Chronic Vomiting in Cats

Cats

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Vomiting is the forceful ejection through the mouth of the contents of the stomach. Occasionally material from the duodenum of the small intestine also accompanies the stomach (gastric) contents. Chronic vomiting is characterized by persistent or recurrent vomiting for more than two weeks.

An occasional bout of vomiting may cause no alarm to the owner; however, persistent, chronic vomiting is usually indicative of an underlying disease. Chronic vomiting often leads to decreased absorption of nutrients and subsequent weight loss. Diarrhea may also accompany the vomiting.

General Causes

  • Dietary indiscretion (eating inappropriate food/material)
  • Dietary intolerance
  • Infectious agents, such as bacteria, fungi, and parasites
  • Drugs and certain toxins
  • Obstruction/blockage of the stomach or intestinal tract
  • Metabolic diseases such as liver and kidney disease, hyperthyroidism
  • Abdominal disorders such as pancreatitis, abdominal tumors and adhesions, etc.
  • Motility disorders of the gastrointestinal tract that prevent the posterior movement of food
  • Inflammatory bowel diseases
  • Miscellaneous conditions such as gastric/duodenal ulcers, constipation, etc.
  • Cancer of the gastrointestinal tract

    What to Watch For

  • Intermittent vomiting
  • Variable appetite
  • Weight loss
  • Lethargy
  • Diarrhea
  • Increased thirst
  • Presence of blood in the vomitus or stool

    Diagnosis

    Obtaining a thorough medical history with details on the timing and material vomited is very important. A thorough physical examination is performed, including careful palpation (examining by hand) of the abdomen. Additional diagnostic tests may include:

  • Complete blood count (CBC)
  • Urinalysis
  • Biochemical profile
  • Chest and abdominal radiographs (X-rays)
  • Multiple fecal examinations

    Treatment

    Chronic vomiting is difficult to treat symptomatically, because effective treatment usually depends on the underlying cause. There are several steps your veterinarian might recommend, however, while diagnostic testing is underway. The goals of symptomatic therapy are to initially rest the gastrointestinal tract and then introduce easily digested materials. Symptomatic treatments include:

  • Withhold all food for 12 – 24 hours, then gradually introduce a bland diet.

  • A trial of a hypoallergenic diet may be started, for a minimum of six weeks, if dietary hypersensitivity is suspected.

  • Antiemetic drugs that symptomatically decrease the frequency of vomiting may be tried.

  • Antacids (drugs that block acid production by the stomach) may also be administered.

  • Gastric protectants, which are drugs that coat and sooth the GI tract, may also be considered.

    Home Care

    Administer only the prescribed medications and diet recommended by your veterinarian. Observe your pet very closely. If clinical signs are not improving, and/or your pet is getting worse, have your pet evaluated at once.

  • Vomiting is often preceded by restlessness, salivation, and retching, and requires forceful abdominal contractions to expel the stomach contents. One must differentiate acute from chronic vomiting. One must also differentiate vomiting from regurgitation, which is the effortless evacuation of fluid, food, or mucus from the esophagus. The causes, diagnostic tests, and treatments for regurgitation are quite different from those for chronic vomiting.

    Chronic vomiting generally does not respond to symptomatic therapy, and most often necessitates a full diagnostic work-up to determine the underlying cause. If the patient continues vomiting despite being kept off food, if the vomiting is recurrent, and/or if blood is present in the vomitus, your veterinarian should examine the animal. In addition, if your pet appears to be in distress, seems painful, lethargic, or sick in any other way, you should contact your veterinarian at once.

    Causes

    Chronic vomiting can be caused by diseases of the gastrointestinal tract or can occur secondary to other systemic diseases. It is important to try to establish the cause of chronic vomiting. If the underlying cause is not removed or treated, it is unlikely the vomiting will resolve.

  • Chronic, recurrent dietary indiscretion can include eating spoiled food, overeating, ingesting foreign material, and sudden dietary changes.

  • Dietary intolerance is a reaction to some normal food component. It is most often a response to a particular protein, but can be associated with lactose, diets high in fat, and certain food additives.

  • Bacterial causes of chronic vomiting include Salmonella and Helicobacter.

  • Fungal causes of chronic vomiting include histoplasmosis, aspergillosis and phycomycosis

  • Parasitic causes of chronic vomiting include roundworms, hookworms, and Giardia.

  • Administration of certain drugs and/or exposure to toxins can cause chronic vomiting by directly irritating the lining of the gastrointestinal tract. Examples include nonsteroidal anti-inflammatory drugs, corticosteroids, certain antibiotics, insecticides, heavy metals, and lawn and garden products, etc.

  • Slowly developing obstruction or blockage of the gastrointestinal tract may cause chronic vomiting. Obstruction may be secondary to foreign bodies, tumors, intussusceptions (telescoping of the bowel into itself), parasites, and other structural abnormalities.

