When Dogs Vomit Blood – Causes, Prevention, and Treatment
Overview of Hematemesis (Vomiting Blood) in Dogs
Vomiting blood in dogs is one of 21 symptoms that should never be ignored.
The medical term for vomiting blood is hematemesis, which 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 can be described as looking like coffee grounds. There are various causes for vomiting blood and the effects on the animal are also variable. Some are subtle and minor ailments, while others are severe or life threatening.
Hematemesis may be the only clinical sign, or it may be accompanied by other clinical signs. It can be 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 solely attempting symptomatic therapy.
Causes for Vomiting Blood in Dogs
Here are the many causes of vomiting in dogs and some specific 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.
Potential Causes of Hematemesis
- Clotting disorders (coagulopathies) that cause bleeding into the gastrointestinal tract. A clotting disorder 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 may be seen as well.
- Vomiting blood that has been swallowed, such as from bleeding in the mouth, nose (epistaxis), coughed up from the lungs (hemoptysis), or licked from the skin.
- Parasitic infections, such as from hookworms, can cause severe symptoms in young pets.
- Viral infections, such as parvovirus, can cause bloody diarrhea and sometimes bloody vomit.
- 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 Addison’s disease.
- Administration of drugs that affect the lining of the stomach, such as nonsteroidal anti-inflammatory agents and corticosteroids.
- Gastrointestinal foreign bodies or tumors, especially of the esophagus, stomach, and 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, or zinc.
- Following anaphylaxis (a severe, life-threatening allergic reaction) or septic shock (due to an overwhelming bacterial infection).
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.
- Blood in the feces
- 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
Diagnosis of Hematemesis in Dogs
Obtaining a complete medical history and performing a thorough physical examination are necessary in order to create an appropriate diagnostic plan for a 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 coagulopathy.
- A coagulation profile is performed on many patients with hematemesis. It 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, 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 to cause hematemesis in a young puppy or kitten than in an adult dog or cat.
- A fecal test for parvovirus can confirm the presence of this serious infection.
Additional Testing Options
These are selected on a case-by-case basis:
- An ACTH stimulation test to rule out hypoadrenocorticism (Addison’s disease).
- 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 to help identify foreign bodies.
- Upper GI endoscopy, which involves passing a flexible viewing scope into the esophagus, stomach, and duodenum, to identify and retrieve foreign bodies or obtain a biopsy.
- An exploratory laparotomy (especially if the cause of the hematemesis remains elusive), which allows for physical examination of the stomach and intestine to identify problems.
Treatment of Hematemesis in Dogs
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. 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.
Symptomatic Therapy Options
- No food or drink given by mouth (NPO). 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.
- Intravenous (IV) fluid and electrolyte therapy. Fluid and electrolyte therapy may be necessary and are directed toward correcting dehydration, acid-base, and electrolyte abnormalities. Occasionally, subcutaneous (under the skin) administration is adequate, and may be performed on an outpatient basis. In more severe cases, IV 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.
- Gastric acid blocking agents and gastric protectant drugs to treat for gastrointestinal ulceration while awaiting test results. Drugs that decrease or inhibit acid production by the stomach, such as Tagamet® (cimetidine), Pepcid® (famotidine), Zantac® (ranitidine), and Prilosec® (omeprazole), 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®).
- Prostaglandin drugs, such as misoprostol (Cytotec®), may help counteract the ulcerogenic effects of nonsteroidal anti-inflammatory drugs (NSAIDs).
- In some cases, surgical intervention is recommended, especially where a hemorrhage is uncontrolled, a bleeding ulcer has perforated the gastrointestinal tract, or a bleeding tumor is present.
Home Care and Follow-up Care for Dogs with Bloody Vomit
- Call your veterinarian immediately if there is blood present in the vomitus.
- It is important to administer all medications and follow dietary recommendations as directed by your veterinarian. Alert your veterinarian if you are experiencing problems treating your pet.
- Avoid drugs that might damage the gastrointestinal tract, such as corticosteroids and other anti-inflammatory drugs.
Optimal treatment for your pet requires a combination of home and professional veterinary care. Follow-up evaluations are critical, especially if your pet does not rapidly improve.
- Never give a steroid, such as prednisone, with an anti-inflammatory drug. This combination can cause bleeding ulcers.
- Minimize your pet’s exposure to molds, garbage, and trash.
- Provide safe chew toys that cannot be ingested.
- Learn about the 21 Symptoms You Should Never Ignore in Your Dog.
FAQs About Vomiting Blood in Dogs
Some frequently asked questions about vomiting blood include the following:
Is a little blood in vomit normal?
Blood in the vomit is never normal. If you see this abnormal symptom in your dog, please call your veterinarian or local veterinary emergency clinic.
When is a dog vomiting an emergency?
Vomiting in dogs is an emergency if your dog is lethargic, weak, not eating, or when the vomiting is not productive.
What should I do if my dog throws up blood?
If your dog vomits blood, call your veterinarian. Read the above information on possible causes and treatments.
What causes my dog to cough blood?
Coughing up blood, also known as hemoptysis, can be caused by infections, bleeding disorders, toxins, heart failure, and tumors. It is always abnormal.
What could cause my dog’s vomit to be black?
Black vomit is caused by ingestion of something black (such as pigmented mulch) or from vomiting of digested blood (often resembling coffee grounds).
My dog is vomiting blood and it is also in their stool.
This can occur due to bleeding disorders, liver disease, bleeding ulcers, and conditions such as Hemorrhagic Gastroenteritis.
Please see your veterinarian if you notice any abnormal symptoms in your dog to determine the best options for treatment.