Vomiting in cats, characterized by the forceful ejection of stomach and upper small intestine contents through the mouth, is often preceded by excessive salivation, repeated swallowing, retching, and abdominal muscle contractions. While occasional vomiting might seem commonplace, it's never considered normal for healthy cats and can indicate underlying health concerns. This article delves into the causes, diagnosis, and treatment of feline vomiting and weight loss, providing a comprehensive understanding for cat owners.
Vomiting vs. Regurgitation
It's crucial to distinguish vomiting from regurgitation. Vomiting is an active process involving abdominal contractions, while regurgitation is passive. Regurgitated food is typically undigested and cylindrical, reflecting the esophagus' shape.
Acute vs. Chronic Vomiting
Feline vomiting is categorized as acute or chronic. Acute vomiting occurs suddenly in cats that don't usually vomit, raising concern if it happens multiple times. Chronic vomiting involves regular vomiting (at least monthly, possibly daily) over a prolonged period, usually once or twice per occurrence. Acute vomiting often requires more urgent veterinary care, unless it's mild (one to three times) and the cat is otherwise normal.
When to Seek Veterinary Care
Occasional, short-term vomiting (less than 1-2 days) without other symptoms might only require supportive care. However, long-term vomiting, frequent vomiting (more than once or twice daily), or vomiting accompanied by blood, abdominal pain, depression, dehydration, weakness, fever, or weight loss necessitates immediate veterinary attention. Some causes of severe or long-term vomiting can be life-threatening.
A cat should be seen by a vet as soon as possible if they vomit more than three times, cannot keep food down, and seem tired. If the cat seems to deteriorate quickly, then an emergency visit is recommended.
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Causes of Feline Vomiting
Vomiting is a vague symptom with varied causes, stemming from toxins, drugs, diet, gastric issues, intestinal problems, organ dysfunction, endocrine imbalances, neurological disorders, infections, or cancer. Specific causes include:
- Toxins: Lilies, antifreeze
- Drugs: Chemotherapy, antibiotics, anti-inflammatories
- Diet: Dietary intolerance, sudden diet change, eating inappropriate items
- Gastric: Foreign bodies, ulcers, inflammation
- Intestinal: Foreign bodies, inflammation, inflammatory bowel disease (IBD), cancer, constipation
- Organ dysfunction: Liver disease, kidney disease, pancreatitis
- Endocrine: Hyperthyroidism, elevated calcium, diabetes ketoacidosis
- Neurologic: Vestibular disease, encephalitis, cancers
- Infectious: Feline infectious peritonitis, feline panleukopenia, heartworm
- Cancer: Direct (intestinal cancer) or indirect (mast cell tumors)
Diagnosing the Cause of Vomiting
Diagnosing the cause of vomiting involves gathering an accurate history, including potential toxin exposure, vomiting onset, diet, outdoor access, vomit contents, medications, presence of diarrhea, appetite, vomiting timing, weight loss, and changes in drinking/urination.
Interpreting Vomit Characteristics
While not definitive, vomit characteristics offer clues:
- Yellow vomit: Bile, possibly liver disease or empty stomach.
- Clear vomit: Regurgitation or empty stomach.
- White, foamy vomit: Regurgitation or empty stomach.
- Blood in the vomit: Bleeding from the mouth, esophagus, or stomach.
- Coffee-ground appearance: Stomach bleeding, often ulcers.
- Brown, smelly vomit: Bleeding in the upper gastrointestinal tract or ingestion of something brown and smelly.
- Undigested food: Food not leaving the stomach, potentially due to intolerances, allergies, obstructions, or upper gastrointestinal tract irritation.
Veterinary Examination and Testing
A thorough physical exam helps identify abdominal pain, masses, foreign bodies, weight loss, heart murmurs, enlarged thyroid, or fever. Initial tests often include abdominal X-rays and blood work with urinalysis. X-rays reveal organ abnormalities, foreign bodies, tumors, or constipation. Blood work detects organ dysfunction and endocrine disorders. A urinalysis aids in diagnosing diabetes, kidney disease, and urinary tract infections.
Further studies may include a barium study (to detect foreign objects or motility issues), ultrasound (to examine organ architecture and potentially collect samples), or endoscopy (to visualize and sample the stomach and upper intestines).
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Exploratory surgery might be necessary for persistent vomiting unresponsive to symptomatic therapy, especially when a foreign body is suspected or to look for signs of intestinal cancer, non-intestinal abdominal disease, or inflammatory bowel disease.
Treating Feline Vomiting
Treatment varies based on the cause. Symptomatic therapy, such as subcutaneous fluids, might be used if the physical exam reveals no abnormalities.
Fluids
Fluid therapy is crucial to combat dehydration, a self-perpetuating problem that worsens appetite and can lead to further vomiting. IV fluids are recommended for severe dehydration, while subcutaneous fluids may be sufficient for milder cases.
Anti-Vomiting Medication
Anti-emetic medications help stop vomiting, reduce fluid loss, relieve abdominal discomfort, and encourage eating. Stomach protectants like Pepcid or sucralfate may be used, although their effectiveness is debated.
