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vulnera-sanentura · 4 years

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Cat Facts: Why’s this Cat Vomiting?

Like most of my posts, this is coming more from a veterinary student/pre-vet education perspective, but hopefully some owners that follow me can get some useful info from this!

Unsurprising to most vet students, there’s about as many reasons for vomiting as there are diagnoses in general. We’re going to attempt to narrow that down a bit, break them into categories which makes it more useful for diagnostics and relevant differentials.

First off, you have to differentiate vomiting from regurgitation.

Vomiting: nausea (drooling, lip licking, swallowing, depression/restlessness), abdominal muscle contraction, contains bile/digested blood/digested food

Regurgitation: no nausea, no abdominal contractions or bile, presence of undigested food in a tubular shape.

Once you’re sure it’s actually vomiting, you’ll need to differentiate it into acute or chronic, as well as emergency/non-emergency. Acute will be in the last few days or day of presentation, often multiple times in the same day, and will often present as more “sick” than the chronic vomiter.

In chronic cases, the vomiting is usually more than 2 times a month and has been going on for months to years. Chronic vomiters can be “apparently healthy” and the vomiting only brought up at a wellness check or prompted by the vet/nurses and the owner didn’t think to bring it up because “cats just vomit, and they seem fine other than that.” History can help a lot! If there’s an acute case, and the cat has access to toxic substances, a habit or likelihood of eating foreign objects (hair ties, string, q-tips, etc), or has had a recent change in diet, that could lead you immediately to the most likely cause and the most appropriate next steps. Acute vomiting generally has fewer causes or at least more obvious causes, and next steps generally include abdominal radiographs or triage/supportive care if indicated. Physical exam can locate a linear foreign body that’s anchored to the underside of the tongue.

So, what if that doesn’t help? That’s when you start your baseline diagnostics! CBC/Chem/UA can rule in or rule out a lot of potential causes for vomiting:

Diabetes: hyperglycemia, glucosuria, ketonuria, low USG

Liver disease: hyperbilirubinemia, decreased BUN, increased liver enzymes, bilirubinuria

Renal disease: increased BUN/creatinine, low USG

Hyperthyroidism: increased T4, increased liver enzymes (ALP, ALT), mild increase in PCV, low USG

Electrolyte/acid-base derangements: Na, K, Cl, Ca, pH, bicarb, tCO2

Eosinophilia: parasites, IBD, hypereosinophilic syndrome, mast cell tumors

Neutrophilia: gastroenteritis, neoplasia

Neutropenia: salmonellosis, retroviruses

Hemoconcentration: dehydration

Anemia: chronic disease, GI blood loss

Fecal may also show parasites, and FeLV/FIV positive snap test might be supportive of vomiting from a FeLV/FIV related illness

Secondary diagnostics beyond bloodwork and urinalysis would be the next step after that. Radiographs may show abnormalities in organ size/architecture (small kidneys, enlarged liver), foreign bodies, GI obstruction, or masses.

Ultrasound is the diagnostic of choice for **chronic vomiting and normal bloodwork**. It can reveal thickening of the stomach/small intestines, wall layer changes, and/or enlarged lymph nodes. It can also show or allow better examination of abdominal masses, or the presence of free fluid.

fPLI may be indicated if pancreatitis is suspected, but may be normal in chronic pancreatitis cases. Heartworm testing if the cat lives in an endemic area, after other causes have been ruled out.

Intestinal biopsy and histopathology is recommended in cases of chronic vomiting with GI thickening seen on ultrasound. This will differentiate between IBD and lymphoma, which cannot be done without the histopath! Though presumptive and empirical treatment may be considered in cases of financial concern. IBD is often in younger cats and lymphoma in older, however that’s simply a generalization and not a hard and fast rule. IBD and lymphoma are the two most common causes of chronic vomiting in cats. Exploratory surgery and full thickness biopsies is preferred over endoscopic biopsy, as you can retrieve intestinal samples from more than just the duodenum, the samples will be higher quality for your pathologist, and you can determine the staging of the lymphoma (if that’s the cause).

What should I tell owners to keep a look out for? 2x a month or more vomiting, INCLUDING HAIRBALLS, is abnormal and justifies an ultrasound study. Cats should in theory be able to process hair since they evolved to groom their fur (a bit more leeway is given to long-haired cats since that’s a genetic mutation we’ve selected for), and vomiting hairballs regularly is suggestive of hypomotility of the GI tract.

The only exception to this is eating grass and vomiting, as grass is irritating to the stomach and can cause vomiting, but is more or less harmless on its own.

Due to this being a very wide topic I didn’t go much into specifics, but I can if you all are interested in any specific parts of this!

#vulnera-sanentura #veterinary medicine #vet med #cat facts #gi disease

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aquarianlights · 5 years

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BABY CAME HOME FROM SURGERY YESTERDAY!!! But we still need help! GFM and paypal links at the end!

For those of you who don’t know what is going on, Echo, my 5 year old pomeranian who is my world, was diagnosed with a cancerous mast cell tumor on 8/4/19. We immediately got him in with an oncologist on the 6th and drew up a plan for surgery. We tentatively scheduled his removal for Friday, with a downpayment of 1.5k against their policy (as they are not allowed to take down payments that are not the full amount) with the promise I would call Thursday night and tell them I had the money and intended to pay at his 7am drop off. I went home that night and immediately started up a gofundme, as his surgery alone ran 2.5k, while the emergency visit that diagnosed him was ~500+ and the surgery consult and all his labs and tests ran ~600+. I wasn’t even thinking about aftercare at this point (chemo, radiation, checking for clean margins, infection fund, suture removal, medications, etc...), because if we didn’t remove the tumor ASAP he could have died from it. And if he had stayed on the medications preventing it from spreading and reducing its size, his adrenal gland could have been shut down altogether and he could have ended up with diabetes mellitus or Cushing’s syndrome. I was scared to post a gofundme, because the one time I really needed help when Echo and I were homeless and posted a gofundme, I got attacked by absolute strangers for no reason just for asking for help.

