Information In-depth

Hematemesis is the presence of flakes, streaks or clots of fresh blood in the vomitus, or the presence of digested blood in the vomitus. Digested blood is often described as looking like coffee grounds. Hematemesis may be the only clinical sign, or it may be accompanied by other clinical signs. It is sometimes difficult for the pet owner to distinguish between true hematemesis, which involves bleeding within the gastrointestinal tract, from secondary hematemesis, which involves the vomiting of swallowed blood. Sneezing or coughing blood, and/or blood dripping from the mouth are signs of bleeding that may be swallowed into the stomach, and then secondarily vomited. A careful history and thorough physical examination will help distinguish between them.

True hematemesis usually indicates a serious underlying disease, and generally warrants hospitalization, extensive diagnostic testing, and supportive care. It is best to determine the underlying cause, and treat the specific problem, rather than attempting only symptomatic therapy.

Causes

There are many potential causes for hematemesis. The most common causes are usually diseases or disorders of the upper gastrointestinal tract, although in some cases, clotting disorders (coagulopathies) may result in bleeding even though the gastrointestinal tract is essentially healthy.

Coagulopathies or bleeding disorders should be considered, especially if there is evidence of bleeding from other body sites as well. Bleeding disorders are uncommon in the cat, but may arise with exposure to warfarin rodenticides, or the ingestion of rodents poisoned by these agents.

Gastrointestinal ulcerations or erosions are one of the more common causes of hematemesis. These ulcers can occur with many different disorders, such as:

Gastrointestinal foreign bodies (especially in hunting cats who eat bones) or tumors of the esophagus, stomach, upper small intestine

Infiltrative diseases of the wall of the stomach or upper intestines, such as inflammatory bowel disease

Chronic inflammation of the esophagus, especially with regurgitation of acidic stomach contents

Chronic inflammation and infection of the stomach

Metabolic diseases, such as kidney failure and chronic liver disease

Administration of drugs that affect the lining of the stomach, including aspirin and corticosteroids

Perioperative hemorrhage (bleeding associated with surgical procedures) following surgery on the stomach or intestines

Overproduction of stomach acid due to certain tumors (rare in the cat)

Heavy metal intoxication with arsenic, lead and zinc (uncommon causes of hematemesis)

Following septic shock (shock due to an overwhelming bacterial infection)