Vomiting blood

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at December 4, 2015
StartSymptomsVomiting blood

Blood in the vomit can be a sign of a serious medical condition. It’s important to understand what it could mean, the causes, treatment, preventions, and prophylactic measures that can be taken. Below, we will discuss the facts of vomiting blood, as well as when to seek medical attention.

Contents

Definition & Facts

Hematemesis, or vomiting blood, is the act of casting or throwing up incompletely digested food mixed with blood, or bringing up blood on its own from the stomach. Blood in the vomit can be either bright or dark red in color, and this color will depend on where the blood is coming from. Darker blood means that it is likely the lower gastrointestinal tract because it had to travel further.

The lower gastrointestinal (GI) tract includes the large intestines, colon, and rectum. Sometimes, when the blood is bright red, it is difficult to tell if the it is regurgitated from the stomach, being coughed up from the lungs, or if it is caused by a nosebleed. It’s important to note that some conditions that cause hematemesis may also cause blood in the stool as well.

Causes

Bright red blood in the vomit may be coming from the upper gastrointestinal (GI) tract. This includes the mouth, throat, swallowing tube (called the esophagus), stomach, and the first part of the small intestine (called the duodenum). Forceful vomiting or vomiting for long periods of time can rupture the blood vessels in the throat, which may cause blood in the vomit.

People with liver damage may have what is called varices, or swollen vessels, in the lower part of the esophagus, and sometimes even in the stomach. If these veins rupture, they will start to bleed, which would lead to regurgitation of blood. Some other causes include, but are not limited to:

  • An open sore (ulcer) that is bleeding in the stomach, esophagus, or duodenum. This is often caused by too much NSAID use. NSAID stands for non-steroidal anti-inflammatory drug and include medications like Aleve® and ibuprofen.
  • Blood vessel defects in the duodenum
  • Swelling, inflammation, or irritation in the stomach or esophagus
  • Swallowing blood from a mouth injury or nosebleed

When to see a doctor

If vomiting of blood causes any of the following signs and symptoms of shock, then it is time to seek emergent medical attention. Call 911 for emergency medical assistance if any of the following are present with hematemesis:

If blood is in the vomit, but there are no signs of the above symptoms, then medical attention is still necessary, just not emergent. Identifying the underlying cause of the vomited blood is of the utmost importance and can lead to more severe symptoms, including death, if not treated.

Treatment & Therapy

When treatment is necessary, the following tests will be performed beforehand in order to determine the underlying cause:

  • Blood work to look at blood cell counts, chemistries, clotting, and liver function. Chemistries will help determine if there is dehydration as a result of the vomiting, which could exacerbate the hematemesis due to dry mucous membranes.
  • An EGD, or esophagogastroduodenoscopy. This procedure puts a little tube into the mouth, stomach, and duodenum to look at the entire upper gastrointestinal tract. There is a camera at the end of the tube, which transmits the images of internal organs for real-time evaluation.
  • Rectal examination to determine if the blood is coming from the lower gastrointestinal tract.
  • Putting a tube into the stomach through the nose to suction out any blood.
  • X-ray to look for any abnormalities in the organ strutures.
  • Nuclear medicine scan. This is a special camera that takes pictures of tissues and organs after a chemical tracer is injected into a vein in the arm.

If there has been a significant amount of blood loss, there may be cause for emergent treatment including:

  • Oxygen administration
  • Electrocautery, which is done during the EGD and will “burn” the area that is bleeding
  • Administration of fluids through an intravenous method
  • Medicine that will lower stomach acids. Stomach acids could irritate whatever is causing the bleeding
  • Surgery if the bleeding does not stop with the above methods. This is a rarity.

Treatment and therapy for hematemesis will depend greatly on the underlying cause, however. For instance, if it is caused by a blood clotting disorder, then treatment will include medication to thin the blood; if the hematemesis is caused by an ulcer, medication and diet change would be the course of treatment. Immediate treatment, however, is of the utmost concern, and that will include any one or more of the above methods.

Prevention & Prophylaxis

As with treatment, prevention and prophylaxis is going to depend on the underlying cause. The following are proven tips that will help prevent vomiting blood in those who have experienced in more than once:

  • Limit aspirin and NSAID intake, but a consultation with a physician is recommended if these medications are part of a prescribed regimen
  • Diet changes. This includes eating less acidic foods and eating more foods that are gentler on the gastrointestinal tract such as fresh fruits, leafy greens, and lean meats.

Home remedies that could help prevent exacerbation of hematemesis include:

  • Resting with the chin lowered so as not to swallow the blood
  • Fasting from any foods until the bleeding has stopped and to avoid aggravation
  • Placing ice packs on the area of bleeding, especially if cause by burst vessels or ulcers
  • Staying warm so that shivering does not cause tension in the organs

The most important aspect of preventing any further blood in the vomit is dietary changes. High levels of stomach acid is the most common cause of ulcers and erosive bleeding in the throat and esophagus.