cat vomiting still-- but now only clear liquid/bile?

2catlady

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So my cat Stan started vomiting late last Friday night.  I came home and found puked up food.  I thought it was from my other cat who sometimes eats too quickly and regurgitates his food.  But overnight and early Saturday morning, I discovered it was Stan.  So I called the vet and we went to get him checked out.  The vet gave him a shot of something -can't remember if it was an antibiotic or something to settle his stomach.  But Stan seemed fine otherwise and the vet did not feel a blockage and outside of just being upset to be at the vet, Stan seemed fine.  We went home, he ate a bit of food and kept it down.  But later in the day he ate and threw up.  This puke was soft food and appeared to be some hair.  Sunday he managed to eat a bit and keep it down, but then later in the day Sunday he was throwing up again.  I took him back to the vet Monday and we did an x-ray.  There was no blockage.  I was given a pill to administer every 12 hours and the doctor again gave him a shot specifically for something to treat stomach.  I had to go to work and could not stay home all day.   The cat was left at home for about 4 hours before I could return.  When I returned, there were numerous spots of throw up--but this was clear throw up in small amounts.  When Stan saw me he meowed and I followed him.  He went up to the bed and laid down and wanted me to pet him.  He was laying on his side looking at me.  He seemed so pathetic and sad.  I sat with him for an hour and since the doctor had suggested also giving him some Pepcid AC which I did not have-- I ran out to get some Pepcid AC to give to him.   I came home, gave him a little food and the Pepcid AC - the amount the vet said -- and within 15 minutes the food and the Pepcid AC 1/4 pill that I had given him -- all came up. 

I was supposed to give him the pill an hour after this --but felt like maybe all this medication was adding to his problem.  Anyway, I did not give him the pill that night.  Instead, he had a bit of food, laid on my lap and we went to bed.  He was fine all night long and stayed beside me for most of the night. 

But the next morning he got up and wanted some water from the faucet.  My cats love to drink the running water.  So I let him have some water.  He ran to the litter box within 5 minutes to pee and then 4 minutes later he was puking water back up.  I gave him the pill, put a call into the vet's office which was not open yet, offered him some food-which he did not eat and had to go to work.   I went home at lunch and he had not puked and seemed normal behavior.  I stopped on the way home from work that night to get different food -- one designed to be easier on the tummy.  I went home, Stan seemed hungry and the vet had suggested giving him small amounts of food every few hours.  My cats are usually grazers and I leave dry food out for them all day.  So I gave him about 12 pieces of food which he ate and he drank some water and he held that down for an hour.  I gave him more and he kept that down for an hour.  He also wanted to drink a lot of water, but I held  him to a little bit because water seemed to make him puke more for some reason.  He kept it down for an hour.  I gave him more food, he wanted more than I was giving him.  So I allowed him a little bit more.  He kept that down.  It was 11 and I gave him one more round of food which he also kept down and we had a restful night.  The next day he ate some breakfast and seemed pretty good.  But I had not seen a bowel movement yet and was kind of concerned.  I talked to the vet that afternoon and she said not to worry too much about that.  So I figured we were all good and the cat was on the mend.

BUT-- this morning when we got up, Stan threw ups some clear liquid this morning-- small amounts-- but two throw ups.   It was close to the time I was supposed to give him the pill--- so I trapped him and got that in him.  He is now a pro at the pill drill and knows when to try and escape from me.  It used to be easy to get a pill into him--but not now. 

He came downstairs and ate some food and kept it down.  I watched him for an hour after he ate.  He also drank some water.  But after he ate, he went under the bed.  He did come downstairs for some affection from me before I had to go to work this morning.

I know this is a long explanation --but my question is -- if he is keeping food down and seemed okay for a day and a half -- why the bile throw up this morning? 

What could be causing this issue?  The vet seemed to think maybe it was just a stomach thing but if the medication is working--why the throw up this morning?  All through this Stan's behavior for the most part has been normal.  When I play with him he is still jumping and playing.  But his behavior this morning -going under the bed - has me a little concerned.  
 

puck

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GI obstruction cannot by ruled out by Xray or ultrasound completely, as pets often eat things that are the same consistency as their organs/fluid. Sometimes, we can see a gas pattern after a point in the GI tract, telling us the intestines are completely or partially obstructed somewhere down the line.

The only way to diagnose a foreign body 100% accurately, is to do an abdominal exploratory laparotomy, surgery that cuts into the belly and looks over all the organs.

Ultrasound is more accurate than Xrays, but not 100% diagnositc for GIFB.

Since your cat persistently vomited by the second day alone, despite antacid/antiemetic, ultrasound would be warranted. Sitting on a vomiting cat can quickly lead to dehydration, angry liver, and low blood glucose after just 12 hours from initiation/onset of symptoms. If a critter vomits, withhold food and water after first vomitus. They don't need water after vomiting... the stomach and esophagus take hours to have normal muscular pulsing and normal amount of acid production post vomiting; anything going down will very likely come back up once a pet has already started vomiting.

If vomits despite not ingesting anything then, as water and food were withheld, concern for gastritis and pancreatitis at a minimum. If no vomit x4hrs, then offer small amount of water, and pet vomits, GI obstruciton is a concern high on the list of rule outs. Days of vomiting, whether he kept a couple small volumes of food/water down, and then vomited again, or never kept anything by mouth down, days of vomiting are highly suspicious of GI obstruction. Sometimes it's just a thick wad of hair, a mass, or a foreign material the cat ingested. Unless it's metal or bone, the obstructions isn't discernable on Xray, even the best, clearest, most detailed and blown up/zoomed in Xray image (I love manipulating and zooming in on my digital images for close inspection!)

