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GI blood loss: ulcer, erosions, and stuff that mimics them (Proceedings)


Hematemesis necessitates a slightly different approach than we take with other vomiting cases because some rule-outs become more likely while others become much less likely. We will be including upper gastrointestinal bleeding of any cause in this discussion. For starters, we will not be discussing vomiting that produces "flecks" of blood because this can be seen in any dog (and perhaps cat) with vigorous vomiting in which the gastric mucosa is traumatized by the physical act of vomiting. It is easy to identify fresh blood in the vomited material as long as the patient is not eating something that is red or that produces a pink color to the vomited material simple secondary to pigment leaching out of the food material. Most of the time, hematemesis is denoted by a "coffee-grounds"-like material that most clients (and some veterinarians) do not recognize as blood. A common mistake is being concerned over "dark stools". Noting that a patient has dark stools is generally useless. Lots of dogs have dark stools and no problems or GI blood loss at all. The color of the stool is not an issue until the stool is pitch-tar-coal-asphalt black. Then it may be melena (if it is not due to Bismuth or a lot of green bile giving it a near-black appearance). If in doubt, just place some fresh feces on absorbent white paper and see if a reddish color diffuses out from the feces, confirming that there is blood present. Melena is only seen if there is acute loss of a lot of blood into the upper GI tract. Most dogs losing blood in the upper GI tract do not have any important changes in the color of the feces. Rather, you might see anemia and hypoalbuminemia. Also remember, you may or may not see hypoglobulinemia; it all depends upon what the serum globulin concentration was before you started losing blood. Sometimes the BUN is higher than expected based upon the serum creatinine, but again this is only expected if there is a lot of blood being lost in a short period of time. Fecal occult blood tests are seldom that helpful or necessary, but can occasionally be informative in confusing cases. However, you need to use a test for which the laboratory has substantial experience in dogs so that the results can be meaningfully interpreted. Some fecal blood tests will routinely give a positive reaction when used on canine feces.

When there is a substantial amount of blood being ejected from the mouth, there tend to be 3 major reasons: coagulopathy, swallowing blood from elsewhere and gastrointestinal ulceration/erosion (GUE).