Table of Contents
Vomiting is the forceful expulsion of the contents from the stomach through the mouth. This act is usually involuntary. Synonyms used for vomiting are- puking, emesis, throwing up, barfing etc. Vomiting is different from nausea. Nausea is an unpleasant feeling, which usually occurs before vomiting or perceived as an urge to vomit. Vomiting can occur due to various causes such as- pregnancy, overeating, motion sickness, sea sickness, stress, infections, ingestion of excess alcohol or various toxins, gall bladder diseases, appendicitis, stomach ulcers, heart attack, and cancers. It consists of half- digested food mixed with stomach acid and saliva, fresh or altered blood, sometimes bile and fecal material. Hematemesis or Blood Vomiting or Vomiting Blood or bloody vomit are synonyms for Vomiting of blood.
Hematemesis can consist of fresh blood, altered blood or blood mixed with stomach contents. It is an important sign of medical conditions and treated as a medical emergency. The colour of the blood may vary and indicate the source of bleeding. It can appear as bright red suggesting fresh blood or brown coloured similar to coffee grounds suggesting altered blood with stomach acids. The amount and frequency of bleeding matters a lot and affects this emergency situation.
Vomiting of blood is usually a medical emergency condition requiring proper and immediate medical care and if not treated properly, it can even cause death. It indicates some underlying cause, which can vary from minor reasons such as trauma to various serious causes such as cancers. There is no long- term harm from the minor causes, whereas the serious reasons require proper medical attention. So, one should know the various causes, symptoms and the management of vomiting blood.
Causes of Vomiting Blood
Various conditions involving different organs of the body can cause vomiting of the blood. It includes various causes related to stomach, heart etc, intoxications and other conditions.
1. Stomach Ulcers or Peptic Ulcers
Peptic Ulcer is the most common cause of vomiting blood. Ulcers can occur both in the stomach and the small intestine. H. Pylori bacterial infection, long term use of some medicines such as Aspirin and other pain killers, excess production of acid in the stomach as in some diseases eg. Zollinger- Ellison syndrome etc can produce ulcers in the stomach and duodenum. Vomiting of blood occurs along with burning or gnawing pain in the upper part of the abdomen below the chest and belly button in case of stomach ulcers. So, one should not use any medicines especially pain killers without doctor’s advice.
2. Cirrhosis with esophageal or gastric varices
Varices are swollen veins. Esophageal or gastric varices occur in lower part of esophagus (muscular tube connecting the mouth to stomach). In case of advanced liver diseases or cirrhosis, the blood supply to the liver is blocked and the esophageal veins become swollen. These swollen veins may leak and can eventually rupture due to increased pressure in these veins. This leads to severe bleeding, vomiting of blood and life- threatening complications.
Gastritis is inflammation in the stomach. Certain bacterial infections, excess of alcohol intake, cocaine, stress, and ageing may cause gastritis. This inflammation causes erosion of the stomach lining and leads to bleeding, which can be small in amounts. This blood acts with the stomach acids and ultimately gives a coffee- grounds colour due to alteration of blood.
It is the inflammation in the esophagus which is a muscular tube connecting the mouth to the stomach. Acid reflux, medications and various infections can cause esophagitis. The inflammation may lead to bleeding in a similar manner to gastritis.
5. Mallory- Weiss tears
Mallory- Weiss tears are the tear in the inner lining of the esophagus. Severe or prolonged vomiting is the most common cause of the tears.
6. Aspirin and the Non-steroidal anti- inflammatory agents
Aspirin can cause ulceration in the stomach and also causes blood clotting disorders. So, it can cause bleeding from both the stomach and injuries caused by any reason.
Stomach, esophageal, pancreas and liver cancer etc also cause vomiting of blood. Cancers of these organs are difficult to diagnose early because the symptoms usually appear in advanced stage of it. One can suspect cancer in elderly persons having unexplained weight loss.
8. Heavy alcohol intake
Heavy alcohol intake causes liver damage and due to which varices, cancer etc can occur and ultimately that causes vomiting blood.
9. Vomiting of ingested blood
Vomiting of ingested blood during trauma or other injuries in mouth, nose or throat can occur but that is not vomiting blood in true sense. It just evacuate the ingested blood.
