Today's Veterinary Practice

NOV-DEC 2017

Today's Veterinary Practice provides comprehensive information to keep every small animal practitioner up to date on companion animal medicine and surgery as well as practice building and management.

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47 NOVEMBER/DECEMBER 2017 ■ TVPJOURNAL.COM CONTINUING EDUCATION Chronic Vomiting in Cats: When to Recommend Endoscopy Kyle Restle, DVM, and Jacqueline Whittemore, DVM, PhD, DACVIM University of Tennessee School of Veterinary Medicine Chronic vomiting is a common presenting sign for cats, and evaluation can be frustrating for both owners and veterinarians because of the long differential list. Chronic vomiting has previously been defined as vomiting 3 or more times per month for at least 3 months. 1 Vomiting of trichobezoars (hairballs) should not be dismissed, particularly in cats without long hair, because their development could reflect altered gastrointestinal (GI) motility due to underlying disease. 2 Endoscopy can be a valuable tool in achieving a final diagnosis, but it is not inexpensive or completely without risk. Additionally, premature performance of endoscopy can result in misdiagnosis because histologic findings do not differentiate among types of chronic enteropathy, such as food responsive disease (FRD) and inflammatory bowel disease (IBD). 3,4 Thus, when evaluating a cat for chronic vomiting, clinicians must follow a systematic approach. Vomiting should first be differentiated from regurgitation. Vomiting is an active process with retching or heaving, and it is often preceded by nausea or hypersalivation. Vomitus may contain partially digested food and be discolored because of the presence of bile. In contrast, regurgitation is a passive process; regurgitated food is typically undigested, might have a mucus coating, and lacks bile. After confirmation of chronic vomiting, the next step is crafting an appropriate differential list based on the patient's signalment, environment and husbandry, history, and physical examination findings because this can drastically alter the diagnostic approach. For example, although metabolic evaluation is generally warranted in older cats before abdominal imaging, immediate performance of abdominal radiography might be more appropriate in a young cat because of increased risk for linear foreign body ingestion. 5 shutterstock.com/Stefano Garau CONTINUING EDUCATION PET PEEVES Chronic vomiting in cats is a frustrating condition, and accurate diagnosis hinges on use of a systematic approach. Endoscopy is warranted after systemic diseases have been ruled out, particularly in cases without solitary jejunal disease.

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