Acute Gastric Dilatation in Cats: Bloat Plus Dry Heaving

Acute gastric dilatation means the stomach fills with gas and fluid faster than it can empty. In cats it is far less common than in dogs, which is exactly why it gets missed: owners read the retching as a hairball and lose the window. The pattern that matters is a visibly distended, tight abdomen combined with unproductive retching — the cat crouches, strains, and brings up nothing but foam or a teaspoon of fluid. Emergency clinicians generally treat that pairing as a 30 to 60 minute problem, starting from the moment the belly begins to look drum-tight.

What the cat actually looks like

Cats hide abdominal pain well, so the signs are structural rather than dramatic. The abdomen is rounded and tense, and tapping it with two fingers gives a hollow, tympanic note instead of a soft thud. Breathing turns shallow and fast — often above 40 breaths per minute at rest, because a swollen stomach pushes on the diaphragm. Many cats sit in a hunched meatloaf position with the elbows out and refuse to lie on their side.

The single most useful distinction is productive versus unproductive vomiting. A cat that vomits a hairball, food, or bile and then relaxes is usually not in this category. A cat that retches five or six times in twenty minutes and produces nothing is. Count the attempts and time them; that count is information the vet will ask for.

The 30 to 60 minute decompression window

As gas accumulates, pressure inside the stomach rises and the wall stretches thin. Two things follow. First, the stretched wall loses blood supply, and ischemia makes rupture more likely with every passing minute. Second, a distended stomach presses on the large veins running under the spine, which drops venous return to the heart and can tip a cat into shock within an hour. This is why the advice is not "watch it until morning" but "drive now".

• 0 to 10 minutes: call the nearest 24-hour hospital, describe the abdomen and the retching, and say the word bloat so they prepare for decompression.
• 10 to 30 minutes: keep the cat calm and confined in a carrier. Do not press or knead the abdomen — a hard squeeze on a thin wall is how ruptures happen.
• On arrival: expect radiographs or a quick ultrasound, an intravenous catheter, and an orogastric tube passed to release gas and fluid.

If the cat collapses, breathes with an open mouth, or the gums turn grey, that is decompensated shock and the trip becomes an ambulance run — call ahead so the team is at the door.

Never induce vomiting, and never wait for it

Inducing vomiting at home is the most common harmful instinct here. If the stomach is already distended, retching against a closed outflow tract raises intragastric pressure further and can rupture the wall. If the cause is a foreign body lodged in the pylorus, adding a strong emetic contraction can drive the object into the esophagus or perforate a weakened area. Some owners reach for hydrogen peroxide; in cats even small volumes cause severe gastritis and it is not a recommended home emetic under any circumstance. Do not give food, water, oil, or hairball paste either — anything added to the stomach adds volume.

Telling bloat from a hairball or a blockage

Feature	Acute dilatation	Hairball	Foreign body obstruction
Abdomen	Tense, drum-like, hollow on tap	Soft, normal size	Mildly tender, sometimes normal
Vomiting	Unproductive retching, repeated	One or two productive episodes	Vomits food or fluid, then stops eating
Appetite	Refuses everything	Usually eats soon after	Refuses food, may still drink
Timeline	Minutes to 1 to 2 hours	Hours, then resolves	12 to 72 hours of progressive decline
Imaging	Marked gas distension, possible volvulus	Normal or hair in the lumen	Obstructive pattern, gas-filled loops
Action	Emergency decompression	Monitor 12 hours, brush daily	Surgery or endoscopic removal

A linear foreign body — string, tinsel, ribbon — is a genuine surgical emergency: if you see thread at the mouth or under the tongue, pull nothing and go in.

What the clinic does, step by step

Expect a rapid triage first: heart rate, gum color, and a brief abdominal palpation before any paperwork. A cat in shock gets a crystalloid bolus of roughly 10 to 20 ml/kg through an IV catheter while decompression is set up, then reassessment within 10 to 15 minutes. Decompression is usually a large-bore orogastric tube, 10 to 14 French in an average adult cat, passed with the cat sternal and the head slightly lower than the stomach; gas leaves first, then fluid. If the tube will not pass, the next move is a large-gauge needle through the abdominal wall at a prepped site, which buys minutes.

Radiographs follow, because the tube treats the pressure but not the cause. The vet is looking for a gas-distended stomach, a displaced pylorus suggesting volvulus, and free gas outside the lumen, which means rupture and surgery within the hour. Bloodwork covers electrolytes and lactate; a potassium under 3.0 mmol/L or a rising lactate changes the fluid plan and the urgency of anesthesia.

Refeeding and the 48 hours after

Once pressure is off, the stomach wall is bruised and ileus is common, so food restarts slowly. A typical schedule is nothing by mouth for 6 to 12 hours, then 10 to 15 ml of a low-fat recovery diet every 4 hours, doubling the volume each day if there is no vomiting. Water goes back in small amounts at 2 to 3 hour intervals rather than a free bowl. Total daily intake in the first days often sits at 50 to 60 percent of the cat's normal resting energy requirement, then climbs.

Recheck at 24 and 72 hours is standard, with films at the second visit if a foreign body was suspected.

Five steps to take right now

1. Look at the shape, not the behavior: a tight drum abdomen plus dry heaving means go.
2. Call the 24-hour hospital on the way to the car, not from the parking lot.
3. Do not induce vomiting, do not give peroxide, oil, or hairball paste.
4. Carry the cat in a carrier, do not squeeze or palpate the belly.
5. Bring a phone photo of the abdomen and a note of retching times — 30 seconds of history speeds triage.

For the vomiting that follows a sting or a bite, the approach differs and is covered in insect stings and snakebite in cats. If the swelling came after a tick was pulled, check tick removal for wound care and the signs of tick-borne illness. And if you suspect the cat ate something from the house or garden, run the substance through the toxic plant and food checker before you decide whether to drive.

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