What is vomiting blood?
Vomiting blood is also called haematemesis, and it is a serious condition where blood is expelled from the mouth. If you vomit blood, it indicates the presence of bleeding in the upper part of the digestive tract, such as the oesophagus, stomach and the upper part of the small intestine. The blood could be bright red, brown or black.
Vomiting blood is different from the slight amounts of blood in your saliva that might occur after brushing teeth or a nosebleed or a gum injury – this is spitting up blood. It also doesn’t refer to the blood that comes from the lungs such as in cases of bronchitis, pneumonia or lung cancer – this is coughing up blood, also known as haemoptysis.
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What causes vomiting blood?
Blood that is vomited is likely to come from the upper gastrointestinal (GI) tract that includes the oesophagus, stomach and duodenum (the upper part of the small intestine). It could also be a problem with the pancreas.
There are a number of reasons that can cause you to vomit blood. Most of them are serious conditions and require urgent medical attention. Such causes include:
- A tear (Mallory-Weiss tear) in the lining of the oesophagus – caused by excessive vomiting
- Swollen veins (varices) in the lower part of the oesophagus and stomach – this is common in those with severe liver damage such as those with long-term alcoholism.
- A bleeding stomach or duodenal ulcer
- Inflammation of the oesophagus called oesophagitis – that causes irritation and swelling
- A benign (non-cancerous) or cancerous tumour in the stomach or oesophagus
- A severe injury to the abdominal area
- Taking too much aspirin or nonsteroidal anti-inflammatory medicines
- A condition called Dieulafoy’s lesion where there is an abnormally large artery in the stomach wall
- Inflammation of the small intestine called duodenitis
- Pancreatic cancer
What symptoms can occur together with vomiting blood?
Vomiting blood may occur together with other symptoms of the gastrointestinal system, such as:
- Abdominal pain or cramping
- Abdominal swelling, distention or bloating
- Blood-streaked stools
- Bloody stool – red, black or tarry blood
- Change in bowel movements
- Diarrhoea
- Nausea
- Rectal bleeding
Vomiting blood may also accompany symptoms related to other body systems, such as:
- Dizziness
- Fainting
- Lethargy or Fatigue
- Jaundice
- Nosebleed
- Pale skin
- Weakness (loss of strength)
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When should I go to the doctor for vomiting blood?
In severe cases, vomiting blood could be life-threatening. Seek immediate medical attention if you have any of these symptoms:
- Abdominal pain or cramping
- Passing out or unresponsiveness
- Respiratory or breathing problems such as shortness of breath, difficulty breathing, laboured breathing, wheezing, not breathing or choking
- Vomiting blood along with rectal bleeding or bloody stool
- Weakness (loss of strength)
What are the potential complications of vomiting blood?
If you fail to seek early treatment for vomiting blood, more serious complications and permanent damage can result. Some potential complications include:
- Anaemia – low red blood cell
- Oesophageal cancer
- Need for blood transfusion
- Recurrent bleeding
- Shock – body is lacking blood
- Spread of cancer
- Spread of infection
- Stomach cancer
- Stomach wall perforation
How is the cause for vomiting blood diagnosed?
Your doctor will ask questions about the nature of the bleeding and ask if there are any other symptoms, followed by a physical examination.
Sometimes, it may be difficult to tell if the source of the blood is really from the upper gut and not coughed up as in haemoptysis or coming from your mouth or nose due to a nosebleed.
Your doctor will determine how much blood you have lost and how serious your condition is based on your symptoms and through checking your pulse and blood pressure.
Blood tests are likely to be carried out to determine how much blood was lost and whether you need intravenous fluid or a blood transfusion to counter any larger amount of blood loss. They may also help to assess your liver function to see if you have “scarring” of the liver or cirrhosis. Or, they could help to diagnose other causes of bleeding.
This is where your doctor or nurse uses their finger to check for any problems inside your bottom (rectum).
Imaging tests like X-rays may be performed to find the source of your bleed.
A nuclear medicine scan makes use of small amounts of radiation to create images of your tissues, bones and organs.
Your blood will be drawn from your vein and mixed with a special radionuclide and injected back into your vein. You will lie down and be placed under the Gamma Camera to obtain the images.
A tube is passed down your nose into your stomach to remove stomach contents using suction in order to find out the source of the bleed
What is the treatment for vomiting blood?
Initial treatment
Initial treatment may involve giving you a drip to give your body fluids, or a blood transfusion if the bleeding is severe. If the bleeding is minor or has stopped, a blood transfusion will not be necessary. We will also try to stabilise any low blood pressure, breathing problems or other complications of excessive blood loss. Medication may be provided for blood pressure or to lower stomach acid levels.
Other treatments
Other treatments depend on the cause of the bleed, but we will first stop the bleeding. Often, the ongoing bleed can be stopped by using instruments passed down the endoscope. Occasionally, emergency surgery will be needed to stop the severe ongoing bleed. Once the bleeding has stopped, we can carry on further treatment that pertains to the root cause of the bleed.
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