Vomiting blood is called by the medical term Hematemesis (emesis meaning vomiting and hemat referring to blood). This is not the same as hemoptysis (coughing of blood) or epistaxis (bleeding in the nose) which happens due to other reasons. Hematemesis is a lot more serious condition. There are a wide range of reasons and conditions which cause vomiting of blood. Further, vomiting of blood is of three types. In this article, we will learn about all that, diagnosing the cause and treating the same.
Introduction
Blood showing up in body-emissions is not a rare thing. For example, vigorous brushing with a new toothbrush can cause a few drops of blood in spit or saliva. Repeated coughing due to various reasons (including lung cancer and tuberculosis) can cause a few drops of blood from the delicate inner-lining of lung-airways to get into the sputum (phlegm). Allergies, infections and injuries can cause nosebleeds. Inflammatory bowel disease, anal fissures, colorectal cancer and haemorrhoids can cause blood in the stools. Kidney conditions can cause blood in the urine, while a range of women’s health issues can cause vaginal bleeding, in addition to menstruation.
However, quite different from all is vomiting of blood, and it causes the most alarm in doctors. Here, we are not referring to one or two drops of blood causing pink vomit, but vigorous vomiting of blood. Of a significant quantity of blood. This is again of three types:
The vomit has red streaks mixed with food: the reasons are less severe in this case
The vomit is bright red: this means the blood flow is fresh and significant in quantity
The vomit is brown and resembles coffee grounds: In this case, the bleeding is old, or it has slowed down, or reduced
When one is showing any of these conditions, he/she must take a sample of the vomit and rush to the nearest hospital. The sample will help speed up diagnosis and hence treatment.
Also Read: UNDERSTANDING PANCREATITIS[1]
Causes and Risk Factors
There are a wide range of conditions that can cause hematemesis, including:
Bleeding ulcers: Peptic ulcer is a type of ulcer that occurs in the stomach and duodenum and is marked by open sores. Its either caused by bacterial infections or long-term use of NSAID medication.
Severe inflammation: Acute inflammation of the esophagus (called Esophagitis) or stomach lining can cause haemorrhage (ruptured arteries leading to bleeding) in the arteries underneath. Common causes for this include alcohol abuse, long-term use of NSAIDs or aspirin, and severe acid reflux in some people.
Portal hypertension: This is one of the consequences of cirrhosis of the liver. It is marked by increased pressure in the abdominal veins, especially in the esophagus and stomach. These eventually rupture leading to bleeding in the gut.
Chronic pancreatitis: Long-term pancreatitis is known to affect blood vessels surrounding the pancreas, leading to their rupture and hence bleeding. Thereafter, the blood enters the duodenum.
Trauma (injury): Sporting injuries, vehicle collisions, accidental or intended bullet-shots and stabbing can cause severe injuries in the stomach or esophagus leading to hematemesis. In rare cases, surgical procedures can also cause vomiting of blood.
Mallory-Weiss syndrome: Violent vomiting due to alcohol abuse can cause a tear in the esophagus called a Mallory-Weiss tear which leads to hematemesis.
Tumours: Both benign and malignant tumours of the esophagus, stomach and pancreas can bleed once in a while leading to hematemesis.
Angiodysplasias: Abnormal blood vessels that form on the surface of the stomach and intestines can bleed leading to bloody vomit
Cirrhosis (scarring of the liver)[2] and acute liver failure (stages 3 or 4 of liver failure)
Dieulafoy’s lesion: In this, an artery protrudes through the stomach wall abnormally. It eventually ruptures leading to hematemesis.
Acute inflammation of the duodenum (top part of the small intestine), called Duodenitis
Gastric erosions: In this, bacteria such H. pylori, NSAIDs and other medication cause breakdown of tissue lining the stomach, leading to hematemesis
Gastropathy: Similar to the above. Here, blood-vessels in the stomach-lining get dilated and rupture leading to bloody vomit
Swallowing blood after a nosebleed or oral surgery
Severe case of gastroesophageal reflux disease (GERD)[3] in which there is severe irritation of the stomach-lining leading to haemorrhage in the blood-vessels there
Liver conditions such as alcoholic hepatitis and fatty liver disease
Esophageal varices: Scar tissue or clots in the liver block normal blood flow, after which blood-flows gets redirected to blood vessels in the esophagus which are not meant to carry so much blood. As a result, they swell up (condition called Esophageal varices), eventually rupture and leak blood in to the gut leading to a serious form of hematemesis.
Swallowing a poison, accidentally or intentionally to take one’s life
Viral haemorrhagic fever, where an infectious disease causes severe illness and internal bleeding
A blood condition like anaemia or haemophilia
Gastritis and Gastroenteritis: Viral and bacterial infections can cause irritation or inflammation of the stomach and intestines leading to bleeding there
Anomalies or disoders of the blood, such as anaemia, low platelet-count, haemophilia (blood-clotting disorder) and leukaemia
Congenital (since birth) anomalies of the GI tract or circulatory systems
Vitamin K deficiency – this is more common in children
Milk allergy – in infants
Foreign objects that are accidentally swallowed, which cause tears in the esophagus or stomach wall
Radiation poisoning from cancer treatment
Schistosomiasis which is an infection occurring in the liver or intestine caused by a parasite called Schistosoma mansoni
Latrogenic injury: This is an accidental bleeding caused by invasive surgical procedures such as endoscopy or transesophageal echocardiography
Atrio-oesophageal fistula: Atrial fibrillation ablation is a treatment for an irregular and random heartbeat called atrial fibrillation. It can cause Atrioesophageal fistula which is marked by enormous heat injury to the esophagus and surrounding structures leading to hematemesis.
Yellow fever: A disease transmitted by mosquitoes
Strongyloidiasis: a disease caused by a roundworm from the Strongyloides family
A type of plague called septicemic plague
Complications / When to see a doctor
Vomiting of blood can cause severe blood loss leading to what is called hypovolemic shock when nearly 20% of the blood is vomited out. This leads to organ failure and death. Fortunately, this is rare.
However, shock still occurs when blood-loss crosses a certain threshold. Symptoms of such shock are as below. One must rush to a doctor when they vomit blood and show any of these symptoms:
Feeling dizzy or light-headed
Feeling confused or disoriented
Severe pain in the chest or abdomen
Fast and shallow breathing
Tachycardia or rapid heartbeat
Low urine output
Pale, cold and clammy skin
Fainting (syncope)
Blurred or hazy vision
Also Read: Dangers of Over-the-Counter (OTC) medication![4]
Diagnosis
Upper endoscopy: In this, the doctor pushes an endoscope gently[5] into the stomach through the mouth. This has a light and camera at its end. Images relayed by the camera onto a monitor screen in the operating-room will show the location and possible cause of the problem in the upper GI tract.
Complete blood-count: This will assess the extent of blood-loss, severity of the condition and hence possible causes.
Imaging scans such as PET, MRI, X-ray, CT and ultrasound of the GI tract will show injuries or abnormalities which may be causing hematemesis.
Treatment
The first line of treatment is blood transfusion if there is severe blood-loss. This is important to prevent organ damage. This will be followed by hydration through fluids given through an IV.
Medication will be given to stop vomiting, reduce stomach acid secretions, treat ulcers and certain other conditions that can be addressed quickly.
If the imaging scans reveal perforations (holes) in the esophagus, stomach or bowel, surgery will be done to plug the same. So also, if foreign objects have been swallowed or stuck in the gut after accidents, surgery will be required. Such surgeries are generally laparoscopic or endoscopic, and rarely open-incisional.
Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai (Alwarpet & Vadapalani), Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and pediatric trauma care.