Diet Changes
Dietary changes are vital for both acute and chronic vomiting. Acute cases may involve a temporary switch to easily digestible diets like Royal Canin Gastrointestinal High Energy, Hill’s ID, or bland human food (meat-flavored baby food without onion/garlic or boiled chicken). Chronic cases may require therapeutic or diagnostic diet changes, such as prescription or limited-ingredient diets, maintained for several weeks.
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Prednisone
Prednisone may be used to treat inflammatory bowel disease, but it's not recommended without prior diagnostics due to potential side effects.
Feline Weight Loss: A Concerning Symptom
Unexplained weight loss in cats should not be ignored. It can indicate various underlying issues, ranging from stress to severe medical conditions. Prompt veterinary evaluation is crucial.
Potential Causes of Weight Loss
- Stress or Anxiety: Anxious or stressed cats may eat less, leading to weight loss. Signs include hiding, inappropriate elimination, excessive vocalization/grooming, constipation/diarrhea, reduced appetite, lethargy, or aggression.
- Dental Disease: Oral pain from fractured teeth, gingivitis, or abscesses can hinder chewing and reduce food intake.
- Gastrointestinal (GI) Issues: GI tract problems can reduce appetite and cause weight loss, often accompanied by constipation, diarrhea, or vomiting.
- Infectious Disease: Viral and bacterial infections can reduce appetite and cause weight loss.
- Diabetes: Weight loss is a noticeable sign of diabetes, often accompanied by excessive thirst and frequent urination.
- Intestinal Parasites: Parasites steal nutrients, causing weight loss despite normal food intake.
- Hyperthyroidism: Common symptoms include weight loss, increased appetite/thirst/urination, vomiting, diarrhea, restlessness, aggression, and heart problems.
- Systemic Disease: Kidney, lung, heart, liver, and gall bladder diseases can cause weight loss.
- Cancer: Cancer, particularly lymphoma, can cause weight loss.
Recognizing Weight Loss
Mild weight loss may be noticed while petting the cat, whereas serious weight loss presents as visible thinning.
Recognizing Serious Cases
Serious weight loss presents as visible thinning, prominent spine and hip bones, or a dramatic decrease in weight over days or weeks. Cats with serious weight loss often show additional symptoms like vomiting, diarrhea, increased thirst, or changes in urination patterns.
What to Do
- Call a Veterinary Clinic: Describe your cat's symptoms and weight loss pattern.
- Watch For and Document Symptoms: Keep track of your cat's food intake, water consumption, bathroom habits, and energy levels.
- Handle Food Carefully if Vomiting Is Present: Temporarily withhold food for 2-4 hours to give their stomach a rest.
Potential Life-Threatening Conditions
Fatty liver disease, uncontrolled diabetes and kidney problems can be life-threatening.
Helping Your Pet Before the Vet Visit
Offer Comfortable Rest and Provide Gentle Hydration
Preventing Future Weight Loss
Regular veterinary check-ups help catch weight changes before they become serious problems.
Challenging the Assumption of "Normal" Vomiting
Recent research challenges the notion that regular vomiting is normal for cats. A study involving cats with vomiting, diarrhea, and/or weight loss revealed that most had underlying intestinal disease, either chronic enteritis or lymphoma. This highlights the importance of investigating frequent vomiting.
Lessons from the Study
- Monitor your cat's weight regularly.
- Consider ultrasound for cats with vomiting, diarrhea, and/or weight loss.
- Don't dismiss old age as a reason to avoid anesthesia and surgery for diagnosis.
- Investigate vomiting that occurs more than twice a month.
Ensuring a Logical Work-Up Process
Ensuring a logical and step-wise process to work-up in a cat that is losing weight is vital to ensure that a timely diagnosis is made without excessive or expensive diagnostics. Weight loss in cats can often be tricky to detect, especially in cats with ventral fat pads, but frequent assessment and evaluation of the dorsal muscle tone is essential.
Initial Diagnostic Steps
For most cats with weight loss it is usually important to perform haematology and serum biochemistry along with urine analysis to evaluate for kidney function and diabetes. A urine to protein creatinine ratio may be useful if there is evidence of protein on the initial urine analysis. In the initial stages there is usually no indication to measure feline pancreatic lipase immunoreactivity.
Advanced Diagnostics and Treatment
If there is no diagnosis reached on the initial blood work, then further investigation is warranted. This would generally start with abdominal ultrasound to assess the intestinal tract, pancreas, liver and mesenteric lymph nodes. If any abnormality is seen, then fine needle aspirates should be obtained (and consideration to culture the bile should be considered).
If the cat is sick enough to require fluid therapy or interventional nutrition, and there is no diagnosis reached on the initial blood work, then further investigation is warranted. If any abnormality is seen, then fine needle aspirates should be obtained (and consideration to culture the bile should be considered).
Dietary Therapy
In comparison to dogs, dietary therapy in these cases is challenging if the cats have a reduced appetite. Even cats with severe clinical signs may respond to dietary treatment alone, and so this should be the first step in targeted treatment. Response to diets typically occurs within 1-2 weeks.