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Pet of the Month April 2016 – Winston!
by admin on April 1st, 2016
Category: Pet of the Month, Tags: Tags: cat, feline, vomiting, winston
Young Winston is featured this week as he has fortunately made a swift and complete recovery following treatment for vomiting using an extended course of antacids and a bland diet. Apart from showing off his good looks this article illustrates a common feline problem and the approach taken for pets whose response to treatment is not quite so immediate as his.
You’ve probably witnessed your cat vomiting from time to time without raising too much concern. Vomiting is a protective mechanism that can result from something minor such as overindulgence or access to an irritant, or it can be a sign of a much more serious condition associated with a primary gastrointestinal disorder (e.g. an ingested foreign body) or a systemic disorder (e.g. kidney disease).
What is the difference between your cat vomiting and and your cat regurgitating? Why does it matter?
The oesophagus is a narrow, muscular tube that allows food to pass through on its way to the stomach. In healthy cats, food will move quickly through the oesophagus to the stomach with little to no delay. When you take your cat to your veterinary surgeon because he or she is vomiting, they will ask you questions in attempt to differentiate between vomiting and regurgitation.
Regurgitation is the passive ejection of contents from the oesophagus. The cat will lower its head and food is expelled with little or no effort. The food is usually undigested, may have a tubular shape, and is often covered with a slimy mucus. Cats will also attempt to eat the regurgitated material.
If the muscle of the oesophagus is considered diseased, it will either result in widening of the oesophagus due to loss of muscular tone (called ‘megaoesophagus’), or narrowing of the oesophagus, which acts as an obstruction to material moving down into the stomach (e.g. a stricture, a tumour or a foreign body can all cause narrowing of the oesophagus). A dilated (widened) oesophagus will not effectively, or efficiently, move or push food from the oesophagus into the stomach. This delay can result in regurgitation shortly after eating. The danger of regurgitation is that the contents may also be inhaled into the airways causing pneumonia and a cough. It’s therefore important for your vet to differentiate between vomiting and regurgitation as this will have an impact on deciding which diagnostic tests to perform, and also will help when deciding on the most appropriate treatment options.
Vomiting, on the other hand, is an active process. Cats will often vocalise, be apprehensive and heave/retch to vomit. If food is present in vomit, it is partially digested and can also contain a yellow fluid (bile). Vomiting can be divided down into primary (gastrointestinal) causes, or secondary (non-gastrointestinal) causes.
Primary causes of vomiting are those diseases directly affecting the stomach and upper intestinal tract. Secondary causes are due to diseases lying outside of the gastrointestinal tract and can include neurological disease or accumulation of toxic substances in the blood. Neurological disease and/or toxic substances will stimulate the vomiting centre in the brain and cause the animal to vomit. Additionally, vomiting can be further divided into acute versus chronic causes.
Some common causes for sudden (acute) vomiting in cats include:
- Diet-related causes (diet change, food intolerance)
- Gastric or intestinal foreign bodies (eg. toys, hairballs, or where one part of the intestine moves inside another part of the intestine)
- Gastrointestinal parasites
- Urinary tract causes: acute kidney failure, ruptured bladder
- Acute liver failure
- Pancreatitis
- Ingestion of toxins or chemicals
- Viral infections
- Certain prescribed medications
- Inner ear/neurological disorders
- Decompensation of a more chronic disease
Some common causes for chronic vomiting in cats (vomiting greater than 3 weeks duration) include:
- Gastritis/gastroenteritis (infectious, toxic, dietary indiscretion/intolerance)
- Hyperthyroidism
- Inflammatory bowel disease (gastritis, enteritis, colitis)
- Severe constipation
- Diabetes (ketoacidosis – this is a form of uncontrolled diabetes)
- Chronic liver disease
- Chronic kidney disease
- Pancreatitis
- Cancer (gastric/intestinal)
- Inner ear diseases/neurological disorders
- Heart worm disease
What should I do if my cat vomits frequently?
An occasional, isolated bout of vomiting is normal. However, frequent vomiting can be a sign of a more serious condition. Your vet will normally ask you a very detailed clinical history and perform a thorough physical examination. This information can help your vet narrow down potential causes from the very long list of possibilities.
The presence of fever, abdominal pain, jaundice, anaemia or abnormal masses in the abdomen will help your vet make a more specific diagnosis. The mouth should be carefully examined as some foreign objects such as string can entangle themselves around the base of the tongue with the rest of the object extending into the stomach or small intestine. A nodule may be palpated in the neck of cats with hyperthyroidism.
