47
NOVEMBER/DECEMBER 2017
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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.