Chronic vomiting is a common problem in cats. It may be related to relatively minor causes, such as chronic swallowing of hair, or it may be due to much more serious diseases. At the Animal Hospital at Thorndale, we know you do not enjoy cleaning up after your recurrently vomiting cat. Even more importantly, we understand that your cat does not enjoy the repetitive vomiting process. Our goal is to identify the cause of the vomiting and find the right treatment to make life more enjoyable for all concerned.
How Urgent Is It to Reach a Diagnosis?
Because there are so many causes, there are many tests that may be needed to make an accurate diagnosis. One of the factors that determines how quickly these tests must be performed is the condition of your cat. If the appetite is very poor or non-existent or if weight loss is occurring rapidly, it is important that a diagnosis be obtained rapidly. If pain or a mass is present in the abdomen, tests need to be performed quickly. However, if neither appetite nor weight is affected, and the cat is behaving normally with only intermittent vomiting, the urgency is much less.
Causes of Vomiting
Vomiting may be due to disease in the stomach or intestines, or it may be due to disease in many other parts of the body, also known as systemic disease. As a rule, systemic diseases are detected with blood tests. However, when the vomiting is due to diseases in the stomach or intestines, they may not show up in these blood tests.
Testing Procedure
The sequence of tests will vary from cat to cat. The urgency issues already discussed are one of the most important factors that we must consider. However, as a rule, we recommend blood tests to eliminate the diseases that are not directly involving the stomach or intestines. If those do not detect the problem, the other tests, listed below, will be utilized.
Tests for Diseases of the Stomach or Intestines
The following tests are performed to evaluate the stomach and intestines. Their pros and cons are listed.
Radiographs (x-rays): Plain radiographs find foreign materials if they are made of bone or metal or other very hard substances. Sometimes radiographs with barium contrast material are needed. Barium is placed in the stomach and radiographs are taken every 15-30 minutes until the barium reaches the end of the intestines. These radiographs permit us to evaluate:
- How quickly the stomach empties
- If the barium moves completely through the intestines and how quickly that occur
- If the intestines are dilated
- If there are areas in the intestines that are very irritated
- If there is a rupture of the stomach or intestines
These radiographs do not require sedation or anesthesia unless the cat is very uncooperative. Having barium in the GI system may make the risks during an abdominal surgery more concerning. Often after screening radiology, without barium, it may be recommended to proceed to an ultrasound.
Ultrasound
An ultrasound study is performed with a machine that sends sound waves into the body. Their reflections are analyzed by a computer and formed into an image on a computer-type screen. There is no radiation involved and this is a non-invasive procedure. Keep in mind, the cats hair on its abdomen will be shaved so that a good contact can be made with the ultrasound gel applied between the ultrasound probe and the cat’s skin. These images allow a trained operator to visualize the structure of the stomach and intestinal walls. It also permits evaluation of the liver, kidneys, and other abdominal organs. Biopsy of abnormal areas of most organs is also possible and can provide the needed tissue samples for a diagnosis to be made.
An ultrasound examination usually does not require sedation or anesthesia; however, the cat must lie on its back for 15-30 minutes. Some cats will not do that without sedation. If biopsies are taken, sedation is usually required to prevent pain and to prevent damage to internal organs.
Endoscopy and Biopsy
An endoscope is a flexible scope that is inserted through the mouth, down the esophagus, and into the stomach and first few inches of the small intestines. (It may also be inserted through the anus and into the colon, but this is generally reserved for cats with chronic diarrhea.) This permits us to look at the insides of the esophagus, stomach, and upper small intestines. It also permits biopsies to be taken, which is often the most important part of the procedure.
Endoscopy requires anesthesia so there is always a small degree of risk involved. However, it does not require a surgical incision. One of its limitations is that some tumors of the stomach do not go completely to the inner surface of the stomach. Since the biopsies are only made from the stomach lining, it is possible to miss them.
Surgery
Surgical exploration of the abdominal cavity is generally reserved for those cats that cannot be diagnosed with the above tests. It is the most invasive procedure, but it permits us to see all parts of the stomach and intestines as well as the other abdominal organs. It also permits us to biopsy specific areas of any abdominal organ.
In some cases, surgery is performed as one of the first procedures if an intestinal obstruction is diagnosed or strongly suspected.