Page 703 - Problem-Based Feline Medicine

31 – THE CAT WITH SIGNS OF CHRONIC VOMITING 695

foreign body resulting in obstruction or decreased out- Clinical signs
flow may also result in similar clinical signs.
Lethargy and anorexia are present in almost all cats
Gastric ulcer disease may result in chronic vomiting and usually develop over a 48-hour period.
and abnormal motility.
The classical signs are associated with the dysfunction
Extra-gastrointestinal causes of vomiting include of both sympathetic and parasympathetic nervous
hepatic, renal, metabolic, inflammatory (pancreatitis) system. Ocular signs include dilated pupils, decreased
or endocrine causes. or absent pupillary light reflex and protruding nictitans,
but have normal vision.
Treatment
Gastrointestinal signs are present in about 95% of
Definitive treatment for pyloric antral hypertrophy/steno- cats and include constipation, regurgitation (secondary
sis is surgical correction of the outflow obstruction. to megaesophagus) and dry mouth. Vomiting may
occur or regurgitation may be reported as vomiting.
In cats with motility disturbances, gastric prokinetic
therapy (metoclopramide 0.1–0.2 mg/kg PO q 12 h, or Less commonly observed signs are bradycardia, hypoten-
cisapride 5 mg/cat PO q 8–12 h) may improve move- sion, urinary incontinence or a distended, easily com-
ment of ingesta and reduce clinical signs. pressed bladder, proprioceptive deficits and transient
syncopal episodes.
However, in early cases, medical management with feed-
ing of small meals consisting of highly digestible foods
(low residue, low fat, low fiber) may also be helpful. Diagnosis

Following surgical correction of the outflow obstruc- There is no definitive, antemortem diagnostic test for
tion, some animals will still require medical therapy dysautonomia.
with gastric prokinetics because of residual motility
Diagnosis is made by using the clinical presentation
disturbances.
along with radiographic evidence of megaesophagus
Prognosis and its associated complications, and use of pharma-
cologic testing to evaluate the function of the sympa-
The prognosis is guarded to good with surgical man- thetic and parasympathetic nervous system.
agement, as some animals may still require life-long
Direct-acting parasympathomimetic and sympath-
medical management following surgery to control the
omimetics produce an effect in diseased cats but not
clinical signs.
in normal cats because of post-ganglionic denervation
Cats that develop esophagitis due to reflux disease may hypersensitivity in affected cats. Indirect (pregan-
have a more guarded prognosis because of the problems glionic) acting agents produce an ocular effect in nor-
associated with esophagitis (stricture development). mal cats but not diseased cats.

Ocular testing with sympathomimetic agents, e.g. 1%
DYSAUTONOMIA hydroxyamphetamine (indirect acting) produces no
mydriasis, and 1% phenylephrine (direct acting) pro-
Classical signs duces rapid mydriasis in affected cats.
● Depression and anorexia. Ocular testing with parasympathomimetic agents, e.g.
● Mydriasis, reduced pupillary light reflex, 0.5% physostigmine (indirect acting) produces no mio-
protruding nictitans, normal vision. sis, and 0.1% pilocarpine (direct acting) produces rapid
● Xerostomia (dry mouth and mucous miosis in affected cats.
membranes) and keratoconjunctivitis sicca.
● Retching, regurgitation or vomiting. Systemic testing using 0.04 mg/kg atropine, subcuta-
● Fecal incontinence or constipation. neously, will increase the heart rate if the sympathetic
nervous system is normal. Note: Do not use ephedrine,
epinephrine or other sympathomimetics, because fatal
See main reference on page 792 for details (The Con-
arrhythmias can be induced.
stipated or Straining Cat).