Effective Diagnostic Methods for Cats Post-Vomiting

Diagnosis:

1. Initial Considerations:

Unvaccinated cats should be primarily suspected of having infectious diseases, such as CPV or CDV. In older animals, other conditions like kidney dysfunction, tumors, and endocrine disorders should be considered. A review of medication history is crucial, particularly the use of nonsteroidal antiinflammatory drugs (NSAIDs) that can cause severe gastrointestinal ulcers. The possibility of toxin or foreign body ingestion should also be assessed. Conditions like diabetic ketoacidosis, chronic kidney failure, and polyuria (excessive urination) with polydipsia (excessive thirst) and weight loss may be related to systemic metabolic diseases.

2. Vomiting Characteristics:

The duration, frequency, and relationship with diet, as well as the characteristics of the vomit, are vital. Immediate postprandial vomiting may be due to foodrelated side effects, dietary changes, or overeating. Vomiting 810 hours after eating undigested or semidigested food may indicate a blockage in gastric emptying caused by foreign bodies, mucosal hypertrophy, tumors, or polyps. Morning vomiting of bilecolored fluid may suggest gastroesophageal reflux disease.

3. Description of Vomitus:

The quantity, color, content, and odor of the vomit provide critical clinical information. Undigested food in the vomit suggests a gastric source; digested vomit containing bile indicates an intestinal source; fecal odor suggests a posterior intestinal obstruction or excessive bacterial overgrowth in the small intestine; bile presence indicates the absence of pyloric obstruction; and blood in the vomit (either fresh or occult) may indicate gastrointestinal erosions, ulcers, tumors, or metabolic ulcers related to renal failure, adrenal insufficiency, or uremia.

4. Oral Examination:

A thorough oral examination is essential after a detailed history. Jaundice, uremic taste, and ulcers, or linear foreign bodies at the base of the tongue, which could be the cause of vomiting, may be found. These foreign bodies could enter the intestines or cause obstruction and intussusception.

5. Additional Checks:

Fever may indicate an infection. Cats with vomiting and bradycardia or arrhythmia on auscultation may be suffering from metabolic disorders (adrenal insufficiency). Abdominal palpation for distension or tympany may suggest gastric dilation or torsion. The presence of effusion (peritonitis), masses, or organomegaly (tumors, intussusception, or foreign bodies) may indicate pain (such as peritonitis, pancreatitis, or intestinal obstruction). Gastrointestinal gas and fluid accumulation suggest obstruction, such as that caused by linear foreign bodies leading to intussusception. Rectal examination provides information on colonic mucosa and stool characteristics, with upper gastrointestinal bleeding often presenting as melena. Colitis or chronic constipation can also cause vomiting.

6. Central Nervous System Causes:

In cases where the cause of vomiting is unclear, a neurological cause can be suspected, especially if there are symptoms of vestibular disease (nystagmus, head tilt, ataxia). Disc disease can also cause pain or intermittent bowel obstruction, leading to vomiting.

7. Acute and Chronic Vomiting:

Acute Vomiting: This may be selflimiting and treated symptomatically. Most vomiting is related to gastrointestinal issues, often secondary to dietary indiscretion. All animals with gastrointestinal symptoms should have fecal examinations to rule out parasitic factors. Environmental toxin investigation is crucial, as alcohol intoxication often presents with acute vomiting followed by renal failure. Unvaccinated young dogs should be tested for CPV. This condition often presents with vomiting before diarrhea. Imaging should be performed if there is intestinal effusion or gas, to determine the presence of gastric dilatation and torsion, gastrointestinal foreign bodies, or obstructions. Severe acute vomiting with systemic symptoms requires laboratory and imaging tests.

Chronic Vomiting: If symptoms persist for 57 days or if symptomatic treatment is ineffective, further diagnostic investigation is necessary. Determine if there is hematemesis, check for gastric ulcers, whether NSAIDs have been used for treatment, and assess for gastric tumors and systemic mastocytosis. Further investigation of unexplained hematemesis may require measuring serum gastrin concentration (increased in gastrinomas). Animals with palpable masses should undergo imaging and, ultimately, exploratory surgery.

Routine laboratory and imaging tests can establish the cause of chronic vomiting and allow for direct appropriate treatment. Special tests may be necessary if required. For example, in cats, serologic tests for viruses and heartworms, thyroid testing, adrenal cortical testing, and bile acid testing should be considered.

When nongastrointestinal causes of chronic vomiting are not found, gastrointestinal causes should be considered. Endoscopy, radiographic contrast studies, ultrasound, or laparotomy may be used. Inflammatory damage, such as gastritis caused by Helicobacter pylori or colitis, is the most common cause of chronic vomiting related to the gastrointestinal system. Feline inflammatory bowel disease often presents primarily with vomiting. Endoscopy can diagnose the cause of vomiting due to gastric pyloric antrum mucosal hypertrophy, polyps, foreign bodies, or tumors. Gastric emptying obstruction, leading to gastric dilation, can cause vomiting. Imaging can diagnose obstructive intestinal injuries, such as foreign bodies, intussusception, and tumors. Only after excluding these diagnoses should gastrointestinal dysfunction be considered.

8. Treatment:

For metabolic disorders causing vomiting, symptoms will be controlled once the cause is resolved or eliminated. For druginduced vomiting, stop or change the medication and treat symptomatically. For food intolerance or allergies, use hypoallergenic prescription diets. Surgical treatment may be necessary for gastrointestinal foreign bodies, obstructions, or intussusception. Hepatitis, bile duct or gallbladder stones, and pancreatitis can be treated causally.

9. Casespecific Considerations:

In the case of a young kitten, feline distemper should be ruled out first. Based on the vomit, it should be considered gastric in origin, and treatment can be initiated for gastrointestinal metabolic disorders.