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48 CHRONIC VOMITING IN CATS PEER REVIEWED Tables 1 and 2 present the systemic and GI diseases most commonly associated with chronic vomiting in cats. An exhaustive review of causes of vomiting in cats, along with a ranking of the level of evidence supporting each association, has been published by Batchelor et al. 8 SIGNALMENT AND CLINICAL HISTORY Retrospective analysis suggests that the prevalence of urinary, neoplastic, cardiovascular, and GI diseases increases with age, whereas the prevalence TABLE 1 Extragastrointestinal or Systemic Diseases Associated With Chronic Vomiting in Cats CAUSE SIGNALMENT AND CLINICAL SIGNS PHYSICAL EXAMINATION FINDINGS POSSIBLE RELEVANT DIAGNOSTIC TEST RESULTS INFECTIOUS Parasitic (eg, heartworm, hepatic and pancreatic flukes, Toxoplasma) Young cat that hunts Outdoor exposure Exposure to raw meat Potbelly Underweight ↓ Albumin ↑ Globulins ↑ Liver enzymes + Heartworm test, echocardiogram Viral (FeLV, FIV, FIP) Young to adult, geriatric Outdoor exposure Multicat environment History of cat fights Anterior uveitis or chorioretinitis Fever Peritoneal effusion Thickened intestines Underweight ↓ Hct ↓ WBC ↑ Globulins without ↓ albumin ↑ Liver enzymes and bilirubin Positive viral test results METABOLIC Chronic kidney disease PUPD Hyporexia/food aversion Weight loss Hypothermia (without shock) Hypertension, retinal hemorrhages Poor hair coat Irregular, small kidneys ↓ Hct ↑ BUN, creatinine ↑ tCa, PO 4 , ↑/↓ K+ Isosthenuria/minimally concentrated urine ↑ UPC Diabetes mellitus Burmese Polyphagia PUPD Ill-kempt coat Obese Plantigrade stance ↑ Glucose, fructosamine Glucosuria Hepatobiliary disease (eg, lymphocytic cholangitis, suppurative cholangitis) Middle-aged Weight loss (lymphocytic) Dehydration and fever (suppurative) Jaundice Peritoneal effusion Underweight (lymphocytic) ↓ Hct (lymphocytic) ↓ Albumin ↑ Globulins ↑ Liver enzymes, bilirubin Hyperthyroidism Behavioral changes Polyphagia PUPD Weight loss Heart murmur Hypertension Palpable goiter Thickened intestines 6 n/↑ Hct ↑ Liver enzymes n/↑ BUN, creatinine Isosthenuria/minimally concentrated urine ↑ UPC 7 ↑ T4/fT4 GI thickening Pancreatitis Middle-aged Hyporexia/food aversion Weight loss Ill-kempt coat Cranial abdominal pain Peritoneal effusion Thickened intestines ↑ Liver enzymes ↑ fPL/DGGR lipase Widened gastroduodenal angle, loss of serosal detail Hypoechoic or heterogenous pancreas, hyperechoic mesentery, duodenal corrugation NEOPLASTIC Hepatic and pancreatic Adult Hyporexia/food aversion Weight loss Cranial abdominal organomegaly Underweight ↓ Hct ↑ Liver enzymes Organomegaly on radiography Mass on ultrasonography Round cell tumors (lymphoma, mast cell tumor) Any age Hyporexia Weight loss Cranial abdominal organomegaly (uncommon) Variable Gastric ulceration (mast cell) BUN, blood urea nitrogen; DGGR, 1,2-o-dilauryl-rac-glycero glutaric acid-(6'-methylresorufin) ester; fPL, feline pancreas-specific lipase; fT4, free thyroxine; GI, gastrointestinal; Hct, hematocrit; n, normal; PUPD, polyuria and polydipsia; T4, thyroxine; tCa, total calcium; UPC, urine protein-to-creatinine ratio; WBC, white blood cell.