With each patient my nurse goes into the room first to get an initial history, temperature, pulse and respiration. They also make sure all the information has been received from the patient’s primary doctor.

Then we go over all of this before I (Perry Jameson) go and chat with Mom and Dad. My nurse explained that a recent patient was a 4-year-old neutered male, miniature Pinscher that was vomiting about once a month for the past few months.

I immediately start thinking of all the possible causes for vomiting. Unfortunately, there are hundreds of them, so it is not always easy to come to a quick conclusion as to the cause. Generally, I break it down into two categories: metabolic and primary gastrointestinal.

Looking over the blood tests the family veterinarian had performed, I did not see any obvious metabolic causes such as renal or liver disease to explain the vomiting. So before speaking to his parents, I was leaning toward a primary stomach or intestinal disorder.

In the exam room, I met both Mom and Dad who I could tell loved little Koloa. He was sitting on Mom’s lap and let me know he would protect Mom if I got too close.

After introductions, I started going through a detailed history with them. Koloa had been healthy for most of his life with no serious issues requiring attention.

He was up to date on vaccines and heartworm prevention. I could tell he was well taken care of.

His vomiting had started about three months ago. It only occurred at night and it never contained food, only grass and liquid. He would only vomit once and then go back to sleep. His appetite might be a little off the next morning, but overall he was eating well. He was fed a good, commercial dry dog food.

Mom explained she fed him at 5:30 a.m. and 2 p.m.

I treat my pets like people, so they eat when I eat around 6 a.m. and 6 p.m., so I asked Mom how she got into this routine. The morning feed was when she wakes up and the afternoon feeding is when she gets home from picking her children up from school.

That made sense to me but it also started me thinking of a possible cause for his vomiting.

Bilious vomiting syndrome is an idiopathic (fancy word for we do not know why) cause of vomiting. This syndrome is most commonly seen in dogs and rarely in cats. Most dogs are middle-age or older when the vomiting starts. It is not more common with any certain breed or gender.

Clinical symptoms usually occur early in the morning, suggesting that fasting or inactivity may play a role. The vomiting can be daily but usually is intermittent as it was with Koloa. Between the episodes the dogs are normal in all other respects. Physical exams don’t pick up anything unusual in these dogs as well.

Bilious vomiting syndrome is believed to occur from duodenal fluid refluxing into the stomach and irritating the gastric wall. The cause is unknown but believed to be from decreased stomach motility that allows bile from the intestine to move back into the stomach rather than down the GI tract.

The syndrome is diagnosed by having a history that fits as well as eliminating other causes for vomiting.

Fortunately, most dogs will respond to treatment. The easiest thing to do is offer a meal before bed time so the stomach is not empty all night long. The food probably buffers the intestinal fluid as well as promotes gastric motility. If a late night snack does not work, then medications to decrease acid production, such as Prilosec or Pepcid, can be tried.

When feeding and acid blockers fail, medications that promote stomach motility are started. These drugs promote the movement of intestinal contents down rather than back up and into the stomach.

Koloa’s parents were instructed to divide her feeding into thirds and offer the last meal just before bedtime. She also was started on Pepcid as well. So far she is doing great.

Dr. Henri Bianucci and Dr. Perry Jameson are with Veterinary Specialty Care LLC. Send questions to petdocs@postandcourier.com.