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When a dog is vomiting after surgery, you are right to be concerned. However, a dog having an upset stomach after surgery is not very uncommon; actually, if you read through your post-op instructions you may find some information in regards to preventive measures you can take to prevent this annoying form of vomiting.

 The receptionist or vet tech should also have warned you about this possibility and should have suggested to you to withhold food and water for some time. 

However, how can one know if the vomiting episodes are normal or not? When should one be concerned? What is causing the vomiting in the first place? 

A good place to start is learning if your dog is vomiting or regurgitating. Following are some explanations for vomiting and regurgitation in dogs after surgery.

Why is My Dog Vomiting After Surgery?

If your dog is vomiting after surgery, you are rightfully concerned. Your dog should be recovering, instead he is sick, retching and vomiting! 

Fortunately, there are some explanations for this, but it's best to let your vet know if your dog has repeated bouts of vomiting without an explanation. Even though uncommon, there are cases where dogs may develop complications.

Dog Vomiting From Drinking Excessive Water

Your dog may likely have been very excited coming back home, then add the car drive and saying hello to your other family members. 

All this enthusiasm along with the car drive may likely have caused him to pant, and he may be very thirsty. So once home, he may start drinking, and drinking and drinking.

 Next thing you know, a little bit later, he brings up all the water he drank.

 It's best to limit the water to frequent but smaller amounts, suggests Veterinary Care Specialist of Southeast Michigan. Giving ice cubes to lick may be an option if the dog is nauseous after surgery.

Dog Vomiting From Feeding too Early

Most post-surgery instructions for dogs recommend feeding your dog a few hours after coming home. This is for two reasons:

1) Some dogs are so excited to come home they may wolf their food down and vomit it back up

2) Some dogs may have nausea as they recover from the anesthesia and eating too soon may trigger vomiting.

Usually, the instructions state not to feed food or water for the first 3 hours. Then, a small amount of food and water can be given and the amounts can be gradually increased over the next 24 hours. 

In some cases though, dogs may not want to eat or drink until the next day.

Vomiting Due to Side Effect of Medications

Most likely, your dog came home with some medications to give to help him recover. Non-steroidal-anti-inflammatory drugs (NSAID) and pain medications such as Rimadyl, Previcox, Deramaxx, Metacam are known for causing upset stomach in dogs, which left untreated may lead to ulcers.

Common side effects of these drugs include appetite loss, vomiting and diarrhea or tarry stools. Consult with your vet immediately if you notice side effects.

 Your dog may also have been prescribed antibiotics to prevent infection. Read this article on dog upset stomach on antibiotics for more information. Steroids may also contribute to vomiting.

When giving medications to your dog, make sure you follow directions carefully. Some medications are best given with food to prevent stomach upset. It may difficult at times to tell which medication is causing problems if they're given together.

Consult with your vet for the best approach. He or she may suggest a different drug, tell your to discontinue it or reduce dosage. 

Your vet may also recommend stomach protective drugs. He or she may even suggest trying giving different drugs at different times to determine which one is causing trouble. Never give NSAIDs along with other NSAIDs or with steroids without a wash-out period. 

Vomiting From Anesthesia

Anesthesia can be tough on the body and some vulnerable dogs can be susceptible to complications. 

The kidneys are particularly vulnerable if the dog's blood pressure gets too low for too long while under. The pancreas and intestines may suffer as well when there's low levels of oxygen. 

Vomiting more than once or twice over the course of 24 hours may be suggestive of organ problems.

Even though vets run blood work prior to surgery to ensure important organs are in good shape, it's important to re-run these tests if a dog presents repeated vomiting after surgery. 

Urine specific gravity, complete blood count ad serum biochemistry profile with electrolytes should be re-checked; however, early kidney problems can be difficult to detect.

An ultrasound may be also helpful. Fluid therapy can help improve blood flow to organs that have suffered as a result of low blood pressure. If your dog has been vomiting repeatedly for more than 24 hours, please consult with your vet.

Vomiting from Complications

Sometimes the vomiting is caused by complications from the surgical procedure.

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For instance, if a dog has undergone an enterotomy, which involves cutting open the intestine to remove a section of the intestine, the chances for complications such as peritonitis (inflammation of the peritoneum from leakage in the abdomen) are high.

Symptoms suggestive of peritonitis include lethargy, loss of appetite, vomiting and fever.

Vomiting from Unrelated Conditions

And then of course, vomiting may occur because of something totally unrelated with the surgery. Your dog may have gotten into the trash can, eaten something unusual swallowed a sock and many other things that don't fall under the post-surgery category.

