Hematemesis (Vomiting Blood): Causes, Diagnosed & Treatment

Types of Hematemesis

• Mild Hematemesis: You may see small streaks or spots of blood in your vomit. This usually happens due to small tears in the food pipe caused by forceful vomiting.
• Moderate to Severe Hematemesis: This involves vomiting larger amounts of blood. The blood may be bright red (indicating fresh bleeding) or dark and clotted (indicating older or slower bleeding).

What causes Hematemesis?

There are several causes of vomiting blood. Most of them are very serious and require immediate medical attention. The causes can include:

• A tear in the esophagus's lining, caused by excessive vomiting
• Swelling of the veins ( varicose veins) in the lower esophagus and stomach is a common hematemesis cause, often seen in people with severe liver damage, including those with long-term alcoholism.
• Stomach bleeding or duodenal ulcer
• Irritation or swelling of the esophagus called esophagitis
• A benign or cancerous tumor of the stomach or esophagus
• A serious injury to the abdominal area, caused by a car accident or a blow to the abdomen
• Inflammation of the stomach called gastritis
• Taking too much aspirin or nonsteroidal anti-inflammatory drugs
• A condition called Dieulafoy's lesion, which affects an artery in the wall of the stomach
• Inflammation of the small intestine called duodenitis
• Pancreatic cancer

Conditions that Cause Hematemesis

• Gastroesophageal Reflux Disease (GERD) with severe erosion
• Esophageal Varices (commonly due to liver cirrhosis)
• Peptic Ulcer Disease
• Gastric or Esophageal Carcinoma
• Portal Hypertension
• Erosive Gastritis
• Hemorrhagic Pancreatitis
• Coagulation Disorders (e.g., Hemophilia, liver failure-induced coagulopathy)
• Angiodysplasia of the GI tract
• Stress-related mucosal disease (SRMD) in critically ill patients
• Post-endoscopy or surgical complications

What are the Symptoms of Hematemesis?

• Vomiting Blood: The primary symptom is the presence of blood in vomit, which may appear bright red or have a "coffee-ground" appearance if the blood has been in the stomach for a while.
• Abdominal Pain: Discomfort or pain in the stomach area may accompany the vomiting, often related to the underlying cause of the bleeding.
• Nausea: Persistent nausea is common and may occur alongside the vomiting of blood.
• Signs of Shock: In severe cases, symptoms like dizziness, rapid heartbeat, pale skin, and low blood pressure may indicate significant blood loss and require immediate medical attention.

When to Seek Medical Help for Vomiting Blood?

• Vomiting blood, known as hematemesis, is a concerning symptom that should never be ignored. While some cases may result from minor causes, such as a small tear in the esophagus from excessive vomiting, it can also point to more serious health issues, including internal bleeding, organ damage, or gastrointestinal disorders.
• If you experience large amounts of blood or notice any other concerning symptoms like dizziness, rapid heartbeat, nausea or weakness, it's crucial to seek medical care as soon as possible.
• Remember, even if the blood seems minimal, always consult a healthcare professional right away. Early detection and intervention are key to preventing serious outcomes.

Diagnosis and Tests

Vomiting blood (also called hematemesis) can be caused by many different health problems. To find out the cause, your doctor will first ask about your symptoms and any recent injuries.

If your doctor suspects hematemesis, they may use the following tests to see inside your body:

• CT scan
• Endoscopy a device that allows your doctor to look into your stomach
• Ultrasound
• X-ray
• MRI

An upper endoscopy is commonly used to check for bleeding inside the stomach. It's done while you're sedated (relaxed or asleep), and helps the doctor see exactly where the bleeding is coming from.

Your doctor might also order a blood test to check how much blood you've lost. In some cases, a biopsy (taking a small tissue sample) may be done to check for inflammation, infection, or cancer. Your doctor may order additional tests depending on your blood count result.

Treatment and Management

If you vomit blood, your healthcare team will first try to stabilize any low blood pressure, breathing problems, or other complications from excessive blood loss. You may need a blood transfusion, breathing help, and medicine for your blood pressure or to lower stomach acid levels. You may also need IV fluids and possibly surgery.

Once a patient is stable, the cause of vomiting blood will be treated. To determine the cause, several tests can be performed. These include:

• Blood tests to take a complete blood count, check blood chemistry and clotting function
• Liver function tests
• X-rays
• A nuclear medicine scan to look for any active bleeding in the gastrointestinal tract.
• A rectal exam
• Insertion of a tube through the nose into the stomach to check for the cause of the blood loss
• A test called an esophagogastroduodenoscopy (EGD) to look for sources of bleeding in the upper digestive tract

Once the cause of the vomiting blood is determined, your doctor will determine the best treatment plan that will address both your symptoms and the underlying condition causing the vomiting.

Prevention Tips for Hematemesis

• Limit alcohol intake
• Avoid excessive NSAID use
• Manage underlying liver or gastrointestinal conditions
• Eat balanced meals and avoid overly spicy foods
• Treat acid reflux early

Home Remedies for Hematemesis

While home remedies cannot replace medical treatment, some supportive measures include:

• Drinking cold water to soothe irritation
• Avoiding spicy, acidic, or hot foods Using ginger or chamomile tea to calm the stomach (with caution)
• Rest and hydration

Lifestyle Changes for Hematemesis

• Avoid smoking and alcohol
• Maintain a healthy weight
• Manage stress through yoga or meditation
• Follow up regularly with your doctor if you have chronic liver or gastrointestinal conditions.
• Eat small, frequent meals to reduce stomach irritation.