Vomiting Cats - Beyond the Furball

Although emergency medicine can be dramatic and exciting, much of our time is spent dealing with the glamour couple: vomiting and diarrhoea.

While these can often be spectacular, generally they are acute and short lived. Not so for 16 year old domestic shorthair, Coco. She had been vomiting after eating for two weeks. She had been seen by her regular vet within a few days of starting vomiting. Her owner reported that blood testing then had not revealed any specific cause and Coco had been given Convenia™ and metoclopromide with Hills™ i/d diet.

Unfortunately Coco continued to vomit after eating and started to become more picky with her food (surprisingly refusing the delicious i/d food) and losing weight. Her owner was becoming increasingly concerned.

Symptomatic treatment was no longer suitable and Coco required further investigation. Blood testing was repeated (without consent from primary care vets we do not have access to external lab results), showing a mild hypokalaemia and little else. With such diseases in mind as the myriad of IBDs, neoplasia and pancreatitis our next diagnostic step was imaging. Plain radiographs suggested a degree of intestinal ileus and abdominal ultrasound revealed marked and quite diffuse gastric mucosal thickening. While the pancreas did not display key features of pancreatitis, it was visible (its often hard to find in normal cats).

Pending the next step (biopsy) intravenous fluids with potassium supplementation, vitamin B complex and a metoclopromide CRI were given to treat the ileus and any potential cobalamin deficiency (common in intestinal diseases in cats and correction may improve appetite). The H2 blocker, ranitidine was also given. Coco did indeed begin eating with gusto without vomiting. She was discharged pending her owners decision about further work-up.

A week later Coco was represented, the vomiting and inappetence had returned as well as a more apparent nausea (lip-licking) and depression. Her owner was keen to pursue further diagnostics and elected they be done at SARC (owners are encouraged to return to their primary care vets, but sometimes both owners and primary care vets request further work-up to be done here).

Blood was sent away for feline pancreatic specific lipase (negative) and we performed a gastroscopy under GA. The gastric mucosa had a diffuse, very pale appearance. No ulceration was identified. Multiple biopsies were taken and sent to an external lab. Coco recovered from her procedure well and her owner requested she remain in hospital until her biopsy results were received.

Biopsy results diagnosed nodular infiltrates of lymphocytes within the deep mucosa and Helicobacter.

How significant is a finding of Helicobacter?

Without any controlled studies, the significance of Helicobacter in cats remains questionable. US based literature suggests that Helicobacter is a very common finding in both normal and abnormal cats, however this may not be the case in Australia. In chatting with Judith Nimmo at ASAP, Helicobacter is a reasonably uncommon finding in feline gastric biopsies and may be a significant pathogen.

The clinical signs reported in chronic Helicobacter-associated gastritis are vomiting, diarrhoea and weight loss, further there is a suggestion of a link with the development of GI lymphoma.

A treatment trial was initiated. We used the triple therapy advised for feline helicobacteriosis of amoxil 20mg/kg bid; metronidazole 10 mg/kg bid and omeprazole 0.7 mg/kg sid. Coco tolerated this well and her appetite returned without any vomiting. She was discharged home and follow-up phone calls reported that she continued to do well at home.

SARC's endoscopy system is provided by Austvet Endoscopy.

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