When Vomiting Isn’t Vomiting: The Case for Better GI History
Why verifying clinical signs before diagnostics matters more than you think
A three-year-old female spayed Labrador Retriever presented for a one-month history of “intermittent vomiting.” The owner reported finding multiple piles of vomit around the house throughout the day, ranging from clear foam to undigested food. No diarrhea was noted.
On exam, the dog was hypersalivating but otherwise unremarkable. The primary care veterinarian had already done a thorough workup: full bloodwork, abdominal radiographs—all normal. Cerenia and a bland diet were tried. No improvement. The dog was referred for an abdominal ultrasound.
The Turning Point
Rather than immediately scheduling the ultrasound, the internist took a more detailed history. The key questions: Do you see active abdominal compression? Do you hear retching?
Then came the diagnostic breakthrough: showing the owner videos of dogs vomiting compared to dogs with regurgitation.
The owner’s response: “Oh no, my dog’s actually regurgitating.”
That single realization changed everything. Instead of a $1,000 ultrasound looking for GI pathology, the next step became chest radiographs—a fraction of the cost. The result: megaesophagus.
Further testing revealed the underlying cause: myasthenia gravis. The dog was started on pyridostigmine at 2 mg/kg twice daily. Follow-up radiographs one month later showed the megaesophagus had resolved.
Why This Matters
Vomiting and regurgitation look similar to pet owners, but they localize to entirely different anatomical structures and require completely different diagnostic approaches.
| Sign | Anatomical Origin | Key Features |
|---|---|---|
| Vomiting | Stomach/GI tract | Active abdominal compression, retching, nausea |
| Regurgitation | Esophagus | Passive expulsion, no abdominal effort, often immediately post-eating |
If the clinician had proceeded with the ultrasound first, it would have been normal—and the owner would have spent money without getting closer to a diagnosis. Worse, the patient might have continued to decline while everyone searched in the wrong location.
Practical Tips for Verifying Clinical Signs
Use video. YouTube has countless examples of dogs vomiting versus dogs with megaesophagus. Showing owners these videos during history-taking helps them accurately describe what they’re seeing at home. Many owners simply don’t know what regurgitation looks like.
Ask specific questions. Instead of “Is your dog vomiting?”, ask:
- Do you see the abdomen contracting?
- Does it happen right after eating or hours later?
- Is there bile (yellow/green) or undigested food?
- Does your dog seem nauseous beforehand (lip licking, hypersalivation)?
Request home videos. Many owners can capture episodes on their phones. A five-second video can save hundreds of dollars in unnecessary diagnostics.
The Broader Lesson
The same principle applies throughout GI medicine. Differentiating small bowel from large bowel diarrhea, for instance, completely changes your differential list and diagnostic approach.
As one internist notes: “If you take home anything from this, it’s that we need to verify and localize clinical signs before spending the owner’s money.”
This applies across species. Whether you’re working up a vomiting dog, a horse with colic, or a cat with weight loss—accurate history taking and clinical sign localization remain the foundation of efficient, cost-effective diagnostics.
This case and discussion are from VetOnIt’s Internal Medicine CE course. For related content on chronic GI disease workups, see our post on atopic dermatitis and the gut microbiome.
Reference
- VetOnIt CE Internal Medicine Webinar: Chronic Vomiting and Diarrhea in Dogs and Cats