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49 NOVEMBER/DECEMBER 2017 ■ TVPJOURNAL.COM CONTINUING EDUCATION TABLE 2 Gastrointestinal Diseases Associated With Chronic Vomiting in Cats DISEASE SIGNALMENT AND CLINICAL SIGNS PHYSICAL EXAMINATION FINDINGS POSSIBLE RELEVANT DIAGNOSTIC TEST RESULTS ANATOMIC Obstruction (gastric or linear foreign body, trichobezoars, neoplasia) History of foreign-body ingestion Long-hair coat Vomiting associated with food ingestion Mass effect Intestinal plication String under tongue Mass effect Intestinal plication Pseudoobstruction (hypomotility) Large, fluid-filled stomach on imaging INFECTIOUS Bacterial (spiral bacteria) Hyporexia, food aversion Generally normal Demonstration of organisms on biopsy (with lack of gross or histologic abnormalities in the small intestine) Fungal (Histoplasma species) Geographic location Outdoor/bird exposure Lameness Respiratory signs Weight loss Anterior uveitis or chorioretinitis Bone pain Fever, jaundice Abnormal lung sounds Thickened intestines Splenomegaly ↓ Hct/WBC/platelets ↑ Globulins, ↓ albumin ↑ Liver enzymes Pulmonary infiltrates Thickened intestines, lymphadenomegaly FeLV positivity Parasitic (Physaloptera, Ollulanus, Ancylostoma, Toxocara, Toxascaris, and Dipylidium species) Hunter Outdoor exposure New cat or dog introduced into home Cattery History of fleas Generally normal Thickened intestines ↑ Eosinophils Positive fecal test result Microscopic visualization in vomitus or gastric lavage samples Direct visualization Viral (dry form FIP) Outdoor exposure Multicat environment Anterior uveitis or chorioretinitis Fever Thickened intestines Underweight ↓ Hct ↑ Liver enzymes and bilirubin ↑ Globulins without ↓ albumin Positive viral test results GI thickening, scant perinephric effusion INFLAMMATORY/IMMUNE FRD Behavioral changes Diarrhea Hyporexia, food aversion Polyphagia Weight loss Dermatologic abnormalities Ill-kempt coat Thickened intestines Underweight ↑ BUN with normal creatinine ↓ Albumin ↑ Eosinophils GI thickening, muscularis thickening Response to diet trial IBD (including ESF) Behavioral changes Diarrhea Hyporexia, food aversion Polyphagia Weight loss Ill-kempt coat Thickened intestines Underweight ↑ Eosinophils GI thickening ± muscularis thickening (primarily duodenal), loss of wall layering Mass effect (ESF) NEOPLASTIC Carcinoma Older animals Hyporexia, food aversion Polyphagia Weight loss Mass effect Thickened intestines Focal mass effect Gastric ulceration GI thickening/mass effect ± loss of wall layering Lymphoma FeLV positivity Diarrhea Hyporexia, food aversion Polyphagia Weight loss Abdominal pain Nausea Mesenteric lymphadenomegaly Thickened intestines Gastric ulceration GI thickening ± muscularis thickening (primarily jejunal), loss of wall layering, mass effect, mesenteric lymphadenomegaly BUN, blood urea nitrogen; ESF, eosinophilic sclerosing fibroplasia; FeLV, feline leukemia virus; FIP, feline infectious peritonitis; FIV, feline immunodeficiency virus; FRD, food responsive disease; GI, gastrointestinal; Hct, hematocrit; IBD, inflammatory bowel disease; WBC, white blood cell.