Vomiting of blood, haematemesis: what are its causes (fresh or digested blood)?

Vomiting of blood (technically also hematemesis) is a symptom of several diseases of the digestive system. We usually associate it with stomach ulcers.

Vomiting blood = hematemesis.
Vomiting = emesis/vomitus.
Haema = blood.

It occurs with illness, injury or after swallowing a foreign object. Haematemesis can also occur after drinking large amounts of alcohol, especially hard alcohol.

Are you wondering why it occurs and what causes may be behind the occurrence in children and newborns or in pregnancy?
Often for alcoholism and cancer?
What does vomiting of digested blood look like?
What is the first aid and how to stop it?

Vomiting (vomitus) is a defensive reflex of the digestive tract to remove harmful substances or excess contents from the stomach or duodenum.

When vomiting occurs, the peristalsis is reversed, contracting the muscles of the digestive tube and emptying the contents of the stomach into the oesophagus, oral cavity and out of the body.

The inappropriate contents may be food, part of food or too much food. But also some irritant that irritates the stomach either physically, chemically or microbiologically.

Vomiting can be provoked from the stomach, i.e. peripherally. The second form is central, namely when the vomiting centre in the medulla oblongata is irritated.

Vomiting may be preceded by a feeling of heaviness on the stomach and a sensation to vomit (nausea).

Vomiting can cause, for example:

• kinetosis and irritation of the vestibular apparatus
  • inappropriate movement
  • travelling in a means of transport, sitting in the back seat or in the opposite direction, on a boat
  • diseases
• intense pain
• excessive emotional experience, stress
• brain injury, accident
• brain disease, stroke, tumour, increase in intracranial pressure
• other diseases such as hypertension
• infectious causes, inflammation, flu
• metabolic causes, renal failure and internal disruption, diabetes and hyperglycaemia
• psychological disorders, anorexia, bulimia and others
• poisoning, intoxication
• adverse drug reaction
• vomiting in pregnancy
• and others

Unpleasant is mainly repeated vomiting. It can cause pain in the abdomen, stomach, esophagus.

Stomach contents (mainly acid) irritate the esophagus and oral cavity.

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A major risk is the penetration of aggressive contents into the respiratory tract.

The risk is increased by impaired consciousness. In the unconscious state, the contents of the stomach can enter the airways. A complication of this aspiration is dangerous aspiration pneumonia.

With repeated vomiting, small tears form in the wall of the stomach and oesophagus. It is then common for blood to be found in the vomit.

Another complication of prolonged vomiting is dehydration.

Read also:
Dehydration in children is dangerous
Symptoms of dehydration

Vomiting blood or admixture of blood in vomit?

Bleeding in the gastrointestinal (digestive) system is always taken with seriousness. It occurs in various diseases. It is differentiated into upper and lower GIT bleeding.

In the case of vomiting blood, it is usually upper GI bleeding.

GIT bleeding = most common sudden abdominal episode.

A higher rate of severe course is reported for upper GI bleeding as it can rapidly progress to shock.

This is hemorrhagic shock + hemodynamic instability = lack of circulating blood.

A serious complication of shock is death.

Forms of GIT bleeding:

• upper GIT - towards the mouth
  • from the duodenal-gastric interface
  • duodenum and lactum - beginning of the small intestine
  • expertly at the level of Treitz's eyelash
• into the lower GIT - downwards, below the duodenum-lactum interface
• occult bleeding - hidden, clinically asymptomatic
• obscure - bleeding with no known cause
• enterorrhagia - bleeding into the bowel and blood in the stool
• haematemesis - vomiting of blood, fresh or digested, or blood clots
  • melanemesis - vomiting of digested blood - coffee grounds
• melena - digested blood in the stool
  • black, tarry, colloidal stools that smell
  • occurs after about 8 hours due to intestinal bacteria, enzymes
  • if bleeding reaches approximately 50-100 ml or more of blood in 24 hours
  • melena is further divided into:
    • fresh melena - thin, black, greasy, colomose stools, as a sign of active bleeding and early sign of bleeding
    • old - emptying melena - black and dry stools, as a manifestation of older, already stopped bleeding
• haematochezia - fresh blood or blood clots in the stool
  • from the terminal parts of the colon
• proctorrhagia - bleeding from the rectum and anal area
  • blood is not mixed with stool
  • is on the surface of the stool
  • blood on toilet paper

The blood can be fresh, but also poisoned.

