SNAP Cats

Provided by the Cornell Feline Health Center, Cornell University

There are few things more frustrating than having a cat that is suffering chronic bouts of vomiting and diarrhea. Vomiting and diarrhea cause dehydration, and if left untreated, can become a life-threatening situation. Therefore, any cat displaying those signs should be examined by a veterinarian. There are many possible causes of vomiting and diarrhea, but inflammatory bowel disease (IBD) is a common cause of gastrointestinal problems in the cat. Although cats of any age can be affected, middle-aged or older cats are more susceptible to IBD.

IBD describes a group of chronic gastrointestinal disorders. Microscopically the disease is characterized by the infiltration of inflammatory cells into the lining (mucosa) of the digestive tract. The cause of IBD is unknown, but the microscopic changes in the tissues (histopathology) imply that immunologic factors play an important role. The scientific names given to the different forms of the disease are tongue-twisters, but they actually describe the features of the disease. For example, the most common form of IBD in cats is called lymphocytic-plasmacytic enterocolitis. Translated this means that lymphocytes (a type of white blood cell) and plasma cells (cells that produce antibody) are the primary types of inflammatory cells present in the mucosa. Less common forms are called eosinophilic, neutrophilic, and granulomatous, depending upon the predominant inflammatory cell present. Enterocolitis refers to the inflammation of the large and small intestines that occurs in this form of IBD. In cases where inflammation occurs only in the small intestines, it is called enteritis; in cases of only large intestine inflammation, it is called colitis; and gastritis in those cases where inflammation of the stomach predominates.

Diagnosis
To rule out other causes of gastrointestinal disease, your veterinarian will perform diagnostic tests that may include a complete blood cell count, serum biochemistries, serum thyroxine level, tests for feline leukemia virus (FeLV) and feline immunodeficiency virus (FIV), urinalysis, fecal examinations for parasitic and bacterial agents, dietary trials, and abdominal radiographs and/or ultrasound.

The most definitive of the diagnostic tests is the microscopic examination of small pieces of the intestinal lining (mucosal biopsy). Tissue samples can be obtained during abdominal surgery (e.g. laparotomy) or during endoscopic examination. Although both procedures require general anesthesia, the choice of methods depends upon a number of factors, including the availability of equipment and the part of the gastrointestinal tract suspected to be involved.

Treatment
A combination of dietary management and medical therapy will successfully manage IBD in most cats. Because there is no single best treatment, your veterinarian may need to try several different combinations in order to determine the best therapy for your cat.

Dietary Management
Sensitivity to food antigens contributes to the gastrointestinal inflammation in some cats, so a change in diet often provides symptomatic relief. Several balanced commercial diets have been advocated as effective in treating IBD. Homemade diets are an alternative for cats that refuse to eat a commercial diet. Your veterinarian can provide you with an appropriate recipe. Ideally, the diet should contain a single source of protein not normally consumed by the cat. The addition of dietary fiber is beneficial to some cats. It may take several weeks or longer for cats to improve after a diet change, and during this trial feeding period, all other food sources (like table food, and flavored medications and treats) must be eliminated from the diet.

Medical Therapy
Corticosteroids are commonly used to treat cats with IBD. These drugs have potent anti-inflammatory and immunosuppressive properties with relatively few side effects in cats. Additionally, corticosteroids may stimulate the appetite and enhance intestinal sodium and water absorption. Oral prednisone is the corticosteroid used most frequently because of its short duration of action and availability in appropriate tablet sizes. If necessary, injectable corticosteroid therapy can be used in cats that are too difficult to medicate orally or if vomiting and malabsorption is severe.

Antibiotics, such as metronidazole or tylosin, can be helpful when combinations of dietary management and corticosteroid therapy have failed to adequately control the disease. Side effects to metronidazole therapy are uncommon at low dosages, but loss of appetite and vomiting may occur. Excessive salivation is a common reaction of cats after receiving the pill. This is probably a response to the unpleasant taste of the medication. Sulfasalazine is a medication that is often used if large bowel inflammation (colitis) is the predominate problem.

If none of these medications successfully control the signs, more potent immunosuppressive drugs may be necessary, but they necessitate closer monitoring by your veterinarian.

Prognosis
It is rarely possible to cure inflammatory bowel disease, but most cases can be satisfactorily controlled by medication and dietary management. Relapses can occur if the treatment regimen is not followed completely.

