Vomiting describes the active evacuation of food from the stomach. Vomiting may be caused by disorders of the stomach but is a clinical sign that can occur with many diseases and problems.
"It is not a specific disease or diagnosis itself."
It is not a specific disease or diagnosis itself. Cats vomit quite readily and occasional vomiting (less than once a month) in an otherwise healthy cat may not indicate anything abnormal. This is particularly true if the vomited material is mainly hair. It is considered a normal process for cats to swallow hair while they are grooming themselves, and they will vomit hairballs periodically. If your cat is vomiting hairballs more than once a month, contact your veterinarian.
If it is normal, then how serious can vomiting be?
It depends on the cause of vomiting. Most cases of acute vomiting, when vomiting has been present for less than two to three days, resolve quickly with simple treatment, without the underlying cause being diagnosed. Severe or chronic vomiting is more serious. It can lead to secondary problems, particularly dehydration and disturbances in the levels of electrolytes such as sodium.
Vomiting can be caused by minor intestinal upset, such as from eating plants, spoiled food, or foul-tasting things such as certain insects. However, vomiting can also be a sign of a more serious illness, such as bacterial or viral infection, intestinal obstruction from foreign bodies (indigestible objects that get stuck in the intestine or stomach), urinary tract obstruction, liver disease, thyroid disease, inflammatory bowel disease, or cancer. Left untreated, these illnesses can lead to serious complications, including death.
How do I recognize vomiting?
Vomiting may begin with a stage of nausea, in which the cat appears restless, and possibly anxious. The cat may lick its lips, salivate, and repeatedly swallow. Vomiting itself involves forceful contractions of the abdominal muscles, leading to expulsion of fluid, froth, or food. The severe effort associated with vomiting may be distressing to the cat.
It is important to differentiate this from the abdominal contractions associated with coughing. Cats may cough up some froth or foamy material that they subsequently swallow. Cats usually crouch down on all four legs when coughing with the neck stretched out. It is helpful if you can show a video to your veterinarian of your cat exhibiting the behavior so they can help you distinguish coughing versus vomiting.
"It is also important to differentiate vomiting from regurgitation."
It is also important to differentiate vomiting from regurgitation, which is usually associated with problems affecting the esophagus and is a more passive process. Features that help to differentiate vomiting from regurgitation include:
- vomiting typically involves abdominal contractions and effort
- regurgitation typically occurs quickly without abdominal contractions
- regurgitation often occurs right after eating or drinking
What does acute vomiting mean?
Acute vomiting is vomiting that has been present for no more than two to three days. Most cases will respond quickly to simple symptomatic treatment. The cause of such cases is often never established and may be due to relatively trivial factors such as eating spoiled food or plants. In a small number of cases of acute vomiting, usually because the vomiting is severe and leads to complications such as dehydration, or because a more serious underlying cause is suspected, further tests, specific treatment, and aggressive supportive care will be required.
What is the symptomatic treatment for acute vomiting?
Non-specific symptomatic treatment is often prescribed initially in mild cases of acute vomiting. Your veterinarian will usually advise you to feed your cat an easily digested, bland diet in small quantities given frequently. A veterinary prescription diet specifically formulated to be easy to digest is often recommended. Alternatively, a specific home-cooked diet may be recommended. It is important that the cat does not receive any other foods other than what your veterinarian advises during this period.
"Water should be freely available and is important to prevent dehydration."
Water should be freely available and is important to prevent dehydration. If the cat is improving, the quantity of food offered at any one time can gradually be increased back to a normal quantity and then the cat's normal diet can be reintroduced gradually over several days.
In some cases, your veterinarian may prescribe medication to control vomiting or relieve inflammation, for example maropitant citrate (brand name Cerenia®) famotidine (brand name Pepcid®) or metronidazole (brand name Flagyl®). This approach allows the body's healing mechanisms to correct the problem.
If your cat does not improve with symptomatic treatment, your veterinarian may make a change in medication or perform further tests to evaluate the problem more thoroughly.
How will my veterinarian decide what type of testing and treatment is necessary?
Features that you may be able to identify that will help the veterinarian decide whether symptomatic treatment or further investigations are appropriate include:
- if your cat is depressed, lethargic, or has a fever
- if your cat is eating
- if there has been weight loss
- if there has been any blood in the vomit (a few specks of fresh blood may not be abnormal but more copious or persistent bleeding is significant)
- if there is any pain or distress, particularly affecting the abdomen
- whether normal feces are being passed, or if your cat has diarrhea or constipation
- what is the frequency and amount of vomiting
- what is the relationship of vomiting to feeding
- whether there is any offensive odor or abnormal color to the vomit
- what your cat has been fed and if there has been a recent change in diet
- whether your cat has any access to other foods or other substances
- whether any treatment or supplements have been given recently
- whether any other cats in the household are affected
What other treatment or diagnostic testing may be required?
If the vomiting is severe or if your veterinarian suspects a serious underlying problem, such as kidney or liver disease, more aggressive treatment may be required. It may be necessary to hospitalize your cat for intravenous fluid therapy to combat dehydration and correct any imbalances in the levels of electrolytes. In some cases, it may be necessary to administer injections to control the vomiting. In less severe cases, you may be able to treat your cat at home. You may be asked to administer fluids and special solutions at home, and if this is the case, you will be shown how to do this. You must be patient, giving only small quantities at frequent intervals. If your cat becomes distressed by home treatment, contact your veterinarian for further instructions.
"If the vomiting is severe, more aggressive treatment may be required."
Additional diagnostic tests may be required in cases of chronic vomiting, or when the cat has been vomiting for more than two to three weeks, even though the vomiting may be intermittent and the cat may appear otherwise well. In these cases, the underlying cause must be determined in order to treat the problem appropriately. Some of the more commonly used tests are:
Blood tests may show evidence of infections, kidney and liver problems, thyroid disease, or diabetes, and may provide other clues leading to the diagnosis.
X-rays may show abnormalities of the esophagus or stomach. It may be necessary to give barium to help identify any obstructions, tumors, ulcers, foreign bodies, etc.
Ultrasound is another way of viewing the stomach and intestines. Ultrasound is able to identify blockages/obstructions, tumors, as well as inflammation within the stomach or intestinal lining.
Endoscopy, which is viewing the inside of the stomach directly through an endoscope (a flexible viewing tube), may provide a diagnosis in some cases or the procedure can be used to obtain biopsy samples (samples of tissue that can be examined under a microscope to identify disease). Endoscopy requires a general anesthetic.
Laparotomy, or an exploratory surgery, is necessary in some cases, particularly if an obstruction or blockage is suspected or if biopsy samples are required. Laparotomy can be both a diagnostic and a treatment procedure. Your veterinarian will be able to examine all the organs in your cat’s abdomen during surgery and take biopsy samples to try to identify the source of the vomiting.
See handout "Testing for Vomiting” for a more in-depth discussion of what other tests your veterinarian might perform.
Once the diagnosis is known, treatment may include special diets, medications, or surgery.