Little did I know that this time would be an entirely different experience.

My friends, their friends, my family, strangers... everyone came together and rallied for Echo. Donations poured in over gofundme and through my paypal and through cash from people physically with me. On top of that, the people physically here with me were helping out by babysitting him when I had to leave and couldn’t avoid it and by keeping me company and bringing me food and checking up on me as my mental health took a sharp decline. Everyone would come over to give Echo and me lovings.

I usually feel so alone in my battles since I live alone and don’t reach out for help that often anymore. I have my therapist, but that’s different. My catastrophic thoughts always end up in places like “no one would care if you died; it would be best since no one even checks in on you or bothers to help unless they need something”.

This experience opened my eyes to something I have been missing all these years. People care more than I’ll ever know. And in times of crisis, every single one of the people I hold near and dear to my heart will band together to back me. I had at least 20-30 of my friends just messaging me constantly, sending support, sending money, sending their love and keeping Echo and me in their thoughts. I have a very small circle of best friends, with 2 of those being platonic soul mates. And then I have what I would consider a smaller circle of very good friends in the 15-20 number range, and the rest of my friends are people who I don’t know if I can trust or not. But those people in those two circles, both very good friends and good friends, I know for a fact would go to the ends of the earth for me if it was within their power and I would do the same for them. And in this moment of crisis, the SECOND I said I needed help, they were ALL there. Every single person on that list was there in some shape or form. And even beyond that, there began to be friends that I wasn’t sure of just jumping in to back me and Echo as if it were their sacred duty. I was SHOOK.

I cannot even express to you all how much I cried every time I would see a donation alert from GFM or paypal or a text pop up from someone in support of Echo and our situation.

It made me realize just how many people genuinely cared for me and would do what they could if it is within their power. It made me realize I wasn’t alone. And I only wish there was some way I could tell Echo how much he is loved by so many people and how many people banded together to save his life. He would be so grateful.

Albeit this has been such a traumatic experience for both of, I never expected for it to become such a unique bonding experience between us. He is depending on me more than *ever* before and trusting me with everything possible.

As you can see above, he has a TON of meds, so I made him my medication buddy and set up a system where we take some of our meds at the same time. He takes his meds much more frequently than I do at all different times and different frequencies, so I have to keep track of the schedule. He has to stay confined to his kennel 99% of every day, only coming out to pee, which I have allowed him to pee and defecate on the pee pads with the rubber mat underneath, that way it doesn’t affect my carpet at all and I don’t have to pick him up and carry him down and up 3 flights of stairs, thereby hurting him. Getting anywhere near his incision site makes him scream and shriek in pain. He also has to wear the cone of shame 99% of the day, too. The only time it comes off is when he is attached to the leash, with my room door closed, while I am feeding him and giving him meds and letting him drink (and cleaning the e-collar) so I can grab him if he tries to lick or scratch the staples. I feel bad leaving him in the kennel but as a pre-med major and a former vet tech major, I know the extreme importance of following post-op instructions to a T.

He also gets cold therapy with a frozen gel pack for the first 5 days, 3x/day, 10-15 minutes each session. Then we switch to heat therapy with a warm washcloth in a pillow case. All directly applied to his incision site to reduce swelling.

We will not know the grade of the tumor or whether we got clean margins on this surgery (you go 2cm out from the tumor as a rule, but that doesn’t guarantee you get clean margins) until his biopsy comes back. His biopsy should come back in about 5-7 business days from last Friday (8/9/19). We are hoping it will be low-grade and that we got clean margins.

If we didn’t, he will need radiation therapy or chemo or possibly even another surgery to go back in and excise what they didn’t get. Or god forbid it is high grade and has spread, in which case chemo will be a necessity.

Now, all of these things are ridiculously pricey as I mentioned. And Echo is on practically as many meds as I am on. And he has a 2-week healing period where just about anything can go wrong. One wrong move and he could tear a staple and need to be rushed to the ER. An infection could happen. ANYTHING. I have set up a little area next to him (pictured above) to make sure I can be right next to him at night and during the day when I’m home and not doing anything. I made sure to clear my schedule as much as I could these 2 weeks to be here for him. I don’t want him suffering alone and if anything goes wrong, I want to be *right here* to rush him somewhere and save him.

Due to everything mentioned above, I am keeping the fund open for not only his aftercare but for an emergency fund in case anything goes wrong, god forbid.

So now that you know a little about my baby and what we’re fighting against, here are the links I promised at the beginning:

Echo’s GoFundMe: https://www.gofundme.com/echoscancerfund

My Paypal if you’d rather donate directly: [email protected]

Thank you to anyone and everyone who has shared and helped in any way. You’re all heroes in my book and if Echo knew the extent you’ve all gone for him, I’m sure he would be as endlessly grateful as I am to everyone for their help and support. Because of all of you, Echo now has another 7-10+ years to live with me and I get those years to thrive with him. I can’t thank everyone enough.

-Killian & Echo

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