Vomiting fresh blood can be in the form of direct vomiting of blood.
Or the blood is mixed with the contents of the stomach.
Alternatively, the blood is in the form of tiny red threads.

Digested blood has the appearance of coffee grounds. Because it's been exposed to digestive juices.

The source of the bleeding could be:

• esophagus - varices
• Mallory-Weiss syndrome - a tear in the esophageal mucosa after repeated and violent vomiting
• stomach - erosion, peptic ulcer, gastropathy, cancer
• duodenum - ulcer
• other
  • injuries of the oral cavity
  • after tooth extraction
  • nosebleeds
  • polyps and benign tumours, lipomas, fibromas
  • hemangioma
  • vasculitis
  • inflammation - oesophagitis, gastritis, intestinal inflammation, Crohn's disease and ulcerative colitis
  • diverticulosis and diverticulitis
  • aneurysm - rupture of the aorta into the alimentary canal
  • disorders of blood clotting and platelets

What are the most common causes of bleeding from the upper digestive system

Ulcers of the stomach and duodenum are cited as the most common source of upper GIT bleeding. Ongoing infection with helicobacter pylori and use of NSAIDs (non-steroidal anti-inflammatory drugs) are risk factors.

Another serious condition is bleeding from oesophageal varices. These are dilated varicose veins, similar to varicose veins of the lower limbs.

They most often arise because of portal hypertension (increased pressure in the portal vein that goes to the liver). And with this, cirrhosis is given as the most common cause.

According to the source, they are roughly divided into:

• nonvariceal upper GIT bleeding
  • 80-90% of cases of upper GIT bleeding
  • bleeding not from varices
  • ulcerative disease - 28-59%
  • mucosal erosion - 1-47%
  • esophageal rupture - 4-7%
  • malignant disease - 2-4%
  • other causes - 2-7%
  • no known cause - 7-25% - cause not found
• variceal bleeding from the upper GIT
  • oesophageal variceal bleeding
  • complications of cirrhosis and other liver disease
  • for portal hypertension
  • High risk of mortality (mortality risk ratio)

The table lists the most common causes of bleeding by location

Bleeding is further divided into acute and chronic.

• acute - arises suddenly and may come from arteries, in the case of ulcers, or from veins in the case of oesophageal varices
• chronic - may be hidden and accompanied by problems such as weakness, fatigue, malaise and malaise
  • usually involves bleeding at:
    • oncological diseases
    • liver or kidney disease
    • blood diseases and clotting disorders
    • inflammatory diseases

Esophageal varices and haemorrhagic conditions are complications of long-term liver disease. Alcoholic liver damage and the conversion of healthy tissue to cirrhotic tissue are well known, for example.

Cirrhosis of the liver is a significant factor in the development of portal hypertension, which in turn influences the formation of oesophageal varices.

+ Liver damage is accompanied by impaired blood clotting.

Esophageal varices are a serious cause of upper gastrointestinal bleeding.

Learn how alcohol affects the body.

Bleeding in this case can be acute and massive. It manifests itself in vomiting of blood. It is a life-threatening condition that needs immediate professional treatment.

Otherwise, there is a risk of bleeding, shock and even death.

The opposite is the case of mild bleeding, which usually stops and the cause heals itself. In this case, it is a small erosion of the lining of the alimentary canal or a tear in the oesophagus, which may have occurred after persistent and repeated vomiting.

An example of irritated oesophageal and gastric mucosa is the drinking of large quantities of alcohol, especially if it was harder alcohol. And this can occur even in a person who drinks only sporadically, occasionally.

Similarly, vomiting of blood can also occur after taking certain drugs that irritate the stomach. An example is acylpyrine or a drug from the group of non-steroidal anti-inflammatory drugs.

In a few cases, haematemesis also occurs when a foreign object is swallowed.

It has been reported that approximately 80-90% of objects pass through the GIT without damage.
The remaining percentage is treated endoscopically because of associated difficulties.
Surgery is required in approximately 1%.
Examples are mainly small watch batteries or magnets.
Of course sharp objects.

