Blood in the vomit

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Alternative names
Hematemesis; Vomiting blood

Definition
Vomiting blood is a regurgitation of blood from the upper gastrointestinal tract, which includes the mouth, pharynx, esophagus (the feeding tube that transmits food and secretions from mouth to stomach), stomach, and small intestine.

Considerations
Vomiting of blood results after there is upper gastrointestinal bleeding. This condition can sometimes be difficult to distinguish from coughing up blood (from the lung) or a nosebleed (bloody post-nasal drainage).

Conditions that cause blood to be vomited can also cause blood in the stool.

Common Causes

• Prolonged and vigorous retching (may cause a tear in the small blood vessels of the throat or the esophagus, producing streaks of blood in the vomit)
  
• Bleeding ulcer located in the stomach, duodenum, or esophagus
  
• Irritation or erosion of the lining of the esophagus or stomach
  
• Bleeding esophageal varices
  
• Vascular malformations of the GI tract
  
• Tumors of the stomach or esophagus
  
• Esophagitis
  
• Gastritis
  
• Ingested blood (for example, swallowed after a nosebleed)
  
• Gastroenteritis

Home Care

Although not all situations are the result of a major medical problem, this is difficult to know without a medical evaluation. Seek immediate medical attention.

Call your health care provider if

Call your doctor or go to the emergency room if vomiting of blood occurs—this requires immediate medical evaluation.

What to expect at your health care provider’s office
The medical history will be obtained and a physical examination performed.

Medical history questions documenting the vomiting of blood in detail may include:

• Time pattern
  o When did this begin?
  o Has it ever occurred before?
  o Did it occur after retching or vomiting?
  
• Quality
  o How much blood was in the vomit?
  o Was the vomit entirely blood?
  o Was the blood bright red, dark red, or black?
  o Were there clots?
  
• Aggravating factors
  o Has there been a recent nosebleed?
  o Has there been recent vigorous vomiting?
  o Has there been a recent episode of gastroenteritis (nausea, vomiting, abdominal pain)?
  o Has there been a recent episode of coughing?
  
• Other
  o What other symptoms are also present?
  o Is there bleeding from the nose, rectum, or elsewhere?
  o Is there abdominal pain?
  o Is there blood in the stools or black stools?
  o Is there weakness or fatigue?
  o Is there coughing or coughing up of blood?
  
• Additional important information
  o What medications are being taken?
  o Is the patient a drinker of alcohol or smoker?
  o Have there been any recent injuries to the nose, mouth, or abdomen?
  o Have there been any recent surgical procedures?
  o Have there been any recent dental procedures such as tooth extractions?
  o Is there a history of bulimia or self-induced vomiting?
  o Is there a history of ulcers, esophageal varices, or liver problems?
  o Has the patient ever turned yellow (jaundice)?
  o Is there a history of problems with blood clotting?

Diagnostic tests that may be performed include:

• Endoscopy (EGD)
  
• X-rays
  
• Nasogastric tube (nose-to-stomach tube) placement to check for blood
  
• Blood work, such as a CBC (blood count), blood clotting values, and liver function tests

Intervention:
If massive hematemesis, emergency intervention should be anticipated. This may include intravenous fluids, medications, blood transfusions, or other treatments. Medications to decrease stomach acid may be prescribed. Bleeding that doesn’t stop may require surgery.

After seeing your health care provider:
You may want to add a diagnosis related to vomiting blood to your personal medical record.

After seeing your health care provider:
You may want to add a diagnosis related to early satiety to your personal medical record.

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