Power hour—chronic vomiting in cats: it's really not hairballs (Proceedings)

ADVERTISEMENT

Power hour—chronic vomiting in cats: it's really not hairballs (Proceedings)

source-image
Aug 01, 2011

Overview

     • 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.

Typical history

     • "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."

Cobalamin/folate

     • 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)

Differential list

     • 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.