Vomiting In Cats
Vomiting describes the active expulsion of food from the stomach. Vomiting may be caused by disorders of the stomach but is a clinical sign that can occur with many diseases and problems.
Vomiting can be caused by minor intestinal upset, as from eating spoiled food or foul-tasting things such as certain insects. However, vomiting can also be a symptom of a more serious illness, such as bacterial or viral infection, intestinal obstruction from foreign bodies, urinary tract obstruction, liver disease, or cancer. Left untreated, these illnesses can lead to serious complications, including death.
HOW DO I RECOGNIZE VOMITING?
Vomiting may begin with a stage of nausea, in which the cat appears restless, and possibly apprehensive. Your cat may lick its lips, salivate and repeatedly swallow. Vomiting itself involves forceful contractions of the abdominal muscles, leading to expulsion of fluid, froth or food. The severe effort associated with vomiting may be distressing to the cat.
WHAT DOES ACUTE VOMITING MEAN?
Acute vomiting is vomiting that has been present for no more than one to two days. Most cases will respond quickly to simple symptomatic treatment. The cause of such cases is often never established and may be due to relatively factors such as eating spoiled food.
WHAT IS THE SYMPTOMATIC TREATMENT FOR ACUTE VOMITING?
Non-specific symptomatic treatment is often prescribed initially in mild cases of acute vomiting. Your veterinarian may advise you to withhold food for a time ranging between six and twenty-four hours. After this time, you will usually be advised to feed your cat an easily digested, bland diet in small quantities given frequently. A diet based on boiled chicken and boiled rice is often recommended. It is important that the cat does not receive any other foods during this period.
"Unless otherwise directed, water should be freely available and is important to prevent dehydration."
If your cat is progressing well, the quantity of food offered at any one time can gradually be increased back to a normal quantity and then your cat's normal diet can be reintroduced gradually over several days.In some cases, your veterinarian may prescribe medication to control vomiting or relieve inflammation. This approach allows the body's healing mechanisms to correct the problem.
If your cat does not improve with symptomatic treatment, your veterinarian may make a change in medication or perform further tests to evaluate the problem more thoroughly.
HOW WILL MY VETERINARIAN DECIDE WHAT TYPE OF TREATMENT IS NECESSARY?
The search for answers starts with a complete history and physical examination. A pet’s “history” is the information you give the veterinarian about your pet’s illness. In a vomiting pet this would include details such as:
- If your cat is depressed, lethargic or has a fever
- If your cat is eating
- If there has been weight loss
- If there has been any blood in the vomit (a few specks of fresh blood may not be abnormal but more copious or persistent bleeding is significant)
- If there is any pain or distress, particularly affecting the abdomen
- Whether normal feces are being passed, or if your cat has diarrhea or constipation
- What is the frequency and amount of vomiting
- What is the relationship of vomiting to feeding
- Whether there is any offensive odor or abnormal color to the vomit
- What your cat has been fed and if there has been a recent change in diet
- Whether your cat has any access to other foods or other substances
- Whether any treatment or supplements have been given recently
- Whether any other cats in the household are affected
Physical examination involves looking at all parts of the body, and typically includes listening to the heart and lungs with a stethoscope and “palpating” the abdomen (gently squeezing or prodding the abdomen with the fingertips to assess the internal organs). A complete physical examination may give clues about the cause of vomiting. For example, a tense painful abdomen could be a sign of pancreatitis, a large amount of hard stool in the lower abdomen could indicate constipation, a fever might indicate an underlying infection, and an abdominal mass could be a tumor.
Sometimes a diagnosis can be made just with history and physical examination. However, in many cases additional diagnostic tests will be needed and your veterinarian may recommend doing screening tests. These are a series of simple tests that provide information about the overall health of the pet and often provide further clues about the underlying problem.
WHAT SCREENING TESTS ARE RECOMMENDED?
In a vomiting pet the most commonly recommended screening tests would include: complete blood count (CBC), serum biochemistry profile, and urinalysis. Other screening tests might include a fecal flotation for intestinal parasites especially in puppies and kittens, and a serum thyroxine (total T4) test in middle aged and older cats.
DO ALL OF THESE TESTS NEED TO BE PERFORMED IF MY PET IS FEELING WELL OTHER THAN OCCASIONAL VOMITING?
No. If a pet is bright and alert and everything seems normal on physical examination, your veterinarian may delay testing. This is especially true if the vomiting seems to be an isolated event or the cause seems obvious, such as dietary indiscretion. However, if the vomiting doesn’t clear up with treatment, or the vomiting recurs, or the pet is clearly unwell and shows signs of fever, lethargy or painful abdomen, then screening tests are strongly recommended.
WHAT CAN THESE SCREENING TESTS TELL US?
Screening tests will likely provide clues about the cause of the vomiting. In addition, they may uncover problems caused by the vomiting such as electrolyte disturbances and dehydration.
