadequate during vomiting or diarrhea since they may pass through the animal too quickly to be sufficiently absorbed.
Antibiotics are given if the vomiting is caused by bacteria. They may also be given if the stomach or intestine has been damaged (eg., blood in the stool or vomit would indicate an injured intestine or stomach) and there is a chance that the injury could allow bacteria from the digestive tract into the blood stream.
In some cases, medications may be given to decrease vomiting. As a general rule, these drugs should not be given if the dog could have ingested a toxin or may have a bacterial infection. Therefore, it is always important to have an accurate diagnosis before use of these drugs.
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