Overview of Feline Hematemesis (Vomiting Blood)
Hematemesis is the act of vomiting blood. Hematemesis may involve the vomition of new or recent blood, which is bright red. It can also involve the vomition of old, partially digested blood, which has the appearance of brown coffee grounds. There are a variety of causes of vomiting blood in cats and the effects on the cat are also variable. Some are subtle and minor ailments, while others are severe or life threatening.
General Causes of Vomiting Blood in Cats
Clotting disorders (coagulopathies) that cause bleeding into the gastrointestinal tract
Gastrointestinal tract ulcerations, primarily of the stomach, esophagus or upper small intestine (duodenum)
Bleeding tumors of the stomach, esophagus and upper small intestine
Bleeding in the stomach or esophagus from the presence of foreign bodies
Administration of medications that are irritating to the stomach
Ingestion of foreign material or bones that lacerate the lining of the esophagus or stomach
Vomiting blood that has been swallowed, such as from bleeding in the mouth, from a nose bleed (epistaxis), from blood that was coughed up from the lungs (hemopytsis), or licked from the skin
What to Watch For
Blood in the vomitus. Fresh blood is usually bright red. Old, partially digested blood is brown and has the appearance of coffee grounds.
Digested, dark black blood in the feces (melena)
Fresh, red blood in the feces (hematochezia)
Possibly abdominal pain
Paleness or pallor of the gums with severe blood loss
Rapid breathing with severe blood loss
Weakness, collapse, and shock with severe blood loss
Signs of bleeding at other sites in or on the body
Diagnostic Tests for Cats that Vomit Blood
Complete blood count (CBC)
Coagulation (clotting) profile
Abdominal and chest (thoracic) X-rays or radiographs
Upper gastrointestinal contrast study
Endoscopy of the esophagus, stomach and small intestinal tract
Examination of other sites of bleeding, such as examination of the mouth, chest x-rays, x-rays and scooping of the nose, etc.
Treatment for Vomiting Blood in Cats
The vomiting of blood that represents bleeding within the gastrointestinal tract is a serious condition. It generally warrants hospitalization, the performance of numerous diagnostic tests, and at the very least, supportive care. Symptomatic therapy in cats may include the following:
No food or drink given by mouth (NPO)
Intravenous fluid and electrolyte therapy
Blood transfusions as needed
Gastric acid blocking agents and gastric protectant drugs to treat for gastrointestinal ulceration while awaiting test results
Determining the underlying cause and instituting specific treatments for the cause
Call your veterinarian immediately if there is blood present in the vomitus, and administer all medications and dietary changes as directed by your veterinarian. Avoid drugs that might damage the gastrointestinal tract, such as corticosteroids and aspirin.
Information In-depth on Hematemesis in Cats
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 of Hematemesis (Vomiting Blood) in Cats
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)
Obtaining a complete medical history and performing a thorough physical examination are necessary in order to create an appropriate diagnostic plan for the patient with hematemesis. A history of recent toxin exposure or administration of certain medications may be of paramount importance. Your veterinarian may also recommend the following tests:
A complete blood count (CBC) evaluates the presence of infection, inflammation, and anemia.
A biochemical profile helps rule out metabolic causes of hematemesis. It assesses the status of the kidneys, liver, electrolytes, blood proteins, and blood sugar.
A urinalysis helps evaluate the kidneys and the hydration status of the patient. Additionally, the presence of blood in the urine may help support a diagnosis of a coagulopathy.
A coagulation profile is performed on many patients with hematemesis. Such a profile generally includes various clotting tests and a platelet count.
Abdominal radiographs (X-rays) evaluate the abdominal organs, and may detect the presence of a foreign body (such as bones), tumor, or chips containing lead.
Thoracic radiographs evaluate for the presence of fluid or blood in the lungs or chest cavity, the spread of cancer (metastasis), and the presence of esophageal diseases.
Multiple fecal examinations for parasites and occult blood are important screening tests. Parasites are more likely a cause of hematemesis in the young puppy or kitten than in the adult dog or cat.
Your veterinarian may recommend additional tests to ensure optimal medical care. These are selected on a case-by-case basis:
Bile acids to evaluate liver function
Measurement of blood lead level
Measurement of fasting serum gastrin level, the hormone responsible for increasing gastric acid production
An abdominal ultrasound to evaluate the size, shape and texture of abdominal organs and help assess for the presence of tumors
An upper gastrointestinal (GI) barium series
Upper GI endoscopy, which involves passing a flexible viewing scope into the esophagus, stomach and duodenum
An exploratory laparotomy, especially if the cause of the hematemesis remains elusive
Treatment of severe clinical signs is necessary while diagnostic testing is underway. The following nonspecific (symptomatic) treatments may be applicable to some pets with hematemesis. These treatments may reduce the severity of symptoms or provide temporary relief. Nonspecific therapy is not a substitute for definitive treatment of the underlying disease responsible for your pet’s condition.
Withholding food and water for 12 – 36 hours allows the GI tract to rest and is important when treating the patient with hematemesis. Complete dietary restriction allows the lining of the GI tract to heal. Gradual reintroduction of small amounts of bland food is instituted after the fast. Once all vomiting and hematemesis have resolved, the original diet may be slowly reintroduced. If at any point clinical signs recur, discontinue all oral food and water and contact your veterinarian.
Fluid and electrolyte therapy may be necessary and is directed toward correcting dehydration, acid-base, and electrolyte abnormalities. Occasionally, subcutaneous (under the skin) administration may be adequate, and may be performed on an outpatient basis. In more severe cases, intravenous administration is indicated and necessitates hospitalization.
Blood transfusions may be indicated if your pet is anemic from continued blood loss and hematemesis.
Drugs that stop vomiting (antiemetic) are used with caution. It is best to identify and treat the underlying cause of hematemesis, although in selected cases these medications may be recommended.
Drugs that decrease or inhibit acid production by the stomach such as Tagamet® (cimetidine) and Zantac® (ranitidine), may encourage and expedite the resolution of hematemesis, especially if it is related to gastrointestinal ulcers.
Medications that protect or sooth the lining of the esophagus, such as sucralfate (Carafate®) may be helpful.
Antibiotics are given for bacterial infections.
In some cases, surgical intervention is recommended, especially in those cases where hemorrhage is uncontrolled, a foreign body must be removed, or a bleeding tumor is present.
Follow-up Care for Cats that Vomit Blood
Optimal treatment for your pet requires a combination of home and professional veterinary care. Follow-up evaluations are critical, especially if your cat does not rapidly improve.
Administer all prescribed medications as directed and alert your veterinarian if you are experiencing problems treating your cat. Also, discontinue or avoid any medication or substance that may be irritating to the stomach lining, especially corticosteroids and aspirin. Return to your veterinarian for follow-up testing as directed.