Welcome to our fourth case of the month! This week we have a cat with a common problem, vomiting, with an unexpected cause. If you want to see last month's case, scroll down to the bottom of the page.

 

I CAN'T BELIEVE I ATE...

 

HISTORY

Tippy was a 7-year-old cat who for a little while just hadn't been herself. She'd been eating poorly, vomiting occasionally, and losing weight. She'd also been chewing and moving her mouth strangely, like she was having trouble swallowing. In a short period of time she'd dropped from her normal weight of 11.8 pounds to 10 pounds.

 

PHYSICAL FINDINGS

Tippy's exam showed her to be significantly thin and dehydrated, and her heart rate was elevated. On feeling her abdomen, a localized area of her small intestines appeared to be thickened. Nothing else appeared unusual. She had no pain. Examining her mouth and throat revealed no evidence of anything that should cause her to have problems swallowing.

Many things can cause vomiting and weight loss in cats. They include:

To help narrow down our choices, some blood tests were run. For a comprehensive evaluation, we sent blood to the lab for a complete blood count, blood chemistries, and thyroid hormone levels. To help correct Tippy's dehydration and support her until we got all of our results, we gave her antibiotics and some fluids under her skin (subcutaneously).

 

BLOOD RESULTS

Here are highlights of Tippy's blood results:

Test          Results    Normal Range    Indicator
                       LOW   NORMAL   HIGH
AMYL    =    768 U/L    400-1200    bar
ALT    =    61 U/L    12-75    bar
BUN    =    21 mg/dl    22.0-40.0    bar
CREA    =    2.0 mg/dl    0.80-1.80    bar
GLU    =    126 mg/dl    52.0-100.0    bar
TBILI    =    0.6 mg/dl    0.1-1.0    bar
T4   =   1.3 ug/ml   1.5-5.0   bar

If you don't know what these mean, you can look back at March's Case of the Month. T4 is a measure of the body's thyroid hormone level. The normal values listed here are slightly different from what was listed in March's case; this reflects minor differences between the way results are determined.

The end result is that no major abnormalities were revealed by the blood work. There are some values which are just a little to either end of the normal range, but nothing far enough out of line to cause Tippy's problems. Her complete blood count was also normal, which helped us rule out any kind of infection or severely debilitating disease.

Well, Tippy seemed to do a little better for a few days after we saw her (sometimes just fixing dehydration can get a sick pet back on the right track). She started to eat and drink a little, but then lost her appetite again. Our next step was to take some x-rays.

 

X-RAY RESULTS

Tippy's x-rays showed no signs of any tumors or obvious obstructions. Her kidneys and liver looked normal. The only thing unusual was a medium-sized gas pocket in her small intestines. This can be normal, resulting from normal digestion; or it can signal some problems such as intestinal upset or a blockage. In many cases the only way to know whether a gas pocket is a concern is to repeat the x-rays later and/or do other types of testing.


What's what?

Here's a close-up:

We discussed options with Tippy's owners, and decided to treat her with some medications to reduce any inflammation that might have been present and to stimulate her appetite. She wasn't vomiting, and was no longer dehydrated. We knew from her blood work that she had no significant blood abnormalities that needed to be corrected. Further alternatives for diagnosis at this point included repeat x-rays, exploratory surgery, ultrasound, or a barium study to evaluate her small intestines.

Tippy did better for a few days with her medication, but then started to have problems again. This time she stopped eating completely, and seemed depressed. We re-examined her and found that the suspicious firm area of her small intestines was still present, and she'd lost another pound. We repeated x-rays:

 And a close-up:

There are still gassy areas present. This made us strongly suspect an obstruction. We decided the next step should be surgery.

TREATMENT

We performed exploratory surgery and found that there was indeed an obstruction of her small intestine. There was an area that had become completely blocked. Here's why:

Can you tell what it is? It's a toy mouse head! Evidently Tippy has gotten a little carried away and eaten the head of one of her toy mice. It had travelled about halfway through her intestinal tract before it turned the wrong way and got stuck. After a while, nothing could get past it. She couldn't digest her food properly and she couldn't keep things down. The other problem was that the mouse head put so much pressure on the surrounding intestine that its blood supply was cut off and some of the tissue died. Because of this we had to remove about 6 inches of Tippy's small intestine:

 

OUTCOME

After surgery Tippy spent a few days in the hospital receiving intravenous fluids and antibiotics until her digestive tract was able to handle food again. Her recovery was uneventful and she went home and was able to return to her usual routine (except, no more toy mice!)

 

DISCUSSION

Intestinal obstructions are not uncommon in pets and often result from something that was ingested and got stuck somewhere on the way through. We've seen garbage, pantyhose, string, Easter grass, rocks, and pieces of toys all result in intestinal blockage. The hard part is that pets can be sneaky about eating things, and their owners often don't even realize something's missing. Some pets will vomit, some pets have diarrhea, some are painful, some lose their appetite, some have something you can feel during an exam. Some pets will get only a partial blockage (which may have happened with Tippy at first).

The good news is that we can, if we're determined, find the source of the problem and fix it. Unless the intestine has ruptured (which it can in long-term cases or cases where something sharp was swallowed) or the pet has become debilitated from dehydration, vomiting, and/or malnutrition, the results of surgery are positive. Sometimes the biggest unknown is what we'll find in the intestines during surgery.

Watch what your pet eats, and we'll see you next month!

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