If you see vomiting, and you are thinking "inside GI" causes....what thing should come to your mind immedaitely?
PARASITES, PARASITES, PARASITES
vomiting workup flow chart (pic)
* what are the 3 major reasons for hematemesis?
(1) coagulopathy (2) swallowing of blood (3) GI ulceration/erosion
If you suspect coagulopathy as a cause for the hematemesis, what are your main reasons this could happen and what plan (tests) should you do?
Thrombocytopenia / - pathia, Intoxication (rodenticides) / DIC / liver ..... to figure it out, do a platelet count, a coag panel (aPT, aPTT, fibrinogen, ACT,...) and a buccal mucosal bleeding time (BMBT)
what is considered a low platelet count which might lead to coagulopathy-->hematemesis?
< 30-50 x 10^9 /L (1 platelet / 100 x oil field ~ 10 -15 x 10^9 /L)
if you think the dog that vomited blood just swallowed the blood, where are the places this blood can be coming from? and why might it be coming from there?
cause study: not a clotting problem. ACTH stim normal, diffuse thickening of duo...diet change and anti-nausea/acid meds helped a little bit. You will now want to endoscopy because your two major DDx are...?
suspect IBD / exclude lymphoma
Lymphoplasmacellular gastritis & enteritis--> how do you tx this? for how long?
Sucralfate, ranitidine, omeprazole, prednisolone 1-1.5mg/kg/dag, 2 weeks beyond clinical cure, than tapering over weeks
major clinical sign of Lymphoplasmacellular gastritis & enteritis?
VOMTING!! remember, need to differentiate acute vs chronic, Self limiting vs. life threatening systemic illness, GI vs. Non-GI causes
Chronic Gastritis-- what are the 5 types, which two are most common?
in a chronic vomiting case, what will be your first choice of workup, and why?
in chronic cases, usually do diet change first- you have some time. if just a GI prob, win first 2weeks should see good chance, if not, stop and try sthing else
what is the general work-up plan for chronic vomiting?
(1) Exclude extra GI causes ... (2) Testing for parasites (direct smear, Giardia,Flotation,SNAP) (3) Treatment for parasites (4) Abdominal ultrasound (5/6) Diet change (new carb, new protein) for >2-4 weeks (6/5) Endoscopy
she said chronic vomiting is most often what problem?
what is the TX plan for chronic vomiting, and what should you always do first with tx??
(1) *** ALWAYS treat for parasites first-- Fenbendazole for 3-5 days (2) Diet change: new protein / new carbohydrate (3) Biopsy outcome determines further specific treatment: ---- (4) Prednisolone 1mg/kg SID in lymphoplasmacytic gastritis (5) Triple therapy if helicobacter like organisms and no other reason: Amoxicillin, metronidazole, famotidine (High recurrence rate)
chronic vomiting--> what is "triple therapy" and when do you do this therapy?
Do this if you have elim other reasons for chronic vomiting, because then the suspect is helicobacter like organisms. The Trip therapy is: Amoxicillin, metronidazole, famotidine
what are you gonna treat suspected GI parasites with?
Fenbendazole ((she listed some study and the conclusion was that If you want more certainty of if it is parasites: combine the tests!
***how do you detect giardia with confidence?
Giardia-oocyst shedding occurs intermittently, but three fecal analyses are 90 - 95% sensitive
***if you want more certainty of your possible parasite diagnosis, what should you do?
If you want more certainty: combine the tests! (such as fecal zinc sulfate flotation + fecal SNAP, + possibly PCR) (note, 10% of healthy dogs=positive)
If you choose to attempt a diet change....what is the biggest problem you face?
OWNER COMPLIANCE!!! no snacks from anyone and such- these little snacks mess up dietary trials
*what is the diet she recommends for a diet trial?
Diet change: new protein / new carbohydrate--- so, she recommends 2/3 rice and 1/3 TURKEY (not chicken- chicken has high allergic potential). A commercial sensitivity diet like from royal cannin might work too.
what is something you can reccomend your owners should do if their dog is on a diet trial and they want to take them out out walks?
dogs can eat things in the environment!! put a muzzle on them so they cant