Vomitting

Vomiting is a very common problem in dogs and cats. There are many causes of vomiting. Primary or gastric causes of vomiting are those that are due to diseases of the stomach and upper intestinal tract. Secondary or non-gastric causes of vomiting are caused by diseases of other organs that cause an accumulation of toxic substances in the blood. These toxic substances stimulate the vomiting center in the brain causing the animal to vomit.

A problem that can be confused with vomiting is regurgitation. Vomiting is the ejection of contents of the stomach and upper intestine; regurgitation is the ejection of contents of the esophagus. The esophagus is a narrow, muscular tube that food passes through on its way to the stomach. In health, food moves quickly through the esophagus to the stomach. If the muscle of the esophagus loses tone, the esophagus dilates, a condition called megaesophagus. A dilated esophagus does not effectively move food to the stomach and the animal will regurgitate food usually shortly after eating. The food may also be inhaled into the airways causing pneumonia and cough.

When you present your pet to the veterinarian because he or she is vomiting, the veterinarian will ask questions in attempt to differentiate between vomiting and regurgitation and to try to determine if your pet is vomiting due to gastric or non gastric disease. Vomiting is an active process. The pet is apprehensive and heaves and retches to vomit. If food is present in vomit, it is partially digested and a yellow fluid, bile may be present. Regurgitation is fairly passive. The animal lowers its head and food is expelled without effort. The food brought up by regurgitation is usually undigested, may have a tubular shape, and is often covered with a slimy mucus. The pet will often try to eat the regurgitated material. You may bring a fresh sample of “vomit” for the veterinarian to examine. The pH of vomit containing food is acid, the pH of regurgitated materials is higher. Your ability to answer questions about your pet’s activity, habits and environment will help the veterinarian decide which causes of vomiting are most likely in your pet. A history of any drugs your pet is receiving is important. Over-the-counter pain medications such as aspirin and ibuprofen can cause severe stomach ulcers in dogs depending upon the dose and duration of treatment. The veterinarian may ask you to describe the appearance of the vomit, as well as describe how your pet looks when it vomits and the relation ship of vomiting to eating. If the vomit contains blood it may be fresh, red blood or look like coffee grounds if the blood is digested. Blood is most often seen with stomach ulcers, stomach cancer or uremia (a collection of signs including vomiting seen in pets with kidney failure). Stomach ulcers can be caused by drugs or the presence of a mast cell cancer in the skin. Mast cell cancers release histamine that leads to stomach ulcers. Regurgitation often, but not always, happens right after eating and the pet will try to eat the regurgitated food. Vomiting occurs a variable time after eating or may occur in a pet who is off food. Animals with a twisted stomach, gastric dilation-torsion, may make frequent attempts to vomit without producing anything. Pets with a hacking cough may retch and sometime vomit at the end of an episode of forceful coughing. An accurate description in this case would lead to an investigation of the causes of coughing, rather than vomiting.

If your pet vomits just occasionally and has a specific series of actions associated with vomiting, you may consider video taping an episode of vomiting to help describe the episodes to the veterinarian.

The physical examination of the vomiting pet can also provide information to narrow the list of possible causes. The presence of fever, abdominal pain, jaundice, anemia or abnormal masses in the abdomen will help the veterinarian make a more specific diagnosis. The mouth should be carefully examined as some foreign objects such as string can wind 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.

The list of non-gastric causes of vomiting is long.

Pancreatitis in the dog causes vomiting that is sudden in onset and often severe. The dog may have a painful belly. Pets with pancreatitis often have a history of eating garbage or fatty table scraps. Tumors of the pancreas can cause similar signs to pancreatitis. Pancreatitis occurs in the cat but the signs are subtle and non specific and often don’t include vomiting.

Kidney failure is a common cause of vomiting in dogs and cats. The kidneys can be acutely (suddenly) damaged by poisons such as antifreeze or by severe dehydration. Waste products that the kidneys normally get rid of, rise to high levels in just a few days. The kidneys can also gradually lose their ability to remove waste products from the body as the pet ages. Early signs of kidney failure include drinking and urinating large amounts called polyuria and polydipsia or PU-PD. PU-PD may be present for months to years before the kidney failure is severe enough to lead to waste product accumulation and vomiting. Vomiting in chronic kidney failure may began as occasional episodes and progress to severe, frequent vomiting. The pet with chronic kidney failure will often lose body condition and may have pale gums due to anemia.

