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Vomiting blood

Definition:

Vomiting blood is regurgitating (“throwing up”) contents of the stomach that contains blood.

Vomited blood may appear either a bright red or dark red color. The vomited material may be mixed with food or it may be blood only.



Alternative Names:

Hematemesis; Blood in the vomit



Considerations:

It may be hard to tell the difference between vomiting blood and coughing up blood (from the lung) or a nosebleed.

Conditions that cause vomiting blood can also cause blood in the stool .



Causes:

The upper GI (gastrointestinal) tract includes the mouth, throat, esophagus (swallowing tube), stomach and the duodenum (first part of the small intestine). Blood that is vomited may come from any of these places.

Vomiting that is very forceful or continues for a very long time may cause a tear in the small blood vessels of the throat. This may produce streaks of blood in the vomit.

Swollen veins in the walls of the lower part of the esophagus, and sometimes the stomach, may begin to bleed. These veins (called varices) are present in people with severe liver damage.

Other causes may include:

  • Bleeding ulcer in the stomach, first part of the small intestine, or esophagus
  • Blood clotting disorders
  • Defects in the blood vessels of the GI tract
  • Swelling, irritation, or inflammation of the esophagus lining (esophagitis) or the stomach lining (gastritis)
  • Swallowing blood (for example, after a nosebleed)
  • Tumors of the mouth, throat, stomach or esophagus


Home Care:

Get medical attention right away. Vomiting blood can be a result of a serious medical problem.



When to Contact a Medical Professional:

Call your doctor or go to the emergency room if vomiting of blood occurs. You will need to be examined by a health care provider right away.



What to Expect at Your Office Visit:

The doctor will examine you and ask questions such as:

  • When did the vomiting begin?
  • Have you ever vomited blood before?
  • How much blood was in the vomit?
  • What color was the blood? (Bright or dark red or like coffee grounds?)
  • Have you had any recent nosebleeds, surgeries, dental work, vomiting, stomach problems, or severe coughing?
  • What other symptoms do you have?
  • What medical conditions do you have?
  • What medicines do you take?
  • Do you drink alcohol or smoke?

Tests that may be done include:

  • Blood work, such as a complete blood count (CBC), blood chemistries, blood clotting tests, and liver function tests
  • Esophagogastroduodenoscopy (EGD) (placing a lighted tube through the mouth into the esophagus, stomach and duodenum
  • Nuclear medicine scan
  • Rectal examination
  • Tube through the nose into the stomach and then applying suction to check for blood in the stomach
  • X-rays

If you have vomited a lot of blood, you may need emergency treatment. This may include:

  • Administration of oxygen
  • Blood transfusions
  • EGD with application of laser or other modalities to stop the bleeding
  • Fluids through a vein
  • Medications to decrease stomach acid
  • Possible surgery if bleeding does not stop


References:

Overton DT. Gastrointestinal bleeding. In: Tintinalli JE, Kelen GD, Stapczynski JS, Ma OJ, Cline DM, eds. Emergency Medicine: A Comprehensive Study Guide. 6th ed. Columbus, OH: McGraw-Hill; 2006:chap 74.

Henneman PL. Gastrointestinal Bleeding. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, PA: Elsevier Mosby; 2009:chap 22.




Review Date: 1/1/2013
Reviewed By: Jacob L. Heller, MD, MHA, Emergency Medicine, Virginia Mason Medical Center, Seattle, WA. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, Bethanne Black, Stephanie Slon, and Nissi Wang.

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