Vomiting Blood (Haematemesis): Causes, Symptoms, Diagnosis and Treatment

Vomiting Blood

Vomiting is one of the conditions that happen when you have certain disease conditions. Sometimes, vomiting doesn’t indicate the presence of any serious medical conditions. However, if you are vomiting blood, that will make the alarm bells in your head go off.

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Vomiting blood, otherwise known as haematemesis, is the process by which the stomach contents are regurgitated along sides blood from the stomach into the mouth.

In some cases, the stomach contents may not be involved. The patient may only be regurgitating blood from the gut through the mouth.

Although vomiting blood might be a cause for concern, however, in some cases, it may be due to minor reasons such as a nose bleed, injuries in the mouth, or an injury to the gum.

If you are vomiting blood due to these minor injuries, then you have non cause for concern as these injuries can’t cause any harm to you.

However, vomiting blood may be as a result of other major injuries. Injuries such as organ rupture, internal bleeding, or an injury to an organ causing the organ to bleed can also result in the patient vomiting blood, and this is a serious cause of concern.

Blood that is being vomited has several presentations. Some blood may be brown, some dark-red, some bright-red, or even coffee-colored when vomited. Often, the color of blood that is vomited tells your doctor where the bleed is coming from.

For example, blood that is dark-red in coloration can indicate that the billed you are experiencing comes from the upper gastrointestinal tract (usually the stomach).

Usually, blood that is dark-red often indicates that the source of the bleed is often less brisk and steady in position. This means that although you are losing blood, however, the bleeding rate is quite slow.

However, on the other hand, if you are vomiting blood that is bright red, then it can indicate that you have acute bleeding from two sources; either the esophagus or the stomach, and it can also tell you that you are losing blood at a faster rate.

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In some cases also, the color of the blood may not always reveal the source or how severe and fast the bleeding rate is. However, it is important that you ensure that your doctor gives you a full body work-up to know what is going on.

If you are vomiting blood at a fast rate, possibly the size of a small cup(or 500cc) within minutes, then you definitely need to get to the hospital immediately. However, what can result in your vomiting blood?

Causes

In medicine, there are so many causes of vomiting blood. In reality, vomiting blood often indicates the presence of an underlying problem.

The reasons you are vomiting blood can either be major or minor; however, they are usually because of an internal injury, injury to an organ, illness, wrong medication use, and prescriptions.

For the purpose of this article, we would categorize these causes into two groups.

1. The minor causes

When you are vomiting blood due to these cases, more often than not, you have no reason to be concerned as they are often due to sources that can easily be resolved or treated.

The sources that fall under this classification include:

  • Irritation of the esophagus
  • Bleeding from the root of your nose
  • Swallowing blood as a result of a mouth or nose bleed
  • A lesion or tear in the esophagus which is often as a result of excessive vomiting or coughing
  • Swallowing of foreign objects. For example, if you swallow a sharp bone in the process of eating, it can cause an injury to your esophagus and cause you to vomit blood.
  • Ulcers; mostly stomach ulcers
  • Side effects of certain medications such as aspirin and non-steroidal anti-inflammatory drugs.
  • Inflammation of the stomach(often known as gastritis)
  • Inflammation of the pancreas (also known as pancreatitis)

2. The major causes

If the reason why you are vomiting blood falls under this category, then you may need more invasive methods such as surgery to help you treat it.

The sources that fall under this classification include:

  • Liver Cirrhosis often caused by excessive alcohol intake
  • Cancer of the esophagus
  • Eroding of the stomach lining
  • Stomach cancers
  • Pancreatic cancer.
  • Radiation poisoning
  • Uncommon infections of the upper gut
  • Injury to the internal organs.

In rare cases, sometimes vomiting of blood may have no cause. However, this occurs in less than 1% of all cases. Bleeding from three organs in the upper gut can result in your vomiting blood.

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These organs include:

  • The esophagus
  • The stomach
  • The duodenum

Bleeding from the esophagus

When a person is bleeding from the esophagus, it could be as a result of the following:

1. Esophageal Varices

Esophageal Varices is often caused when the blood vessels in the upper part of the gut (esophagus, and the stomach) become enlarged. Mostly, esophageal Varices is often as a result of complications that arise from liver cirrhosis.