So, persistent vomiting, with or without retaining some food/water, is very concerning, and needs to be worked up, with more advanced, aggressive diagnostics. A partial obstruction can allow some digesta to pass, move a wee bit down the intestine, then reobstruct intermittently, causing problems for months, and can even go misdiagnosed as pancreatitis, gastroenteritis, lymphoma, food allergy, etc, until positive abdominal ultrasound or CT scan or exploratory surgery. Best to rule out the GI obstruction first, absolutely rule it out, before considering allergies, IBD or cancer.

Hope they sort your baby out soon, and get him back to normal without too much time in between recommendations/diagnostics here on out. Good Luck!
 
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2catlady

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Thanks for replying.  Your response has scared me and now I fear my cat will die overnight if I don't rush him to a vet.  He has managed to keep down food and water since Tuesday night.  He had a rough Monday after coming home from the vet.  I talked to my vet Wednesday night and all seemed fine from her perspective since the cat went two days with holding down food, was hungry and eating and holding down water.  I only got concerned this morning because he seemed to vomit up some bile or clear liquid.   I have not had a chance to talk to my vet today.  But I have continued the medication Metronidazole and he is eating and drinking normally and has not puked up anything today.  I will wait and see what happens in the morning, and consult my vet again.  I guess I was looking for some reassurances and not a post that would scare me so much that I fear I will not sleep well tonight.  But I do appreciate your reading my post and responding.  
 
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feralvr

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So sorry about your dear Stan and that he is having this problem. It has been five days since your last post and I am sorry about no more replies!!! How is Stan today?? I am concerned hearing about the white clear small amounts of puke because this can be a typical symptom of a blockage. I am not thinking IBD or Pancreatitis because of the frequency in liquid vomit. Personally, I would be getting an ultrasound at this point because hairballs do not show up on xrays. It is very possible there is some sort of blockage and the fact that he ate fine for a couple of days just means that things may have passed by the blockage or it moved a little bit and got stuck again. Not trying to frighten you by any means but think it is a possibility - a hairball. Metronidazole?? Has the cat had diarrhea because that is an intestinal antibiotic. But - certainly won't hurt. Just know that it is very, very, very bitter and will make a cat foam and/or vomit up foam if they get a taste of it in their mouth. Ask about Cerenia - for nausea. Although, if Stan is still having troubles - then further diagnostics need to be followed such as the ultrasound :vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes: Stan. Let us know, please.
 
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2catlady

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Thanks for your concern and for reading my post.  I had to take a break from this  site as the response I got scared me to death and made me crazy with worry.  Stan seems to be fine although reading your post, I fear I will again be overly concerned with each nuance in his behavior and every bowel movement and trip to the litter box.  My vet does not seem worried about a blockage and I am not either.  He has no issues with throwing up and is doing just fine now.
 

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I'm glad Stan has settled down now and doing OK, and sorry that you were frightened by the response you got here. That's the trouble with internet diagnoses, same as for humans as well as our pets. Puck is a very knowledgeable member and was no doubt just trying to cover all possibilities! It's great that your vet could reassure you though. One never knows when something will be serious or not, so IMO it is still worth finding out as much as you can, even if some of the possibilities are frightening. I find if I'm armed with some knowledge when I go to the vet it's not as confusing and I can ask more informed questions.
 

stephenq

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Thanks for your concern and for reading my post.  I had to take a break from this  site as the response I got scared me to death and made me crazy with worry.  Stan seems to be fine although reading your post, I fear I will again be overly concerned with each nuance in his behavior and every bowel movement and trip to the litter box.  My vet does not seem worried about a blockage and I am not either.  He has no issues with throwing up and is doing just fine now.
I think your cat is basically ok.  Cats sometimes puke up bile when they get really hungry - what happens is when they get hungry, they start secreting stomach acid in anticipation of a meal which isn't coming fast enough, this upsets their stomach and they puke.  If he's doing this in the early am, it sounds like he may be going too long between meals, and a nice late nick snack/meal about an hour before bed may help settle him.  I'm sorry you got worried, your cat is not at risk of dying. :-)
 
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2catlady

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Thanks for your post. I did actually see this explanation in another post and figured that was the reason Stan threw up bile that morning because he had kept down the small meals he had the day before. The vet said to keep the meals small at first to see how he was managing. I probably should have allowed him more the night before, but I did not want to push it. Thank you for your post. I just find some of these responders to be panicky and if you read the first response -- it was pretty gloom and doom.
 

feralvr

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  My vet does not seem worried about a blockage and I am not either.  He has no issues with throwing up and is doing just fine now.
Very, very happy to hear this and that Stan is doing better. I am glad that you trust your vet too as that is so very important. Any on-line advice/suggestions are never going to be as close to diagnose as what you and your vet are seeing first hand. I take what suggestions/advice people offer up and realize that what they suggest may be so far off base but still I learn from it and will take those questions to my vet directly. Loads of vibes that Stan continues to do well and that this is nothing at all serious. :vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes:
 

stephenq

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Thanks for your post. I did actually see this explanation in another post and figured that was the reason Stan threw up bile that morning because he had kept down the small meals he had the day before. The vet said to keep the meals small at first to see how he was managing. I probably should have allowed him more the night before, but I did not want to push it. Thank you for your post. I just find some of these responders to be panicky and if you read the first response -- it was pretty gloom and doom.
Understood. :-)
 
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