Gastrointestinal Case Discussions

Acute and chronic vomiting, chronic diarrhea, abnormal behavior or pain while eating are the topics that will be addressed during the session. This interactive lecture will provide a case based, very practical step-bystep approach to the patient with gastrointestinal problems in order to provide the practicing veterinarian with a logical and easy to follow support in his/her decision making.

In some patients a distinction between vomiting and regurgitation can be difficult, and it might not be immediately obvious whether behavioral problems or pain are the etiology of abnormal behavior of a pet. During the presentation of example cases from the gastroenterology service of the veterinary teaching hospital in Utrecht these problems will be discussed with the audience.

Vomiting

Apart from toxicities differential diagnoses for vomiting include etiologies of the central nervous system (excluded based on the results of a physical examination), etiologies within the gastrointestinal system, and extra-alimentary etiologies.
Extra-alimentary etiologies for vomiting in dog as and cats are uremia, hepatic insufficiency, pancreatitis, peritonitis, pyometra, cholangitis, adrenal insufficiency, and feline hyperthyroidism in cats older than 6 years of age. Gastrointestinal etiologies for vomiting include parasites (including giardia), dietary indiscretion, gastritis, enteritis, colitis, ileus, IBD, and neoplasia (including pyloric stenosis).
Due to the fact that parasites occur commonly in animals the author recommends to exclude parasites by treating the animal with fenbendazole for 5 days (panacur: 50mg/kg PO once daily) if the etiology remains unsolved after a clinical examination of the patient.
If vomiting continues diagnostic imaging may aid to exclude intestinal ileus. In patients below 1-1.5 years of age the 3 main differential diagnoses for vomiting and/ or diarrhea are parasites, dietary indiscretion, and intestinal ileus.
The patient can be assessed for dietary indiscretion by management with a commercial diet containing a new protein and a new carbohydrate source (e.g. d/d or sensitivity control), or by management with a home made diet (e.g. turkey and potato, turkey and rice, duck and potato). Although the patient remains strictly on the provided diet, improvement of clinical signs of the disease may be seen after 10 days if the diet is effective. Once toxic and non-specific causes for vomiting have been excluded, the patient was treated for parasites, pyometra, abdominal neoplasia, and ileus were excluded during diagnostic imaging, and good dietary management was not successful to overcome the problem of vomiting, blood and urinary examination can help to asses for extra-gastrointestinal etiologies (ALT, bile acids for liverfunction testing, pancreatic lipase for pancreatitis, blood urea/creatinine and specific gravity of the urine for uremia, total T4 in older cats). Endoscopy is indicated to assess the stomach, upper small intestine, and colon for immune-mediated inflammatory or neoplastic changes. [...]