When you have liver cirrhosis, the affected or already scarred liver tissue cuts off the blood supply to the liver. Usually, due to the presence of valves in the veins, there is no backflow of blood in the body (except in certain places such as the heart) or in diseased conditions.

Hence, once there is a blockage of blood supply to the liver, it causes an increase in the pressure present within the vein that supplies blood from the gut to the liver. This vein is known as the portal vein.

Once this occurs, the increase in pressure will push back blood into the gut, thereby increasing the blood pressure in the veins present in the upper gut. It is important to note that most of the veins present in the upper gut don’t have thick walls and, as such, can easily burst.

Once these veins burst open, it can result in bleeding within the gut and inadvertently cause you to begin to vomit blood.

2. Inflammation of the esophagus

Inflammation of the esophagus, often known as esophagitis, is often due to a condition known as Gastroesophageal Reflux Disease(GERD). This condition occurs as a result of the reflux of acid from the stomach to the esophagus.

Mostly what causes the reflux is due to the lax of the lower esophageal sphincter, which is normally meant to be tight and closed shut after food has passed from the esophagus into the stomach.

Hence, once GERD occurs, the vessels within the esophagus can become swollen and also burst, causing the gut to bleed and you to vomit blood.

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3. Esophageal cancer

Cancer is usually the abnormal growth of cells within a particular organ.

In the case of esophageal cancer, the cells present in the esophagus may become cancerous, causing it to grow abnormally, putting pressure on the blood vessels and, as a result, cause the veins to burst open spilling blood into the gut.

4. Mallory-Weiss Syndrome

This syndrome is said to occur when there is a large tear within the esophagus, the stomach, or both at the same time. Often, this tear can be a result of anything that causes a sudden increase in pressure within the esophagus or the stomach.

Most times, this syndrome occurs when you are struggling to vomit, vomiting excessively, having violent coughs, or having violent hiccups.

Bleeding from the stomach

If you are vomiting blood, it may be because you are bleeding already into your stomach. The causes of bleeding in the stomach include:

1. Stomach ulcer

Stomach ulcer often called a gastric ulcer, is caused as a result of a small tear or laceration in the linings of the stomach walls. Normally, you are not meant to have any lacerations in your stomach.

However, you may begin to experience stomach ulcer as a result of:

  • Bacteria infection: Stomach ulcer is due to the infestation of a particular bacteria known as Helicobacter pylori (H. pylori).
  • The use of NSAIDs. These drugs are mostly used to treat certain medical conditions. The most common drug that falls in the NSAIDs category is aspirin, and one of the major effects of NSAIDs is stomach ulcers.
  • The use of anti-inflammatory drugs, which are often used to treat medical conditions such as arthritis, can result in stomach ulcers.

2. Stomach cancer

As seen in the case of esophageal cancer, stomach cancer operates using the same technique.

Once there is the abnormal growth of cells within the stomach wall, it can cause the increase in pressure of the vessels found there and, as a result, cause bleeding into the stomach and also cause you to vomit blood.

3. Gastric or stomach varices

Same method as esophageal Varices

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4. Mallory-Weiss Syndrome

It can affect the stomach the same way it affects the esophagus.

Bleeding from the duodenum

In some rare cases, bleeding from the duodenum can result in your vomiting blood. The following are major causes of duodenal bleeding.

1. Duodenal ulcer

Just like the stomach ulcer, the duodenal ulcer is also caused as a result of the infestation of the bacteria H. pylori. Although this condition can be managed easily, however, sometimes, it can result in bleeding within the duodenum.

The use of aspirin and anti-inflammatory drugs, which are common causes of stomach ulcers, are, in very rare cases, the contributing factors to duodenal ulcers.

2. Duodenitis

Duodenitis, which is caused as a result of the inflammation of the internal linings of the duodenal walls, has the same causes as stomach ulcers and, in some cases, may cause pressure to build within the blood vessels there causing it to burst.

