Vomiting blood, or hematemesis, is the regurgitation of stomach contents mixed with blood, or the regurgitation of blood only. Vomiting blood can be a frightening experience, but in some cases it may be triggered by minor causes. This includes swallowing blood from a mouth injury or from a nosebleed. These minor causes will likely not cause you any long-term harm. Vomiting blood may also be caused by more serious conditions such as internal injuries, organ bleeding, or organ rupture.
Regurgitated blood may appear brown, dark red, or bright red in color. Brown blood often resembles coffee grounds when vomited. The color of vomited blood can often indicate to the clinician the source and severity of the bleeding. For example, darker blood generally indicates that the bleeding is coming from an upper gastrointestinal source, such as the stomach. Darker blood usually represents a less brisk and steady source of bleeding. Bright red blood, on the other hand, often indicates an acute bleeding episode coming from the esophagus or stomach. It may represent a more brisk bleeding source. The color of the blood in the vomit may not always indicate the source and severity of the bleeding, but should always prompt investigation by your doctor.
If you vomit a large amount of blood, typically 500 cc or the size of a small cup, or if you vomit blood in conjunction with dizziness or changes in breathing, you should call 911 immediately.
Why does vomiting blood occur?
There are many causes of vomiting blood. They range in severity from minor to major and are normally the result of an injury, illness, or medication use.
Vomiting blood may be caused by minor conditions such as:
- esophagus irritation
- swallowing blood
- tear in the esophagus due to chronic coughing or vomiting
- swallowing a foreign object
Other common causes of vomiting blood include:
- stomach ulcers
- aspirin side effects
- gastritis, or stomach inflammation
- nonsteroidal anti-inflammatory drug side effects
More serious causes of vomiting blood include:
- alcoholic hepatitis
- esophageal cancer
- erosion of the stomach lining
- pancreatic cancer
All instances of vomiting blood should be reported to your doctor.
Symptoms that accompany vomiting blood
Several symptoms may be present along with vomiting blood. These symptoms include, but are not limited to:
- abdominal discomfort
- abdominal pain
- vomiting stomach contents
Vomiting blood can indicate a serious medical emergency. Call 911 if you experience any of these symptoms:
- blurred vision
- rapid heartbeat
- changes in breathing
- cold skin
- clammy skin
- severe abdominal pain
- vomiting blood after an injury
At the doctors
There are many potential health issues that could cause you to vomit blood. To determine your diagnosis, your doctor will begin by asking you questions about your symptoms, and whether or not you were recently injured.
Your doctor may order an imaging test to look inside your body. Imaging scans reveal abnormalities in the body such as ruptured organs or abnormal growths. Common imaging tests used for these purposes are:
- CT scan
- endoscopy, a device that allows your doctor to look in your stomach
Your doctor may wish to do an upper endoscopy to look for blood in the stomach. This procedure is performed while you are sedated. Your doctor will place a small, flexible tube called an endoscope into your mouth and down into your stomach and small intestine. A fiber optic camera in the tube allows your doctor to see the contents of your stomach and examine you internally for any sources of bleeding.
Your doctor may order a blood test to check your complete blood count. This helps to assess the amount of blood lost. A biopsy may also be performed to determine if the source of bleeding represents an inflammatory, infectious, or cancerous source. Your doctor may order additional tests based on your blood count result.
Complications of vomiting blood
Choking, or aspiration, is one of the main complications of vomiting blood. This can lead to blood collecting in the lungs, impairing your ability to breathe properly. Aspiration of blood in the vomit, although rare, can be life-threatening if not treated immediately.
People who are at risk for aspiration of stomach contents include:
- older adults
- people with a history of alcohol misuse
- people with a history of stroke
- people with a history of disorders affecting their ability to swallow
Depending on the cause, vomiting blood may cause additional health complications.
Anemia is another complication of excessive bleeding. It’s a deficiency of healthy red blood cells. It occurs particularly when the blood loss is rapid and sudden. However, people with conditions that progress slowly, such as gastritis, or people with chronic NSAID use may develop anemia over several weeks to months. In this case, anemia may remain without symptoms until their hemoglobin, or blood count, is very low.
Vomiting blood caused by excessive bleeding can also lead to shock. The following symptoms are indicators of shock:
- dizziness upon standing
- rapid, shallow breathing
- low urine output
- cold, pale skin
If not treated immediately, shock can lead to a decrease in blood pressure followed by coma and death. If you experience any symptoms of shock, have someone take you to the emergency room or call 911.
How is vomiting blood treated?
Depending on the amount of blood lost, you may need a blood transfusion. A blood transfusion replaces your lost blood with donor blood. The blood is fed into your vein through an IV line.
You might also require fluid to be given through an IV to rehydrate your body. Your doctor may provide you with medication to stop vomiting or to decrease stomach acid. If you have an ulcer, your doctor will prescribe medications to treat it.
In certain more severe cases of upper GI bleeding, a gastroenterologist may perform upper endoscopy to not only diagnose but also treat the source of the bleeding. In severe cases, such as people with stomach or bowel perforation, surgery may be needed. Severe cases may also include a bleeding ulcer or internal injuries.
Some foods and beverages increase the likelihood of vomiting blood. These include but are not limited to highly acidic foods and alcoholic beverages. If you regularly consume these foods or beverages, your doctor will create a special diet to decrease this risk.