Many times, a full physical examination may be normal and unremarkable. At this stage, your vet may choose to adopt trial treatment/supportive care by implementing a brief starvation period, with or without administration of fluid therapy and various medications (e.g. pain relief, anti-nausea medications, antacids) and assess your cat’s response.
Further investigation of vomiting in cats
Depending on response, your vet may need to perform further investigations to differentiate primary from secondary causes of vomiting. Depending on history, clinical examination, and response to trial therapy, further tests may be needed and may include blood tests, urine analysis and faecal examination to rule out possible toxicities, parasites, and metabolic diseases. Further blood tests may include FIV/FeLV (Feline Immunodeficiency Virus and Feline Leukaemia Virus) to assess viral status. Although FIV/FeLV are not common primary causes of vomiting, they may reflect underlying immunosuppression which may make the cat more susceptible to certain diseases. Your vet may also decide to perform tests to assess the pancreatic health (e.g. pancreatitis).
Depending on the case, your vet may then decide to proceed with ‘second tier’ testing. This usually would involve some diagnostic imaging – x-rays and ultrasound – which can be useful in identifying masses, foreign objects, and other gastrointestinal tract problems such as pancreatitis.
Finally, if indicated, further ‘third tier’ testing may be indicated to obtain a biopsy of intestinal tract tissue if cancer or inflammatory bowel disease is suspected. Biopsies can be collected using either minimally invasive procedures (endoscopy and/or laparoscopy) or more invasive procedures (exploratory laparotomy). Endoscopy (a small camera attached to a long flexible tube) is commonly used to visualise the inside of the oesophagus, stomach and first part of the small intestine and to obtain small biopsies called ‘pinch biopsies’. It may also be possible to provide therapeutic interventions with an endoscope. Laparotomy (open surgery) or laparoscopy (‘key hole surgery’) may be considered for those cases where samples of organs lying outside of the stomach/small intestine and full thickness biopsies of intestines are needed.
This information will help your vet to identify the cause, streamline a treatment plan, and also provide you with a prognosis.
What are some treatment options?
The treatment for vomiting depends upon the underlying cause.
Non-specific treatment may include a 12-24 hour fasting period. Fluids may need to be withheld for a short period of time until vomiting has ceased. Water should never be withheld from an animal with known or suspected kidney disease without replacing fluids intravenously or subcutaneously (under the skin).
Water can be reintroduced in small volumes after a 6-12 hour period. You may wish to start with tuna water (not brine) or chicken broth (with NO added onion/garlic or powders) to encourage fluid intake. Gradual increases in volume may commence over the course of the day if vomiting does not recur.
Provided oral fluids have been well-tolerated, small volumes of a bland, high quality protein source (boiled chicken breast, tuna in spring water, turkey breast, boiled white fish) may then be introduced. It’s advisable to start with a teaspoon size portion every 4-6 hours for 1-2 days. Again, if tolerated, gradual increases in food volume may be attempted with the aim to wean back to the original diet over a 3-5 day period. If a cat is bright and alert and has had no previous health problems, episodes of acute vomiting may be managed at home, although veterinary consultation prior to home treatment is strongly advised. In certain situations (e.g. depression, dehydration, or symptoms lasting longer than 12-24 hours), your cat may require fluid therapy or drugs to help control vomiting. You’ll need to see your vet to determine the proper course of action.
What other symptoms should I watch for?
The causes of vomiting are so varied and can be extremely difficult to accurately diagnose. It’s therefore important to monitor for other signs of ill health that may help direct your vet in his/her quest in identifying the underlying cause.
What to watch for:
- Frequency of vomiting. If your cat vomits once and proceeds to eat regularly and have a normal bowel movement, the vomiting was most likely an isolated incident
- Diarrhoea
- Dehydration (sticky gums, weak, sunken eyes, increased ‘skin tenting’)
- Lethargy
- Blood in vomit
- Weight loss
- Change in appetite and water intake (either increased or decreased)
When is it time to see the vet?
Please see your vet if you notice any of the symptoms mentioned above or if vomiting persists. Depending on your cat’s age, medical history, physical examination findings and particular symptoms, your vet may choose to perform various tests and/or admit your cat for more intensive treatment.
