Expert: Jessica - 5/9/2010

Question
My 15 year old cat wouldn't eat so I took her to the emergency vet, the vet said her blood work was very healthy looking. They gave me some prescription a/d food. She ate most of it and now I'm trying her on Science Diet because it's made by the same company. She hasn't pooped in a few days, and she's peed outside the catbox. She purrs constantly, but she gets nauseous and throws up yellow foam about once a day. She's been lethargic from the start and I was wondering what would a vet do to "cure" her If she has pancreatitis or irritable bowel? What are your thoughts on her symptoms?

Answer
Hi Brittany.  I think it would be a really good idea to proceed to the next step of diagnostics for your kitty.  I feel that an ultrasound or x-ray should be done to see if there may be an abdominal mass or obstruction that is causing problems.  It’s disconcerting that your cat hasn’t had a bowel movement in a few days.  This is very abnormal.  It’s difficult to say if she’s having fewer bowel movements because she’s eating less or if she’s suffering constipation or fecal obstruction, which can be deadly in just a couple days.  Severe constipation and fecal obstruction could be responsible for her vomiting and lack of appetite.  These problems can occur due to poor hydration, cancerous masses in the intestines and foreign bodies.  I would make the assumption that your cat’s intestines felt empty during her last exam because she hadn’t been eating, but now that she has been eating, the vet may be able to feel a pattern of where the stool seems to be “caught”.  This will also show on an x-ray.

An abdominal ultrasound would also afford you a look at the pancreas since you have questions about whether this may be pancreatitis, and I think that’s a valid concern.  Pancreatic ultrasounds can be helpful in making the diagnosis.  The most accurate test for pancreatitis is a blood test called a Spec fPL (or a slower version called a PLI).

Unfortunately, there is no real treatment for pancreatitis.  IV fluids are a mainstay.  Vitamin B-12 can be helpful, and some vets administer antibiotics as well as steroids to reduce inflammation.  Managing pain is of paramount importance to help the cat recover, so a narcotic pain reliever is sometimes given, and an anti-nausea medication should be prescribed for cats suffering from pancreatitis.  Most vets recommend a prescription diet formulated for sensitive stomachs or for liver patients, which should be fed in small portions several times a day.

As for inflammatory bowel disease, it’s usually much easier to treat.  Most cats respond very well to an oral corticosteroid such as prednisone, usually started out given twice daily, then tapered down to the lowest effective dose.  Ideally, a sensitive stomach food is given, too, to enhance the results.  There are other medications, such as cyclosporine and chlorambucil, which can be used if no response is achieved with prednisone.  I would be a little surprised if your cat is suffering strictly from IBD, since most of them will have evidence of an inflammatory process in their blood tests (elevated globulin, neutrophils, eosinophils, etc.).  Nevertheless, it may still be a possibility.  Most vets will want to rule out all other possibilities with either the x-ray or the abdominal ultrasound before chalking symptoms up to IBD.

I would certainly ask the vet about having some Cerenia sent home to control her nausea, at least.  This is generally given once daily and is a potent anti-emetic that can be given up to several days while you try to discover what’s ailing her.  Also, she does need to have a bowel movement very soon, so be sure you address that with the vet.

Best of luck!

Jessica