Causes of digestive problems that don’t show up on ultrasound?

treeclimber

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Murphy has reduced appetite that has gotten worse over the course of a year. He vomits clear or sometimes beige liquid when he goes too long without eating. If he is free fed and willing to eat, there is no vomiting. He has diarrhea that I think is triggered by dry food. If he does not get dry food, there is no diarrhea (but since he’s fussier with wet foods he currently does get about 30-40% dry food in his diet.)

He had an ultrasound that was 100% textbook normal - no signs of thickening/inflammation of the stomach/intestines, no tumors, etc.

But my formerly eats-anything boy spent the last year becoming a very fussy eater, lost 1.5 pounds in four months (his weight was already trending downward before that), and feels like a skeleton with a fur covering - SOMETHING is making him sick.

Other details:
  • He is around 10 years old
  • I think it might be painful or uncomfortable for him if I pick him up by putting my hand under his abdomen to support his weight, but it’s hard to tell for sure
  • He has had two dentals in the past year since that was the first suspicion, his teeth are in good shape
  • He has asthma, treated with a fluticasone steroid inhaler, plus albuterol when he has an attack. There haven’t been any changes in his asthma symptoms and his attacks haven’t increased.
  • Sometimes he acts hungry like he wants to eat and will sniff food, approach the bowl from several angles to sniff and occasionally even open his mouth like he’s going to take a bite, but then not eat. And then continue begging for food even though there’s already a food he likes in his bowl. Other times he just has no interest in food at all.
  • We use a wide low-sided bowl to avoid any potential whisker issues
  • Despite obsessive observation of his food intake, I can find no correlation between what he’s been eating and when he feels good/bad. He is more likely to have low energy/hiding when his food intake is low.

I’m worried all the focus on food sensitivities and potential IBD treatments like the steroid he will be starting on soon might lead to missing something else if the problem is not IBD (especially since the ultrasound did not show signs of IBD - I’m not sure how common it is to have IBD but look normal on ultrasound).

What else besides IBD might produce symptoms like this?
 
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FeebysOwner

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I presume you have had senior blood work done on Murphy (CBC, Super Chemistry, T4), and nothing showed up out of the ordinary on any of it? I would also have a cobalamin (B-12) test done. If his level is low, that can affect weight and can be helped with B-12 injections, which you can administer at home. Aside from that, have you repeated thoracic radiographs to see if anything has changed? An echocardiogram?

Perhaps, what he is throwing up is phlegm that he is expelling due to his asthma? My husband has a form of asthma, and he was going through coughing and would spit out phlegm. He was mostly doing this overnight and many hours after he had eaten. They put him on a different kind of inhaler, which seems as if it might have corrected the problem. If the new inhaler didn't help, he was going to be given oral steroids. I also noticed that he would lose his appetite during these spells. Although, he does have some intestinal tract issues, no one has said they are not at all related to his asthma. I don't think they know, tbh.

So, if you can find any correlation from the asthma/eating aspect, it is worth further investigation.
 
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treeclimber

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Thanks!

He had the full senior panel, and the only abnormal things were high eosinophils (possibly asthma-related) and protein in his urine (vet said it could be due to the steroid inhaler).

No thoracic X-ray yet but I’ll ask at our appointment on Monday!

Regarding whether it’s puking or phlegm - it’s definitely puking. There are differences in his sound/posture with vomiting vs. coughing, and what he brings up sometimes has fur in it (not a hairball, but loose hair or tiny pre-hairball clumps).

But I will look further into the asthma/eating aspect - his steroid inhaler is prescribed as “once or twice a day” and we’ve been doing once a day since it seems to be enough to keep attacks at bay, but could be worth trying twice a day and seeing if the food issues improve.
 
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treeclimber

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Did you have his teeth checked and cleaned?
Thanks!

He’s had two dentals in the past year, the last one only 4 months ago (to try to find a cause for his not eating). His teeth are in good shape.
 

lisahe

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But I will look further into the asthma/eating aspect - his steroid inhaler is prescribed as “once or twice a day” and we’ve been doing once a day since it seems to be enough to keep attacks at bay, but could be worth trying twice a day and seeing if the food issues improve.
We have an asthmatic cat with mild asthma and she gets her inhaler (110/125 so middle dose) twice a day. That seems pretty standard since Flixotide/Flovent is apparently only active for 12 hours. There's a handy dosing chart (from Dr. Padrid, whom our vet has been known to quote!) on the Aerokat page, here.

Constipation can cause a lot of the symptoms you mention. Our asthmatic cat tends to get constipated. There's a lot of helpful information about constipation in cats on this page. She does much better now that she takes Vet's Best hairball relief tablets every day. I started her on those after reading that other cats had become more regular with them. Ireland loves them, they're like a treat for her.

This is a long shot but one other thought for your cat's digestive issue is parasites... When our cat had a stomach problem and the ultrasound showed severe inflammation in her stomach (part of which had to be surgically removed) nobody -- the ultrasound vet or the biopsy vet or our regular vet -- could figure out what went wrong in Edwina's gut. But parasites, particularly a certain kind of nematodes (these!), were suspected. Since these creatures don't always show up in tests, our vet just prescribed a course of Panacure, which is apparently a broad-spectrum drug for getting rid of various parasites. We're going to give it to our cats three times a year now. These nematodes can be in some insects, including camel crickets, which are one of Edwina's favorite snacks; she finds them in our basement.

Good luck. Digestive issues can be really hard to sort out.
 
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treeclimber

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We just got some great news back on his bloodwork - folate so high it was outside the test’s measurable range, and moderately low B12. We’re still waiting on results for one test in the GI panel (TLI) that will tell us if it’s exocrine pancreatic insufficiency or intestinal dysbiosis in the upper small intestine. Given that his appetite went down instead of up I think the last test will come back saying he doesn’t have EPI, which will leave the dysbiosis as the most likely explanation.

It seems to fit every symptom - possibly including some recent incidents where he was sleeping next to me and unleashed some extremely stinky farts - and it also explains why it didn’t show up on ultrasound.

He only had 2-3 days of metronidazole before so the vet is going to try a 2-week course now. She seems pretty confident that we’ve found the answer, and I’m thrilled that it’s not anything progressive or fatal!! (He will also be very happy he can have the foods he likes back and no more intermittently tormenting him to see if he’ll eat funny-smelling novel proteins. He’s getting a special dinner tonight to celebrate.)
 
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treeclimber

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A celebration dinner! Yay! This is great news. Get well quick sweet kitty!
Thank you!!

Celebration dinner went a little oddly - like he didn’t recognize his favorite Friskies flavor or thought I was trying to trick him with another novel protein. Multiple trips to the food bowl for some hesitant sniffing and circling, but he’s finally eaten some of it now.

He’ll probably be able to enjoy it more once he’s feeling better.
 

lisahe

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Glad to hear it! Fingers crossed that he continues to improve.
 

louisstools

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I stumbled upon this and the initial post is spookily similar to my girl's issues that we're still trying to diagnose. How is Murphy doing?
 
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