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Cat projectile vomiting with no diagnosis after many tests
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Cat projectile vomiting with no diagnosis after many tests

My cat started violently projectile vomiting about 6 months ago.  In the 1st month, she vomited about every 2 weeks.  I thought it might be a bug but in the 2nd month the frequency grew to once a week, she had lost weight despite a normal appetite and she became increasingly lethargic, so on 10/2/2009 I took her into her regular vet.  They performed xrays and did blood-work and everything was normal.  Her weight has always averaged between 9.5 and 10.5 pounds.  When I took her in on 10/2/2009 she weighed 8.31 pounds.  They performed an enema, gave her fluids subcutaneously and sent her home w/pain meds and said to watch her.  Over the course of the next 2 weeks, her vomiting continued and grew in frequency to every 5-7 days.  I took her to the University of Minnesota Veterinary Clinic on 10/13/2009.  Her weight that day was down to 8 pounds.  They performed more xrays and blood work, took samples of her liver and lymph node and did an abdominal ultrasound.  Everything was inconclusive.  We tried treating her for IBD with prednisolone for 3 weeks and there was no improvement.  Her vomiting is now a bit sporadic where she may vomit 2 days in a row or she may make it a week without vomiting.  She vomits at least once a week though.  She has always been a VERY vocal and active cat.  Around November she got her spark back and has been the same vocal and active cat that she always has been, has a normal appetite, normal everything; the only thing abnormal is the projectile vomiting.   The U of MN said the only thing left to do was either an endoscopy (which they don't feel would get far enough down her intestine to get anything conclusive) or a full thickness surgical biopsy - which I won't put her through.  There have to be SOME other possibilities in diagnosing / treating this.  I'm at a loss and seeking as many professional opinions as I can.      
Type of Animal
:  
cat
Age of Animal
:  
Angel
Sex of Animal
:  
Female
Breed of Animal
:  
angora
Last date your pet was examined by a vet?
:  
November 23, 2009
City
:  
woodbury
State/Province
:  
mn
Country
:  
usa
Blood Test Results
:  
10/2/2009: Chem 8+, CBC, TT4, Total T4 - Blood work showed no significant abnormalities
10/13/2009: Chemistry 8 profile: no clinically significant abnormalities, Total T4: results normal
X-Ray Results
:  
10/2/2009: abdominal radiographs revealed a fluid filled pyloric region and a feces filled colon.  Buprenorphine was prescribed and fluids were administered subcutaneiously and an enema performed.  Angel defecated the next day and seemed to improve w/pain med.

10/13/2009: radiographs were taken and were compared to those taken on 10/2/2009.  There was persistent moderate fluid and gas distension of the stomach with an irregular mucocsal margin localized to the area of the greater curvature.  The small intestines were diffusely fluid filled.  No other significant abnormalities were observed.
Other pertinent test results
:  
10/2/2009: physical exam - all vital parameters were within in normal limits (temperature, heart rate and respiratory rate).
10/13/2009: physical exam - all vital parameters were within in normal limits (temperature, heart rate and respiratory rate).  
10/14/2009: abdominal ultrasound: Mild, multifocal intestinal thickening with loss of normal intestinal tissue layering
10/14/2009: Liver and lymph node aspirates: both samples were normal
Vet assessment: Angel's clinical signs, blood work and ultrasound findings are most consistent with an infiltrative gastrointestinal disease.  Their primary differentials include lymphoma or IBD.  Unfortunately we cannot distinguish between these two diseases with imaging alone and further diagnostics are necessary to obtain a definitive diagnosis.  
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Endoscopy is fairly non-invasive, and can certainly give good information about the stomach and esophagus, such as presence of ulcers or tumors. However prior to endoscopy, it would be worth trial treating your cat for stomach worms such as Ollanulus tricuspis and Physaloptera (dewormers), trial treating for stomach Helicobacter bacterial infection/ulceration (antibiotics/antacids), +/-  trying a hypoallergenic diet trial for possible food allergy. You can talk frankly to your veterinarians at the University of Minnesota about your concerns, and ask to try these medications.
Good luck,
Kimberly Coyner, DVM DACVD
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