Dog Regurgitation After Surgery

If your dog appears to be actually regurgitating and the food brought back up appears similar to the way it went down (not digested), there may be some possible explanations that may be linked with the surgery and anesthesia. 

Here is a guide on the differences between vomiting and regurgitation in dogs

Following are some examples of things that may go wrong.

Being Fed Before Surgery

For a good reason vets emphasize the importance of fasting the dog several hours prior to surgery. This is mainly for your dog's safety so that there are less chances for him to inhale stomach contents into the lungs. 

When your dog goes under, his body and bodily functions are “put to to sleep,” so even the simple action of swallowing is no longer possible and the gag reflex is also gone. 

On a full stomach, those stomach contents may come back up and end up in the dog's airways, which can lead to esophagitis and pulmonary aspiration.

According to the Israel Journal of Veterinary Medicine, gastroesophageal reflux (GER) is a complication that happens more than suspected. It may be triggered by anesthetic drugs such as acepromazine, isolfurane, xylazine, morphine, halotane and atropine since these drugs reduce the tone of the gastro-oesophageal sphincter causing it to relax.

Because this effect is not apparent, as the acidic gastric content sit in the esophagus undetected, (unless the veterinary nurse notices fluid in the mouth) it's often referred to as “silent reflux.” The only sure way to detect this is by checking the pH of the esophagus. 

Fasting is one of the most crucial preventive measures to prevent GER and esophagitis which occurs when the esophagus undergoes prolonged exposure with gastric acid. As little as 20 minutes contact is enough to cause damage to the esophageal lining.

While a case of esophagitis may resolve within 2 to 3 days, things though get problematic when it's severe enough to cause a narrowing (esophageal stenosis) or stricture (esophageal stricture). 

Affected dogs will have problems keeping food down which causes persistent regurgitation, according to Vet Surgery Central. These dogs tend to tolerate liquid meals much better than solids, and over time, if left untreated, they may start getting malnourished and lose weight.

Typically, most dogs will regurgitate within 2 to 3 days from the day the dog underwent general anesthesia, explains veterinarian, Dr. Gene from Ontario Veterinary College. 

The stricture develops because of a poorly healed case of esophagitis. What happens is that if the esophagitis is not treated properly, every time the dog vomits or regurgitates, the esophagus is further traumatized, leading to a vicious cycle. 

It's important to take care of the esophagus by protecting it with medications. Pepcid, sucralfate and anti-emetics may be needed.

Improper Use of Endotracheal Tube

When a dog undergoes surgery, an endotracheal tube is inserted through the mouth so to keep the airway open and allow an adequate flow of oxygen and carbon dioxide.

 The endotracheal tube is characterized by a cuff which inflates so that the trachea is sealed and prevented from aspiration of gastric contents.

Generally, the chances for regurgitation are most likely to occur shortly after the dog is anesthetized. This is a good time for veterinary nurses to check for signs of fluid in the mouth. During surgery, the dog should be positioned in such as way as to allow any reflux to escape from the mouth easily.

After surgery, the tube should stay inflated until the swallowing reflex is back and the dog can protect his airway, explains Brenda K. Feller, a veterinary technician specializing in anesthesia.

 Failure to do so, can cause regurgitate to pool in the dog's esophagus since the dog is unable to swallow, which may cause damage.

 Should regurgitation occur after the tube is removed, the dog's head and neck should be extended and the head kept in a down position with the tongue extended, so the regurgitate can flow out.

Risk Factors for Esophagitis

There are also several risk factors that makes certain dogs more susceptible to esophagitis and strictures. One of them is older age. It appears that older dogs are more prone to this kind of complication. 

Another risk factor is the type of surgery being performed. It appears that abdominal surgeries increase the chances for esophagus damage. The time frame a dog is fasted also appears to play a role.

According to Galatos and Raptopoulos 1995a, prolonged fasting increased the chances for reflux, and the refluxed fluid appeared to be more acidic, and thus, more damaging. The use of propofol was also associated with higher risks than the use of thiopental.

The Bottom Line

Vomiting and regurgitation may be some signs of side effects and potential complications after a dog is discharged from surgery. 

Should the owner notice repeated vomiting and regurgitation it's important to notify the vet. Should reflux be noticed in a timely manner, the dog can be given gastroprotectants such as sucralfate, ranitidine and cimetidine. 

Antimicrobial therapy may also be started and x-rays may help determine if there's any signs of aspiration pneumonia. Left untreated, esophagitis may lead to stricture which is far more complicated to treat.

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