Page 645 - Problem-Based Feline Medicine

30 – THE CAT WITH SIGNS OF ACUTE VOMITING 637

However, some cats with linear foreign bodies have a Pathogenesis
waxing/waning course of vomiting and anorexia that
Gastritis results from hyperacidity, loss of mucosal
may not suggest the diagnosis immediately.
protection (mucus, bicarbonate), reduced mucosal
Other differentials in those cases would include infec- blood flow, or mucosal damage from direct trauma, irri-
tious, dietary or inflammatory gastrointestinal diseases. tation or chemical erosion.

Treatment Continued damage leads to development of a gastric
erosion (lesion in mucosa only) or ulcer (lesion affect-
In cases where the object is still in the stomach, it is ing the deeper tissue layers of the stomach wall).
sometimes possible to safely retrieve the object (nee-
Non-steroidal anti-inflammatory drugs (NSAIDs)
dle, small toy, etc.) via an endoscopic procedure.
reduce the synthesis of prostaglandins which are nec-
Most GI foreign bodies however, will require surgical essary for gastric mucus secretion. Gastric mucus is
removal, and some may be a surgical emergency when the primary means of surface protection against acid,
GI perforation has occurred. irritants and trauma.

Cats that are severely dehydrated from persistent vomit- Hyperacidity can occur secondary to liver failure
ing, or have suspected intestinal perforation and leakage (hypersecretion of gastrin and reduced mucosal blood
should be stabilized as much as possible with aggressive flow), renal failure (hypergastrinemia) or mastocytosis
fluid therapy and broad-spectrum antibiotics prior to (increased release of histamine), or can result from
surgery (e.g. combination of ampicillin/amoxicillin or long-term use of gastric acid-suppressing drugs (e.g.
cefazolin and enrofloxacin, amikacin or cefoxitin). Some proton pump inhibitors), or a gastrinoma (gastrin-secret-
cats with a protracted history of vomiting will benefit ing tumor) which is a very rare endocrine tumor in cats.
from histamine-2 blockers or GI protectants if gastritis
A decrease in bicarbonate delivery to the gastric
or gastric erosions are suspected.
mucosa occurs in metabolic acidosis (e.g. renal failure)
Motility-modifying agents, such as metoclopramide, and in states of reduced blood flow (e.g. shock), thus
should not be used until the obstruction is relieved. resulting in mucosal injury.

Prognosis
Clinical signs
The prognosis is good unless large portions of bowel
Vomiting occurs with or without hematemesis.
must be resected which potentially leads to short bowel
syndrome. Vomiting may be acute in onset with drug-induced
gastritis or ulcers, but for most other causes is
Prevention chronic due to the development of hyperacidity from
metabolic or inflammatory diseases.
The key is to prevent ingestion of string, rubber bands,
needle and thread, string, etc., to not allow cats to Anorexia or decreased appetite and lethargy occur
ingest prey, and to use caution in the type of pet toys in cats with severe erosions or ulcers.
that the cat is allowed to play with.
Anterior abdominal pain is more common with ulcer
GASTRITIS/GASTRIC ULCER DISEASE** disease.

Classical signs
Diagnosis
● Acute or chronic vomiting, with or without
History of acute onset, exposure to NSAIDs, ingestion
hemoptysis.
of chemical or toxin irritating to gastric mucosa, or
● Anorexia or reduced appetite.
episode of ischemia (shock).
● Lethargy.
● Anterior abdominal pain. Radiographic findings are usually non-diagnostic, but
may identify a deep erosion/ulcer with contrast.