• Most chronic vomiting and chronic diarrhea in cats originate in the small bowel
• Many small bowel diseases are segmental
• Endoscopic biopsies are a very poor way to diagnose most cases
o Location: stomach + 1-2 cm of duodenum OR colon
o Sample Size: about 1 mm piece of tissue; not full thickness
• Chronic small bowel disease is manifested as chronic vomiting, chronic diarrhea, or both.
• "My cat has vomited all of its life. The vomiting was occasional for months to years. Then it became 1-2 times per month. Now it is daily. Otherwise, he/she feels good and eats good."
o Think small bowel, not stomach.
• "My cat has had soft stools ("not diarrhea") all of its life. The soft stool was occasional for months to years. Then it became 1-2 times per month. Now it is daily. Otherwise, he/she feels good and eats good."
• Alternative: "has been losing weight" " has a tremendous appetite."
• They are not synthesized in the cat.
• Folate: absorbed in the upper small bowel.
• Cobalamin: absorbed in the lower small bowel.
• If their levels are low, it tells you what part of the bowel is diseased.
o Low folate: rare in the cat.
o Low cobalamin: common in the cat.
o Most chronic small bowel disease occurs in the jejunum and ileum.
• This explains why endoscopic biopsies fail to be diagnostic.
• Recovery from chronic small bowel disease requires successful treatment.
o Cobalamin/B12 injections.
• Diagnosed with fasted blood sample: IDEXX and Texas A&M GI Laboratory.
• Treatment for low serum cobalamin
o 100-250 mcg/cat SC q7d for 6 weeks followed by 100-250 mcg q14d for 6 weeks (3 injections), and another injection (100-250 mcg) 4 weeks later.
o Using the 1000 mcg/ml concentration, this is a very tiny dose (0.1-0.25 ml). I give 1 ml (1000 mcg) per dose because it is not toxic and often stimulates the appetite at this dose.
• Treatment for low serum folate
o Rarely, if ever, needed.
o 5 mg q24h PO. (1 mg tablets available)
• Food intolerance
• Inflammatory bowel disease
• Neoplasia without mass formation
o Small cell lymphoma
o Lymphoblastic lymphoma
o Note: Mast cell tumor, adenocarcinoma, small cell lymphoma, and lymphoblastic lymphoma can cause chronic small bowel signs, but a mass forms resulting in rapid weight loss and vomiting (partial to full obstruction). The mass is found by palpation, ultrasound, or surgery.