Thursday, January 19, 2017

Dog Medical Emergencies Survey: Is Vomiting Bile in the Morning an Emergency?

A few (18.75%) of the of the survey participants believe that vomiting bile in the morning is an emergency. Naturally, not all the symptoms I included are emergencies; else you'd just figure out to check them all. The idea was to make you work for it and consider each of them.

Persistent, projectile or bloody vomiting is an emergency. Unproductive retching is an emergency.


Photo: katno

If a dog vomits bile in the morning every now and then, it is not an emergency.


However, it's not something I'd ignore if it happened to my dog more often than once in a blue moon.

What is bile?


Bile is a fluid which is secreted by the liver and stored in the gallbladder. When a dog eats, bile is released into the first part of the small intestine to aid digestion and removal of waste materials from the body.

A dog will vomit bile when it makes its way into the stomach, causing irritation and vomiting. There are theories why this happens but the exact reason(s) have not been determined.

A popular theory is that it happens when a dog's stomach remains empty for a prolonged period of time.


Which would make sense as bilious vomiting commonly happens in dogs fed only once a day and a popular remedy is feeding more frequent, smaller meals, and/or giving a snack before bed.

On the other hand, in nature, canines often go for prolonged periods of time without eating and their systems should have developed to handle such things.

Here is what in my opinion doesn't add up:

  1. bile is released into the intestine after ingestion of food
  2. bile accumulates when the stomach is empty

See the problem there? If it is food that triggers the release of bile, why would an empty stomach foster excess accumulation? Logically, those two statements don't work together.

Diseases involving inflammation of the intestine and changes in gastrointestinal motility can be at a root of this problem.


Now, that makes much more sense. Something other than the absence of food in the stomach must be triggering this. Intestinal reflux perhaps? Except the GI tract is designed to keep moving food and fluids forward, not backward. When things are moving in the opposite of intended direction, something is causing it. And that something is what, ideally, should be identified and addressed.

With her IBD, Jasmine would get stomach upsets during which she sometimes would vomit bile. Her intestine was, however, chronically inflamed, and her motility was slow. The better we managed her IBD, the less frequent her stomach issues.

More frequent meals and/or bedtime snacks usually help. However ...


Is it solving the issue? While getting rid of the morning vomiting seems satisfactory, what about the problem that might be brewing under the surface? Such as perhaps IBD or other inflammatory process in the GI tract?

Morning bilious vomiting is not an emergency but I do believe it warrants investigation.


Related articles:
Symptoms to Watch for in Your Dog: Vomiting

Dog Medical Emergencies Survey
Dog Medical Emergencies Survey Results
Symptoms to Watch for in Your Dog: Excessive Panting
Dog Medical Emergencies Survey: Is Unproductive Retching an Emergency?
Dog Medical Emergencies Survey: Is Difficulty Breathing an Emergency?
Dog Medical Emergencies Survey: Is Panting an Emergency?
Dog Medical Emergencies Survey: Is Severe Pain an Emergency?
Dog Medical Emergencies Survey: Is Limping an Emergency?




Symptoms to Watch for in Your Dog now available in paperback and Kindle. Each chapter includes notes on when it is an emergency.

4 comments

  1. Brychwyn was diagnosed with BVS as few years ago. The vet said that there were no signs of other issues (blood, stool, and urine was tested) and if changing the feeding schedule to ensure the stomach was never empty did not work, we should do an ultrasound. Well, a snack very early each morning has kept the bile vomitting away 100% but now I am worried that we should go in for more testing anyways. Corgis are susceptible to BVS but also to a slew of other intestinal issues. Thank you for this reminder to revisit the BVS diagnosis with my vet or perhaps go elsewhere for a second opinion.

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    1. The tricky thing with some of the issues, such as IBD, for example, is that labs will be perfectly normal. Though they are presently experimenting with being able to test or predict IBD via testing of the intestinal flora, which sounds quite promising. Other than that, biopsy was the only way to conclusively diagnose that.

      With the absence of any other signs, such as bad stools, weight loss, finicky appetite ... there might not be a reason to go too far with diagnostics but one thing that is always handy and non-invasive is exploring integrative vet med. It has a different way of looking at things and can pick up stuff conventional medicine won't. We've been using the integrative approach ever since we hit a dead end with some of Jasmine's problems and it worked well. It involves food therapy, herbal therapy, acupuncture ... and it can fine-tune things that are subtle or discover things that are "invisible" to conventional approach.

      Another interesting theory one of the holistic vets, Dr. Peter Dobias, out there has that many issues stem from spinal missalignments; he maps out which part of the spine corresponds to which organs ... so a chiropractic check-up might not be a bad plan either. I know that either Jasmine couldn't and Cookie cannot do without regular chiropractic care.

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    2. Corgis strange, long backs are one reason the breed tends to have digestive issues! Chiropractic was recommended back when Brychwyn was limping too but after we solved the limp, I never further explored it. Now I will! Thanks.

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    3. Definitely worth of try. This is a quote from Dr. Dobias' article on pancreatitis, for example,

      "On the surface, most people do not see the connection between back issues and pancreatitis. In reality, they play a significant role. The space between the last thoracic and the first lumbar vertebra supplies energy flow to the pancreas. When the back gets injured or tight in this region, the pancreas gets weaker. It may also get inflamed. That is why I recommend that every dog with pancreatitis gets checked by an experienced animal chiropractor, physiotherapist or an osteopath to treat the muscle spasm."

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