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. There are many different types of clotting disorders that can cause hematemesis.

Hemorrhagic gastroenteritis (HGE) is a syndrome seen in dogs whose cause is unknown. The dog usually experiences acute bloody diarrhea, although vomiting and/or hematemesis is may be seen as well.

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

The overproduction of stomach acid from stress and certain tumors

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 of the stomach, especially from bacteria such as Helicobacter

Metabolic diseases, such as kidney failure, chronic liver disease and hypoadrenocorticism (Addison's disease)

Administration of drugs that affect the lining of the stomach, including nonsteroidal anti-inflammatory agents and corticosteroids

Gastrointestinal foreign bodies or tumors, especially of the esophagus, stomach, upper small intestine

Perioperative hemorrhage (bleeding associated with surgical procedures) as in cases of gastrotomy (cutting into the stomach), gastrostomy (creating an opening in the stomach), or repair of a gastric dilatation volvulus (bloat/torsion)

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

Following anaphylaxis (a severe life-threatening allergic reaction) or septic shock (shock due to an overwhelming bacterial infection)