Foreign object ingestion is encountered in young children, in the elderly, but also in prisoners or people with a psychiatric diagnosis.

Sometimes bleeding and vomiting of blood can be an accompanying symptom. It depends on the type and nature of the object.

Common objects include flashlights, magnets, coins, jigsaw puzzles, small toys, or swallowed large pieces of food, candy, etc.

Damage and perforation of the alimentary canal is especially likely when sharp objects with blades and points are ingested.

What symptoms may be present?

Vomiting blood is a manifestation of another disease. However, when there is bleeding in the digestive system, other health problems may also be present.

Examples of bleeding symptoms may include:

• vomiting blood - fresh or digested
  • massive bleeding = bright red blood + blood coagulation (clots)
  • mild bleeding = darker blood
    • dark brown, coffee-coloured deposit - melanemesis
  • vomiting of stomach contents with admixture of blood
• melena - black stools
• fatigue, weakness, lassitude and malaise - especially with prolonged or even minor bleeding
• abdominal pain, stomach pain
• dyspepsia - heaviness in the stomach and a feeling of vomiting
• lack of appetite
• pyrosis (heartburn)
• difficulty swallowing
• weight loss
• jaundice
• fresh blood in the stool - and this is if the blood has passed quickly through the bowel and at a higher volume
• tachycardia - increase in heart rate and pulse
• pallor, anaemia - anaemia
• rapid breathing - shortness of breath
• low blood pressure
• dizziness, especially when changing position, standing and walking
• syncope - brief loss of consciousness, fainting, collapse
• cold and sticky sweat and cold extremities
• blue limbs and cyanosis
• simultaneous vomiting and coughing up blood is a bad sign

Massive bleeding accompanies shock state and threatens the life of the person.

It is important to distinguish between vomiting of blood and brown smelling fluid (even after stool). This is vomiting of intestinal contents. It happens in intestinal obstruction (ileus). Both conditions are serious and need to be addressed without delay.

What is the diagnosis and treatment?

The history and the present subjective and objective complaints are important. Alcohol consumption, smoking, general lifestyle, use of medications, drugs are detected. An indication of trauma and other long-term diseases (ulcers, liver disease, hepatitis, etc.) is important.

+ Of great importance is the content of vomit and the nature of the vomited blood. Of course, also the frequency and time of vomiting.

Diagnostic methods:

• X-RAY
• USG / SONO
• CT
• MRI
• endoscopy
• ECG
• measurement of vital signs - blood pressure, pulse, respiratory rate
• blood sampling, anaemia, coagulation values, liver tests, etc.
• angiography
• GIT contrast examination

Treatment depends on the course and intensity of the bleeding. In most cases, mild bleeding stops, either spontaneously or after a conservative approach.

Alternatively, a nasogastric probe is inserted. With its help, the stomach is emptied. This has both a diagnostic and therapeutic effect, and further progress is monitored.

In case of intense bleeding, it is important to replenish the blood volume and, depending on the condition, a blood transfusion is necessary.

The Sengstaken-Blakemore probe is used for oesophageal varices. It is inserted through the nose into the stomach, where it is fixed. It inflates in the oesophagus, which compresses the bleeding veins. The advantage is that the contents of the stomach can be suctioned out.

A special technique is thermal and mechanical haemostasis. The aim is to stop the bleeding, for example, to coagulate the vessel by electrocoagulation, laser and otherwise. Mechanically, clipping, clamping the bleeding part, is performed.

Surgery and surgical solution is considered the most invasive intervention. Laparoscopy as a more gentle method.

You ask:

What is the first aid for vomiting blood?

It depends on the general condition and intensity of bleeding.

However, you should initially seek medical attention.
In case of massive bleeding, call the emergency medical services.

The person should be calm, not move, not eat or drink anything.

Vomiting of blood is serious in young children and newborns. Because of their young age, ingestion of a foreign object or an unspecified agent can be assumed.

It is forbidden to induce vomiting artificially, by force.

The child must be examined and professionally monitored.

Similar is the case with vomiting of blood in pregnancy. It may be the cause of repeated vomiting, straining and irritation of the mucous membrane. However, examination is needed to discover the exact cause.