Hematemesis does not refer to the presence of streaks of blood in the vomit. Instead, it refers to more significant amounts of blood that have a bright red color or the appearance of coffee grounds.
Whatever the cause, vomiting blood is a medical emergency. It is recommended that treatment is sought immediately to determine and treat the underlying cause.
There may be many different causes but any blood in the vomit requires immediate medical attention.
The causes of vomiting blood are many and include several health problems such as:
- Stomach ulcers
- Vigorous vomiting
- Tears, irritation, or tissue loss in and of the lining of the stomach
- Enlargement of veins in the food pipe or gut
- Tumors and lesions in the stomach or food pipe
- Damage to the upper gut caused by radiation
- Infections such as hepatitis or H. pylori infection
- Use of certain medications, such as aspirin, NSAIDs, or blood thinners
- Poison ingestion
Specific medical conditions that can lead people to vomit blood include:
- GERD (gastroesophageal reflux disease)
- Blood vessel disorders in the gut
- Inflammation of the food pipe, gut, or pancreas
- Pancreatic cancer
- Certain liver conditions such as acute liver failure and cirrhosis or scarring
- Dieulafoy's lesion, a condition in which an artery sticks out through the stomach wall
- Mallory-Weiss tear, a condition in which there are tears in the food pipe caused by the raised pressure of vomiting or coughing
- Portal hypertension, a condition in which there is high blood pressure in the portal vein
- Blood abnormalities such as low platelets, hemophilia, anemia, or leukemia
Vomiting blood in infants and young children can be caused by a number of other conditions such as:
- Abnormalities present at birth
- Blood clotting disorders
- A lack of vitamin K
- A milk allergy
- Swallowed blood or a swallowed object
Other at-risk groups who may experience vomiting blood include those who drink alcohol excessively and pregnant women.
Alcohol and vomiting blood
For those who drink alcohol excessively, vomiting blood may signal certain medical conditions, including:
- A tear in the gastrointestinal tract: These occur most often in the food pipe due to the increase in pressure in the food pipe, stomach, and gut due to forceful vomiting. A tear can be life-threatening in some cases. Accompanying symptoms can include sudden and severe chest pain that may spread to the back, sweating, shortness of breath, and stomach pain.
- Cirrhosis: The presence of scarring of the liver caused by alcohol and certain medical conditions. This leads to expanding blood vessels that may burst. Accompanying symptoms may include vomiting large quantities of bright red blood, weakness, fainting, and bleeding from the rectum.
- Ulcers may develop in those who consume excessive amounts of alcohol due to the acid content present in alcohol. This can lead to irritation and ulcer development in the stomach. Accompanying symptoms can range from bloody vomit to a large and serious gut bleed, bright red to dark black stool, stomach pain, or pain in the lower part of the chest.
Pregnancy and vomiting blood
Vomiting blood during pregnancy is typically caused by prolonged vomiting secondary to morning sickness. However, other medical conditions may be to blame.
When caused by bleeding in the upper part of the gut, the blood in the vomit may appear black, dark brown, or like coffee grounds. Black, tarry stools may occur in the presence of lower intestinal blood.
Some conditions that may also cause vomiting blood during pregnancy include:
- Dehydration or starvation
- Inflammation of the stomach lining
- Food poisoning
- A tear in the food pipe or gut
- High blood pressure
- Use of certain medications
The color and consistency of the blood vomited may vary depending on the cause of the bleeding. Blood can range from bright red to a coffee ground appearance.
Depending on the cause of the bleeding, people may experience other symptoms that should be discussed with a doctor. People should seek immediate medical attention if they experience any of the following in the presence of vomiting blood. These symptoms could indicate the presence of shock:
- Dizziness, feeling faint, or fainting
- Skin that is cool, clammy, and pale
- A rapid heart rate, anxiety, or agitation
- Enlarged pupils
- Blurred vision
- Rapid, shallow breathing
- Reduced urine production
People should seek care in an emergency room if they are experiencing severe stomach pain, vomiting of large amounts of blood, several episodes of vomiting, or any other concerning symptoms.
Diagnosis and treatment
An endoscopy may be used to diagnose the cause of bloody vomit if other tests are inconclusive.
Treatment of hematemesis is dependent on the cause of the condition. It may require certain tests including blood tests and stool samples.
Procedures like a radiologic imaging and endoscopy may also be recommended. Radiologic imaging tests such as a CT (CAT) scan and X-ray will help the healthcare team to work out the source of the bleed in question. An endoscopy uses a lighted scope to examine the upper portion of the gut for any causes of bleeding.
The causes of vomiting blood may require treatment with certain medications, blood transfusion, and surgery.
In some cases when an arterial bleed is suspected, an angiogram may be required. Performed under sedation, this procedure requires inserting a thin tube and wire through the artery in the groin. Injected iodine dye and X-rays then help doctors to check for blockages.
The outlook for vomiting blood depends on several factors. These factors may include underlying causes leading to vomiting blood, and any other medical conditions that affect overall health.
People who vomit blood should speak to their healthcare provider about their particular medical condition and outlook.