Symptom Information: Vomiting blood / Hematemesis

Symptom:

Vomiting blood (Other names: bloody vomit, hematemesis, haematemesis).

General Description:

Vomiting blood is regurgitation of the blood from somewhere in the upper gastrointestinal tract which includes the mouth, pharynx, esophagus, stomach or small intestine.  It should be differentiated from coughing up blood (hemoptysis).  Vomiting blood usually refers to significant amounts of blood in the vomit.  Blood in vomit may be bright red or it may appear as black or dark brown like coffee grounds.  Vomiting blood may be caused by swallowing blood which has resulted from a nosebleed or from forceful coughing but it normally is caused by something more serious and medical attention should be sought immediately.

Causes:

Some causes of vomiting blood are:

• Peptic ulcer disease: This is the most common cause of upper gastrointestinal bleeding.
• Gastritis: This is inflammation of the stomach lining and can erode the lining (erosive gastritis).  The most common cause is prolonged use of nonsteroidal anti-inflammatory drugs (NSAID’s).  The most common symptoms of nonerosive gastritis include upper abdominal discomfort or pain and nausea and vomiting.  Erosive gastritis may have other symptoms of bloody vomit, black or tarry stools or bloody stools.
• Esophagitis:  This is inflammation, irritation or swelling of the esophagus (food pipe).  Esophagitis is often caused by fluid that contains acid flowing back from the stomach to the esophagus which is commonly called gastroesophageal reflux.  Other symptoms can include cough, difficulty swallowing, heartburn, painful swallowing, hoarseness or sore throat.
• Esophageal tear/esophageal perforation: This is a hole in the esophagus (food pipe) which allows the contents of the esophagus to pass into the mediastinum which is the area surrounding the chest and can result in an infection of this area called mediastinitis.  This can be caused by surgical procedures or trauma.
• Dieulafoy’s lesion: This is caused by a large stomach arteriole ( a small blood vessel that branches out from an artery leading to the smaller capillaries in the blood circulation) that erodes and bleeds.  This can lead to a bleed in the stomach but is an uncommon condition. 
• Gastric varices: These are dilated submucosal (layer of stomach lining) veins  in the stomach. They are commonly found in patients with portal hypertension which can be a complication of cirrhosis (liver scarring due to liver damage).  Other symptoms include passing black, tarry stools or frank blood (which is bright red and highly visible) in the stool.  Many patients can present with shock due to the profound blood loss.

Risk factors:

Hematemesis risk factors include use of Nonsteroidal Anti-Inflammatory Drugs (NSAID’s), aspirin, chronic alcohol use or those with chronic renal failure.

When is it an emergency?

Vomiting blood is a medical emergency and you should see a doctor immediately. It's important to  identify quickly the cause of the bleeding and prevent more severe blood loss or complications. Call the emergency service if vomiting blood causes dizziness after standing, rapid shallow breathing or displaying signs of shock (pallor, fast weak pulse, low blood pressure, feeling faint or cold clammy skin).

How you can help your doctor:

Provide your doctor with as much information as you can, it may help you to think about the answer to these questions you may be asked:

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

Seeking early medical attention will mean diagnosis and treatment is initiated earlier to detect where the bleeding is orginating from and to stop the bleeding.