貓咪慢性嘔吐

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Chronic vomiting in cats
Student: G2荊蕙, G1黃柏堯
Table of content
• Introduction
• The mechanism of vomiting
• Regurgitation v.s. vomiting
• Clinical presentation and initial assessment
• Diagnostic approach
• Treatment
• Conclusions
Introduction
• Active elimination of stomach contents through the mouth
• ± Preceded by nausea, pacing, and salivation.
• Usually digested food or liquid with acidic or neutral pH.
• ≥ 2 weeks duration.
The mechanism of vomiting
• A complex reflex involving the gastro-intestinal system,
respiratory and abdominal muscles, and changes in posture.
1. Start with nausea, and cats may exhibit signs of lip-licking behavior,
hypersalivation, and food aversion.
2. Retching, which consists of powerful contractions of the abdominal
muscles and diaphragm.
3. Gastric contents are forcefully expelled by the contraction of the
abdominal muscles, stomach, and the diaphragm, with concurrent
relaxation of esophageal sphincter.
The mechanism of vomiting
• Emetic center (wide distribution of neurons) is stimulated
• Humoral pathway
• conditions affecting the blood or cerebrospinal fluid
(uremic toxins, drugs, and metabolic derangements )
• Activation of neural receptors and pathways
• Peripheral sensory receptors
(afferent, vagal, sympathetic, and glossopharyngeal pathways)
• Vestibular
• Cerebrocortical pathways
The mechanism of vomiting
• Neurotransmitter
• dopamine, norepinephrine, 5-hydroxytryptamine, histamine, substance P,
opioid, and acetylcholine
Regurgitation v.s. vomiting
• Pathology
• In the cat, distal 1/3~1/2 of the esophagus is composed of smooth muscle.
• Disease that result in inflammation, obstruction, or hypomotility in the
esophagus interrupt the normal swallowing process, can result in
regurgitation.
Regurgitation v.s. vomiting
Most important: History!!!
nausea
• Salivation
• Lip-smacking
Retching
• Sound
• Stomach movement
Diagnostic approach
• History
• Physical examination
 IV fluid if need
(dehydration, shock or
hypothermia)
•
•
•
•
•
• Thoracic radiographs
• Abdomen imagine
• X-ray
• Ultrasound
Haematological examination
Biochemistry profile
Tt4(cat>6yrs)
Urinalysis
Faecal analyses
History
Physical examination
Diagnostic approach
• Advance test
• ACTH stimulation test
• Heartworm (Dirofilaria immitis) testing
• Gastrin
• Biopsy collection and examination
•
•
•
•
Endoscopic aspiration of intestinal contents
Immunohistochemistry
PCR or Warthin-Starry staining on gastric mucosa
Fluorescence in situ hybridization(FISH) in tissue biopsy
Diagnostic approach
Diagnostic approach
Reference
1. Batchelor, Daniel J., et al. "Mechanisms, causes, investigation and
management of vomiting disorders in cats: a literature
review." Journal of feline medicine and surgery 15.4 (2013): 237-265.
2. Hauck, Shannon Ryan, et al. "Chronic Vomiting in Cats: Etiology and
Diagnostic Testing." Journal of the American Animal Hospital
Association 52.5 (2016): 269-276.
Clinical presentation and initial assessment
• The severity of the disease process should be determined at first.
• Assessment starts with the signalment, including the age, breed and gender.
• A complete history is strongly essential.
• Distinguish vomiting from regurgitation
• Onset and progression of signs: sudden, chronic/recurrent, persistent or
chronic intermittent
• Color and odor of vomitus
• Relationship to eating
• Concurrent constipation and tenesmus
• Presence of diarrhea, or even bloody diarrhea, melena
• A complete history is strongly essential. (cont.)
• Appetite, nutritional status and weight loss
• Fluid intake (increased, normal or decreased) and micturition behavior
(dysuria, anuria)
• Presence of abdominal pain
• Diet changes (past and now), recent drug therapy, access to toxins or FBs
• Other clinical signs: dermatology signs, vaginal bleeding or vulvar discharge,
ptyalism or depression
• Concurrent treatments (e.g. hormonal treatment)
• Physical examination is important and should be done carefully.
• Heart rate, respiratory rate, body temperature, blood pressure
• Abdominal palpation: pain, fluid
• Oral examination: color of mucus membrane, FBs
• Hydration status
• Peripheral lymph nodes palpation
• Cervical area palpation for thyroid glands
• Skin condition/fragility
• Nasal discharge
• Vaginal discharge
• Neurological examination
• After we have all the information above, the patient could be categorized in to 2
groups:
• Systemically well patients with no criteria for further assessment or treatment.
• Unwell patients with 1 or more criteria for intervention
Criteria
Nature of the vomiting Frequent acute vomiting, large volume of vomitus, hematemesis
GI signs
Melena, abdominal pain, abdominal swelling/fluid, weight loss,
Other signs
Pyrexia, severe dehydration/hypovolemic, hypothermia, PU/PD,
bradycardia, etc
Time frame
Chronicity (>2 weeks), failure of symptomatic therapy
Diagnostic approach
• Hematological examination
• Biochemistry profile: TT4, GI function tests
• Urinalysis
• Thoracic radiographs
• Diagnostic imaging of abdomen: ultrasonography, contrast radiography,
endoscopy
• Exploratory coeliotomy or laparoscopys
個論
Base on 統計
好發年紀種別特徵等等
造成嘔吐的機制
症狀不用講太多(focus on vomit)
確診方法
治療,預後
Causes
Foreign bodies
Inflammatory bowel disease (IBD)
• Etiology usually includes multiple causes.
• The GI signs are usually persistent.
• Diagnosis depends on histopathology. Specific findings include inflammation of
mucus membrane layer, and the structural change of villous epithelium.
• Therapy
• Immunosuppression: prednisolone or methylprednisolone (1-2mg/kg q12h
PO), chlorambucil, cyclosporine
• Antibiotics: metronidazole (5-10mg/kg q12h PO), tylosine
• Synbiotics: fortiflora/purina
• Diet containing low-carbohydrate and digestible protein is beneficial to cats with
IBD.
Food intolerance and food allergy
• Food intolerance is a non-immunologic, abnormal physiologic response to the
diet.
• Food allergy is an adverse reactions to the diet with a proven immunologic basis.
Food intolerance
Non-immunologic, abnormal
physiologic response to the diet
Vomiting, dairrhea
Food allergy
Immunologic reaction to the diet
7-14 days to see the improvement
8-12 weeks to see the improvement
Vomiting, dermatologic signs
• Dietary elimination trial
• A variety of commercially available and homemade elimination formulations
can be used.
Pancreatitis
• Lymphoplasmocytic pancreatitis is the most common type.
• Unlike dogs, high-fat diet is not a risk factor for cats to get pancreatitits.
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