(a) Complete Blood Count: This is a simple blood test that provides information about the different cell types in blood. These include red blood cells, which carry oxygen to the tissues, white blood cells, which fight infection and respond to inflammation, and platelets, which help the blood to clot. The CBC provides details about the number, size and shape of the various cells types, and identifies the presence of abnormal cells in circulation. (See article Complete Blood Count)
The CBC in a vomiting pet might show:
- Anemia (decreases in the number of red blood cells, pack cell volume, and hemoglobin) could be a sign of bleeding in the stomach or bowel or could indicate a longstanding disease such as Addison's disease, liver disease, kidney failure, or cancer.
- Hemoconcentration (increases in the number of red blood cells, the pack cell volume, and hemoglobin) indicates dehydration.
- High numbers of white blood cells indicates underlying infection or inflammation such as pancreatitis, liver disease, or kidney infection. Some types of cancer can also produce high white cell counts.
- Low numbers of white blood cells could indicate viral infection such as panleukopenia.
- Increased numbers of eosinophils (a type of white blood cell) could indicate allergies or parasitic infections, both of which can cause vomiting.
(b) Serum biochemistry profile refers to the chemical analysis of serum, which is the pale yellow liquid part of blood that remains after the cells and clotting factors have been removed. There are many substances in serum, including proteins, enzymes, fats, sugars, hormones, electrolytes etc. Measuring the levels of the various substances in the blood provides information about the health of the body’s organs and tissues such as the liver, kidney, and pancreas. Changes and abnormalities found in the biochemistry profile can help to diagnose a variety of diseases and disorders.
(c) A urinalysis describes the physical and chemical composition of urine. It measures how well the kidneys are working, identifies inflammation and infection in the urinary system, and helps to detect diabetes and other metabolic disturbances. Urinalysis is important for the proper interpretation of the serum biochemistry profile and should be done at the same time as blood testing.
In a vomiting pet, some changes that could be seen on a urinalysis include:
- Low specific gravity (pale watery urine): this indicates the pet is passing dilute urine. If BUN and creatinine are elevated at the same time, then kidney disease or possibly kidney failure is present.
- High specific gravity (dark yellow urine): this indicates the urine is highly concentrated. It may be a sign of dehydration.
- White blood cells (WBC) and white blood cell casts(tubular-shaped clusters of white blood cells): the presence of large numbers of WBC and WBC cases suggest serious infection of the kidneys.
- Glucose: a large amount of glucose in the urine is usually a sign of diabetes mellitus.
- Ketones: the presence of both glucose and ketones in a urine sample indicates diabetes mellitus. High levels of ketones in the urine are found with diabetic ketoacidosis, a serious complication of diabetes and an important cause of vomiting.
- Bilirubin: this is a pigment associated with liver disease, especially in the cat.
(d) Intestinal Parasite tests: the simplest screening test for intestinal parasites is called a fecal flotation, in which a small amount of fresh stool is prepared and examined microscopically for the presence of parasite eggs. A simple version of the fecal flotation can be done in the veterinary clinic or a sample can be sent to the laboratory for a slightly better test that uses a concentration technique. There are other tests that can be done to detect intestinal parasites and your veterinarian may recommend one of these alternative tests. Intestinal parasites occur in animals of all ages but are most frequently found in puppies and kittens and are a common cause of vomiting in the young.
(e) Serum thyroxine (total T4): this test is used to diagnosis hyperthyroidism in cats. Hyperthyroidism is a common disorder in middle-aged to older cats and is caused by an overactive thyroid gland. The gland produces excessive amounts of thyroid hormones, which substantially increases the body’s metabolic rate and often causes vomiting and diarrhea.
Most cases can be diagnosed with a single blood test that measures the level of total thyroxine (T4) in the blood stream. Affected cats typically have markedly elevated levels of T4 in their blood.
WHAT ADDITIONAL TESTS MIGHT BE RECOMMENDED FOR A VOMITING PET?
"There are many additional tests that might be recommended depending on the results of a pet’s history, physical examination, and screening tests."
X-rays (sometimes called RADs) may show abnormalities of the esophagus or stomach. It may be necessary to give barium to help identify any obstructions, tumors, ulcers, foreign bodies, etc.
Endoscopy, which is viewing the inside of the stomach directly through an endoscope, a flexible viewing tube, may provide a diagnosis in some cases or the procedure can be used to obtain biopsy samples. Endoscopy requires a general anesthetic.
Laparotomy or an exploratory surgery is necessary in some cases, particularly if some obstruction or blockage is suspected or if biopsy samples are required. Laparotomy can be both a diagnostic and a treatment procedure.
Once the diagnosis is known, treatment may include special diets, medications, or surgery.
This client information sheet is based on material written by: Ernest Ward, DVM, Kristiina Ruotsalo, DVM, DVSc, Dip ACVP & Margo S. Tant BSc, DVM, DVSc
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