Boomer, an adorable and effervescent young Cairn Terrier, was recently referred to me for vomiting of three days duration. This mischievous little boy raided the kitchen garbage the day before the vomiting began. Neither blood work nor abdominal X-rays performed by the referring veterinarian provided a diagnosis. When I questioned Boomer’s family, I learned that their dog was bringing up clear fluid after drinking and undigested food after eating. Additionally, none of the retching that dogs typically do right before vomiting had been observed. This history provided some big clues that redirected my thinking. Boomer was likely regurgitating rather than vomiting.
Vomiting occurs when food or liquid is expelled from the stomach or upper small intestine, and is preceded by some audible retching (no different than when you or I are nauseated and hovering over the toilet). The vomited material may consist of clear liquid if it originates from the stomach, yellow or green liquid if it originates from the small intestine, or food that appears undigested or partially digested.
Regurgitation differs from vomiting in that the expelled material almost always originates from within the esophagus- the muscular tube that propels food, water, and saliva from the mouth down into the stomach. The regurgitated material consists of water, saliva, or undigested food that comes spewing forth without any audible retching or warning. Regurgitation typically takes the dog and anyone in close proximity completely by surprise. Because the event is so sudden, the larynx (the opening to the windpipe) doesn’t have time to close, and some of the regurgitated material can be inhaled into the lungs resulting in aspiration pneumonia.
So, why is it important to differentiate whether my patient is regurgitating or vomiting? Here’s the reason. The tests for determining the cause of regurgitation are different than those used to determine the cause of vomiting. And the more wisely diagnostic tests are selected, the more expediently a diagnosis is established (better for my patient as well as my client’s pocket book). Diagnostic testing for regurgitation involves evaluation of the esophagus. Diagnostics for the vomiting patient evaluate the stomach and small intestine and screen for other diseases such as kidney failure, liver disease, and pancreatitis all of which can cause vomiting.
So, what ever happened with Boomer? Given his history, I recommended X-rays of his chest cavity (where the esophagus lives). Low and behold, the images revealed a piece of bone lodged within his esophagus. Using an endoscope (a long telescope device) and some fancy foreign body retrievers I was able to nonsurgically remove Boomer’s foreign body. We treated the resulting esophageal inflammation with medications and counseled his family on preventing their little darling from tampering with the garbage! Thankfully, Boomer experienced a complete recovery.
If ever you have a “vomiting” dog on your hands, carefully think about whether what you are observing is vomiting or regurgitation. Distinguishing the two will help point your veterinarian in the appropriate diagnostic direction.
Has your dog ever been evaluated for vomiting or regurgitation? If so, what was the outcome?
Nancy Kay, DVM
Diplomate, American College of Veterinary Internal Medicine
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Author of Your Dog’s Best Health: A Dozen Reasonable Things to Expect From Your Vet
Recipient, Leo K. Bustad Companion Animal Veterinarian of the Year Award
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
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Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot and Your Dog’s Best Health. There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot and Your Dog’s Best Health are available at www.speakingforspot.com, Amazon.com, local bookstores, and your favorite online book seller.