Once these vessels burst open, you will begin to bleed into your duodenum, and that may cause you to vomit blood.

Symptoms that often accompany vomiting of blood

As earlier said, vomiting of blood is always an indication that there is something wrong with the internal system or organs. However, more often than not, vomiting of blood doesn’t stand alone.

There are some other symptoms that follow after you have started vomiting blood. These symptoms include:

  1. Nausea
  2. Severe pains within your abdomen
  3. Abdominal discomforts.
  4. Regurgitation of stomach contents
  5. Dizziness
  6. Rapid heartbeats, and rapid breathing
  7. Shortness of breath
  8. Clammy or cold skin
  9. Confusion and fainting
  10. Increase in temperature (fever)
  11. Malaena which is characterized by the presence of blood within your stool. If you are vomiting blood and also passing out blood in your stool, this means that there is a lot of bleeding going in your gut, and it is an indication of a serious problem.

Diagnosis

Vomiting Blood

When you visit your doctor, your doctor will ask certain questions such as if you were involved in any recent or past traumas, the kinds of symptoms you are experiencing, the kinds of food and drugs you have been taking, and so on.

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These questions are important and are to be answered as accurately as possible because it will help your doctor give you your precise diagnosis.

After these questions and performing physical examinations, he or she may ask you to carry out imaging tests such as CT scans or endoscopy (which is the use of a small tube-like device that has a camera to look into your stomach), ultrasounds, X-Ray and MRIs.

The purpose of these scans is to know where the bleed is coming from and also the next line of action to take.

Sometimes, your doctor may order a full blood work-up for you. Basically, in this test, your blood will be screened in order to know the amount of blood lost. If it is in the case where cancer is suspected, your doctor may order a biopsy to be carried out on you.

Treatment

If due to the bleeding, you have lost a lot of blood, you may be required to undergo a blood transfusion. This process is carried out when donor blood is collected and put into a blood bag. This blood is then transfused through an IV line directly into your vein.

You may also need the fluid transfusion in order to help you replace the amount of fluid and electrolytes that have been lost.

Sometimes, your doctor may need to change your diet, especially if the cause of the bleeding is as a result of you taking certain acidic foods and alcoholic beverages (as seen in the case of liver cirrhosis and ulcers).

In some major cases, your doctor may refer you to another doctor who is called a gastroenterologist. This new doctor, based on the results of the endoscopy test you have done earlier, will determine if you need surgery or not.

Complications associated with vomiting of blood

There are two major complications that can arise if you are vomiting blood. They include

1. Choking or aspiration of blood

Sometimes, if you have excess blood within your gut, this blood can begin to sip into other organs such as the lungs. Once this occurs, you may begin to find it difficult to breathe because there is too much pressure within your thoracic cavity.

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Aspiration of blood is a rare occurrence, but when it occurs, it can result in life-threatening situations if treatment is not immediately given. People who are often at risk of developing this condition include:

  • The elderly
  • People who already have a history of excessive alcohol consumption
  • People with a history of smoking
  • People who already have disorders that impairs their ability to swallow.

2. Anemia

Anemia can be defined as the reduction in the red blood cells or oxygen-carrying capacity of the blood. Anaemia often occurs as a result of excess bleeding.

People who have certain conditions such as gastritis or ulcers developing from the use of NSAIDs can develop anemia within a couple of weeks or months.

In this case, these people may not have the symptoms that most anemic people have (such as low hemoglobin count, low blood count, etc.).

It is important to note that anemia is one of the leading causes of shock, and people who have developed shock as a result of anemia will show symptoms such as:

  • Rapid or shallow breathing
  • Feelings of dizziness when standing
  • Cold or pale skin
  • Low urine production.

If you have shock and you don’t treat it immediately, it can result in a sudden decrease in blood pressure, which can result in coma and eventual death.

In conclusion, vomiting of blood may not be an indication of a serious problem, as in the case of nose bleeds or an injury in the mouth.

However, it is important you consult your doctor if you are experiencing any symptoms. As they say, “It is better safe than sorry.”

Sources;

Deborah Akinola
Wirter, poet and public speaker