10. Christmas disease (Hemophilia B)
It is a rare genetic disease in which blood does not clot properly. Due to which even small injury or trauma causes prolonged bleeding.
11. Viral hemorrhagic fever
Ebola virus can also cause vomiting blood along with fever and other symptoms.
Apart from these there are some other conditions which can also cause vomiting blood. These are as follows-
- Neck injuries can cause vomiting of blood.
- Iron poisoning can cause vomiting of blood.
- Foreign objects lodged in the esophagus can also cause vomiting of blood.
- Parasitic infections such as Schistosoma cause vomiting of blood along with diarrhoea, abdominal pain etc.
- Eating disorders such as Anorexia nervosa and bulimia nervosa cause vomiting of blood following excessive purging.
- Connection between the large blood vessel and the intestine or stomach can result in significant blood loss in the organ and that can lead to vomiting of blood.
- High blood pressure in the liver veins can also cause it.
Symptoms of Vomiting Blood
Various non- specific symptoms can accompany vomiting blood. So one should never ignore them. Various symptoms are as follows-
It is an unpleasant feeling occurring before vomiting as an urge to vomit.
It is similar to giddiness. It is a feeling of being unbalanced, uncoordinated, and lightheaded and can cause fainting to the person.
3. Abdominal pain or pain in stomach-
Pain in the upper part of the belly between the rib cage and the belly button.
4. Rapid shallow breathing-
Breathing is fast but not to the normal depth.
It is the unusual lightness of the skin colour than the normal colour. It usually occurs due to the reduced blood flow and the reduced oxygen level.
It is a temporary loss of consciousness. It usually occurs due to temporary loss of blood supply to the brain. Fainting can be a sign of underlying more serious condition.
7. Cold clammy skin-
The temperature of the skin reduces below the normal temperature and the skin also becomes wet or sweaty.
8. Blurred vision-
Blurred vision may also accompany vomiting of blood. It occurs due to sudden fall in the blood pressure.
9. Rapid heartbeat-
The heart beats faster than the normal. Excess blood loss causes rapid heartbeat.
So these are some symptoms which can accompany or can occur before vomiting blood. One should know these symptoms to manage this dreadful condition as soon as possible.
Treatment of Vomiting of Blood
Vomiting blood is considered as a medical emergency. The treatment depends upon the amount of blood loss. Vomiting blood should be taken seriously. One should seek medical treatment immediately. The cause of bleeding is identified first and then the treatment is decided. The treatment should be taken with doctor’s consultation only.
If minimum blood loss is there, medications are prescribed. Proton pump inhibitors (eg. omeprazole, pantoprazole, rabeprazole etc) are useful in stomach ulcers. In severe conditions of stomach, endoscopy is done to diagnose the condition. Some cases may also need sugery.
Intravenous fluids or blood transfusion are useful to restore the loss of body fluids.
In cases with severe blood loss, patient can go into shock. So, resuscitation is the priority to prevent cardiac arrest.
If profuse bleeding is there in the stomach or adjacent area, definite airway management is done to prevent aspiration of blood into the lungs. Aspiration of blood into the lungs is one of the most common complication of vomiting blood. Administration of oxygen and monitoring of the heart parameters . Intravenous fluids and blood transfusion depends upon the amount of blood loss and the age of the patient. Clotting factors are given according to the need.
Endoscopy etc are done to diagnose the condition and treatment purposes.
Somatostatins and its longer acting derivatives eg. Octreotide are effective in reducing bleeding from stomach ulcers and varices. Sclerotherapy and Vasopressin are also some of the effective managements to reduce bleeding.
Vomiting blood is a medical emergency condition which needs immediate medical care. It can happen at any age but most commonly occurs in elderly patients. Patients with stomach diseases such as ulcers, varices, gastritis, liver diseases like cirrhosis, cancer of stomach, liver, and pancreas are more prone for vomiting blood. In these condition there are chances of severe blood loss and needs immediate medical care. Other conditions could also be life-threatening, if not treated properly.
So one should know about the various causes and symptoms of vomiting blood. So, that they can seek medical treatment immediately. This condition should not be neglected as it can lead to life-threatening conditions. The treatment should be taken only and only with doctor’s consultation.