3 month history of vomiting at least several times daily, usually associated with food, but timing not consistent.  Bowel movements small, but formed.  Multiple diets have been tried.  Blood work is WNL including an ACTH stim.  In last several days, has stopped eating and drinking.  Maropitant was started last week and that did subside the vomiting.  

Initial ultrasound showed a large amount of partially shadowing, spherical, hyperechoic ingesta (up to 1.5 cm diameter) in the stomach fundus along with a large amount  of fluid and gas.  Pyolorus WNL.  Suspected kibble and delayed gastric emptying.  Mild enteritis and mild increase in echogenicity surrounding the pancreas.  Otherwise unremakable.

Plan was to repeat abdominal ultrasound 6 days from the original ultrasound with a 24 hour fast.  Patient has fasted herself beyond the 24 hours with anorexia.  I’m concerned about potential for something like a wrapper floating around in the fundus with all the gas shadowing and the VD radiograph, but may be overinterpretting.  Also wondering what you think about the dorsal stomach wall in the video I could provide.  Treating for delayed motility and mild pancreatitis and potential next steps endoscopy with biopsies, TX A&M panel, Helicobacter trial treatment.  

Would greatly appreciate any input!