  • Metabolic diseases, such as kidney and liver diseases, uncontrolled diabetes mellitus, and hyperthyroidism may cause vomiting, although it is more common for these diseases to cause acute episodes of vomiting.

  • Some abdominal disorders may result in chronic vomiting. Examples include chronic pancreatitis (inflammation of the pancreas), kidney infections, tumors in other abdominal organs, adhesions of the abdominal organs, etc.

  • Motility disorders of the stomach and small intestines are an important cause of chronic vomiting. With these diseases food does not leave the stomach and intestines as it normally does and builds up in the stomach where it induces vomiting.

  • Inflammatory bowel disease (IBD) is an inflammation of the walls of the gastrointestinal tract, and may be an immune disorder in some animals. Chronic vomiting with IBD may be accompanied by diarrhea, weight loss, and a change in appetite.

  • Certain maldigestion and malabsorption problems, such as lymphangiectasia cause chronic vomiting, diarrhea, and weight loss.

  • Gastrointestinal ulcers associated with intestinal diseases and tumors, liver disease, and kidney disease may result in chronic vomiting, but such ulcers are uncommon.

  • Constipation is infrequent, incomplete, or difficult defecation with the passage of hard, dry feces. Vomiting may occur secondary to constipation.

  • Slow growing tumors of the gastrointestinal tract may produce intermittent vomiting that tends to get worse with time.

  • Diagnosis In-depth

  • Obtaining a complete medical history, and performing a thorough physical examination are necessary in order to create an appropriate diagnostic plan for the vomiting patient.

  • A complete blood count (CBC) evaluates the presence of infection, inflammation, anemia, etc.

  • A biochemical profile evaluates kidney, liver, and pancreas function, as well as electrolyte, protein, and blood sugar levels.

  • A urinalysis helps evaluate the kidneys and hydration status of the patient.

  • Multiple fecal examinations are important to rule out gastrointestinal parasites as a cause of vomiting.

  • Abdominal radiographs (X-rays) evaluate the abdominal organs, and may detect the presence of fluid, a foreign body, tumor or structural abnormality.

  • Chest X-rays are an important part of the diagnostic work up if cancer is suspected, in order to look for metastasis (spread) to the lungs.

    Your veterinarian may recommend additional tests to insure optimal medical care. These are selected on a case-by-case basis.

  • An abdominal ultrasound evaluates the abdominal organs and helps assess the presence of tumors, thickening of the walls of the intestine, foreign bodies, etc.

  • Thryoid tests are often indicated in older cats with chronic vomiting to rule out hyperthyroidism.

  • Bile acids assays may be performed if liver disease is suspected.

  • A blood lead test may be indicated in the vomiting patient when there has been possible lead exposure, if material compatible with lead chips is seen on the abdominal x-rays, or if there are changes in the blood count suspicious of lead poisoning.

  • An upper gastrointestinal (GI) barium (dye) series may be considered in those cases where the initial tests do not confirm a diagnosis, especially if vomiting persists. Barium is administered and sequential x-rays are taken to watch its passage through out the intestines. It is also sometimes viewed under video x-rays, especially when motility disorders are suspected.

  • Gastroduodenoscopy (upper GI endoscopy) is often of benefit in the chronically vomiting patient. It involves the passage of a flexible viewing scope into the stomach and duodenum. It facilitates the removal of foreign bodies in the stomach, helps detect the presence of tumors and ulcers, and allows samples to be taken for culture and biopsy.

  • If other diagnostic tests fail to reveal a cause, or if surgical correction is required for the chronic vomiting, then an exploratory laparotomy is performed.

    Therapy In-depth

    Your veterinarian may recommend one or more of the diagnostic tests described above. It is difficult to treat the patient with chronic vomiting symptomatically. It is very important with chronic vomiting that an underlying cause be identified, so that specific therapy can be instituted.

    While diagnostic testing is underway the following nonspecific (symptomatic) treatments may be tried in some pets. These treatments may reduce the severity of symptoms or provide temporary relief for your pet. However, nonspecific therapy is not a substitute for definitive treatment of the underlying disease responsible for your pet's condition.

  • Withholding food and water for several hours allows the GI tract to rest. Gradual reintroduction of small amounts of bland food is instituted after the fast, and should be continued for several days to ensure the vomiting does not return.

  • Antiemetics (drugs that stop vomiting) should be used with caution. It is best to identify and treat the underlying cause of vomiting, but in selected cases these drugs may be recommended.

  • Antacids (drugs that decrease acid production by the stomach) such as Tagamet (cimetidine), Pepcid (famotidine), or Zantac (ranitidine) may be of benefit in some cases.

  • Gastrointestinal protectants, which coat the irritated intestinal lining, such as sucralfate (Carafate) may be helpful.

    Specific therapy for chronic vomiting is highly variable and depends on the underlying cause. It may involve the administration of medications, changes in diet, and surgery.

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