Non-spayed, middle aged female pets can develop a uterine infection called pyometra. Pyometra occurs within 2 months after a heat cycle and often results in discharge of pus from the vagina. The pet may frequently lick the vagina so discharge may not be seen. Dogs develop pyometra more often than cats. Other signs may include PU-PD and depression.

Liver failure causes vomiting as well as other signs depending on the type of liver disease. Other signs of liver disease may include seizures, jaundice (a yellow discoloration of the areas of skin not covered by fur), PU-PD and fluid accumulation in the belly or legs. Bladder obstruction or rupture will cause a sudden onset of vomiting. The urethra that leads from the bladder to the outside can get plugged by stones or tumors. The animal will strain and pass just a few drops of urine or none at all. They will also have a painful belly. Bladder obstruction if not corrected, is fatal in just a few days. The bladder can be ruptured by blunt trauma such as being hit by a car or kicked.

A form of diabetes called ketoacidosis will cause vomiting along with depression and PU-PD.

Addison’s disease is a deficiency of hormones from the adrenal gland and causes vomiting, diarrhea and weakness. Addison’s disease occurs most commonly in young to middle aged dogs, most of which are female. Addison’s is rare in the cat. The signs of Addison’s disease may be intermittent or may be very severe and constant.

Diseases of the inner ear can cause vomiting accompanied by incoordination, circling and tilting of the head to the side. Motion during car rides stimulates the inner ear and can cause vomiting.

A sudden onset of vomiting in young, poorly vaccinated pets may be caused by infectious agents including canine distemper, canine parvovirus and feline panleukopenia virus.

There are many toxins including lead, insecticides, antifreeze and other chemicals that can cause vomiting.

Cats with elevated thyroid function, hyperthyroidism, may vomit in addition to other signs including, increased appetite, weight loss, hyperactivity and a poorly kept coat. Heartworm disease in cats may cause vomiting in addition to coughing, respiratory distress, weight loss and depression.

Primary causes of vomiting include acute gastritis often due to eating garbage or other types of dietary indiscretions; the ingestion of large amounts of hair during grooming; ulcers of the stomach; stomach or upper intestinal cancer; parasites; food allergies; the presence of a foreign body stuck in the stomach or upper intestine; twisting and dilation of the stomach; and intussusception which is a telescoping of one part of the intestine into another piece of intestine.

The stomach is usually empty 6 to 8 hours after eating. Vomiting of food when the stomach should be empty suggests an obstruction of the stomach or abnormal motion of the stomach muscles that normally grind food and push the ground food out of the stomach.

Tests to differentiate primary causes of vomiting include x-rays or ultrasound of the abdomen and endoscopy. Endoscopy is the technique of passing a flexible scope into the stomach and upper intestine to examine the inside of these structures. It may be possible to remove a foreign body with endoscopy and small biopsies of the lining of the stomach and intestine can be taken for microscopic evaluation. Endoscopy requires general anesthesia.

If the pet vomits sporadically, the results of all tests may be normal. Many healthy dogs and cats vomit occasionally without identifying a cause. Sometimes the cause of vomiting is as simple as the pet eating too fast. The treatment for vomiting depends upon the cause. Nonspecific treatment for vomiting includes fasting, and fluids to correct or prevent dehydration. In episodes of sudden onset of vomiting, food is withheld for 24 – 48 hours and water for 24 hours. Water should never be withheld from an animal with known or suspected kidney disease without replacing fluids intravenously or subcutaneously (under the skin). If vomiting stops, small amounts of a bland low-fat food are fed 3 to 6 times daily for a few days, with a gradual increase in the amount fed and a gradual transition to the pet’s normal diet. Water is also reintroduced in small amounts on the second day. You may start with ice cubes and then gradually increase the amount of water over the day if vomiting does not reoccur.

If the pet 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 advised. Consultation with a veterinarian in your region may reveal a recent outbreak of an infectious disease causing vomiting or identify a cluster of recent poisonings. With this type of knowledge you will want to have your pet evaluated rather than waiting a few days. Dogs and cats who vomit for longer than a few days or are depressed or dehydrated should be presented for veterinary evaluation.

Tag: vomitting

Inflammatory Bowel Disease (IBD)

Cat Vomit