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

Alternative Names:
Hematemesis; Blood in the vomit

Considerations:
Vomiting blood results from upper gastrointestinal loss of blood (GI 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 vomitus)
  • Bleeding ulcer(s) 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:
  • Vomiting of blood occurs. It requires immediate medical evaluation, so call your doctor or go to the emergency room.
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 blood in detail may include:
  • Time pattern
    • When did this begin?
    • Has it ever occurred before?
    • Did it occur after retching or vomiting?
  • Quality
    • How much blood was in the vomit?
    • Was the vomit entirely blood?
    • Was the blood bright red, dark red, or black?
    • Were there clots?
  • Aggravating factors
    • Has there been a recent nosebleed?
    • Has there been recent vigorous vomiting?
    • Has there been a recent episode of gastroenteritis (nausea, vomiting, abdominal pain)?
    • Has there been a recent episode of coughing?
  • Other
  • Additional important information
    • What medications are being taken?
    • Is the patient a drinker of alcohol or smoker?
    • Have there been any recent injuries to the nose, mouth, or abdomen?
    • Have there been any recent surgical procedures?
    • Have there been any recent dental procedures such as tooth extractions?
    • Is there a history of bulimia or self-induced vomiting?
    • Is there a history of ulcers, esophageal varices, or liver problems?
    • Has the patient ever turned yellow (jaundice)?
    • 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.
Review Date: 1/21/2002
Reviewed By: Jenifer K. Lehrer, M.D., Department of Gastroenterology, Graduate Hospital, Philadelphia, PA. Review provided by VeriMed Healthcare Network.
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