Cat Vomiting Blood (Hematemesis)

About

Vomiting is caused by the forceful ejection of the stomach contents and is a common symptom in cats. More often than not, it contains digested food, but you may also notice vomit which contains bile (a green substance) or blood.

Blood in the vomit (also known as hematemesis) has several causes the colour of the blood can provide a clue to the cause.

Causes

Bright red blood in the vomit indicates the vomit has come from the upper digestive tract (mouth, nose, and esophagus).

Dark red with the appearance of coffee grounds means the vomit has come from the lower digestive tract and it has been partially digested.

Blood clotting disorders:

• Rat poison ingestion
• Low blood platelets
• Hemophilia

Ulcers and erosions:

• Ulcers of the esophagus or stomach (ingestion of corrosives or heavy metals, steroids, NSAIDs)
• Mast cell tumours

Trauma:

• Foreign body such as a bone that can cause laceration of the intestines or stomach.

Inflammation:

• Gastroenteritis (viral, bacterial or protozoal infection)
• Inflammatory bowel disease

Swallowed blood:

• From the mouth, nose, esophagus or coughed up and swallowed from the lungs.

Tumours:

• Tumours of the esophagus or stomach.

Other:

• Heartworm or hookworm infection.

Symptoms

Vomiting, with blood, is the prominent symptom, however additional symptoms may occur which can help your veterinarian to narrow down a probable cause, which includes:

• Loss of appetite
• Weight loss
• Black, tarry stools
• Bleeding from other parts of the body, such as the nose, or mouth
• Coughing
• Lethargy
• Pale gums (due to anemia)
• Difficulty breathing

Diagnosis

The veterinarian will perform a medical examination of your cat and obtain a medical history from you, including accompanying symptoms you may have noticed and exposure to medications or toxins.

Diagnostic workup:

• Complete blood count, urinalysis, and a biochemical profile to check the overall health of your cat, look for signs of infection, inflammation, liver function, and platelets.
• Endoscopy – A narrow tube with a light and a camera on the end (endoscope) are inserted into the cat’s digestive tract to look for the presence of tumours, ulcers, and foreign objects.
• Biopsy of the intestinal tract to look for the presence of inflammatory cells in the intestinal wall.
• Prothrombin time – A test to measure how long it takes the blood to clot.
  
• Fecal studies – A sample of stool is evaluated under a microscope for the presence of worm eggs.
  
• Ultrasound or x-ray – To evaluate for foreign objects, growths and look at the internal organs.

Treatment

Most cases of vomiting blood will require hospitalisation to address the cause of vomiting blood and providing supportive care which may include intravenous fluids, nutritional support, and anti-vomiting medications.

• Medicines to reduce stomach acid: Cimetidine, ranitidine or famotidine prevent further damage and also allow the cat’s GI tract or stomach to heal. Sucralfate is a medication that forms a gel-like consistency in the acidic stomach, covering the ulcers and preventing further damage to the already eroded tissue.
• Anti-parasitic medications: Oral tablets or spot-on treatment, to treat hookworm. All cats should be routinely treated for parasites, including indoor-only cats.
• Dietary changes and immunosuppressive drugs: Cats with inflammatory bowel disease can see remission with dietary changes and immunosuppressive drugs to dampen the cat’s immune system.  
• Antibiotics:  For bacterial infections as well as supportive care to manage symptoms, including fluids to treat or maintain hydration and a bland diet to rest the GI tract.
• Surgery: Foreign bodies may be removed surgically or via an endoscope, which is a long, thin tube with a light and a camera at the end. Surgical removal of tumours followed by radiation therapy or chemotherapy where indicated. 
• Gastric decontamination: For cats who have ingested a toxin, induce vomiting or pump the stomach to clear the gastrointestinal tract, followed by administration of activated charcoal to prevent further absorption.
• Blood transfusion: Cats with severe anemia or thrombocytopenia will need a blood transfusion.
• Determining the cause of liver failure and treating accordingly, may include dietary changes or surgery.
• There are no drugs registered for use in cats for heartworm and treatment is aimed at managing symptoms.