Vomiting blood is scary! And with good reason. The cause may be a serious disease, although not always. So it’s important to be seen and thoroughly assessed.
In the oesophagus, the most dangerous causes are oesophageal cancer and bleeding from dilated blood vessels at the lower end of the oesophagus (called oesophageal varices) due to liver cirrhosis (scarring). Cancer and liver cirrhosis are life threatening diseases and must be quickly diagnosed. Less serious causes include bleeding due to reflux oesophagitis eroding into a blood vessel and Mallory Weiss tear, whereby the force of retching and vomiting due to other causes (such as alcohol intoxication or food poisoning) is so great that the lower oesophagus lining tears and bleeds.In the stomach and duodenum, the most dangerous causes are stomach cancer and bleeding from dilated blood vessels at the upper end of the stomach (called gastric varices) due to liver cirrhosis. Less serious causes are commonly peptic ulcers, in the stomach or in the first part of the duodenum, gastritis caused by some types of drugs (typically pain killers of the class of Non-Steroidal Anti-Inflammatory Drugs or NSAIDS) or excessive use of alcohol, or abnormal blood vessels that may spontaneously bleed.How can I be diagnosed?
Vomiting blood is usually alarming enough for patients to be sent to hospitals or to Gastroenterologists or General Surgeons immediately.
A good history is taken to detect a history Hepatitis B or C infections, or prolonged excessive alcohol consumption, that might lead to liver cirrhosis, a history of peptic ulcer disease, use of NSAIDS or use of drugs to reduce the clotting ability of blood to protect from heart attack or stroke. If there is a history of retching or vomiting due to excessive drinking of alcohol or from food poisoning, then it might be Mallory Weiss tears. A history of heartburn and/or acid regurgitation might point towards reflux oesophagitis or oesophageal cancer. Alarm features suggestive of cancer include difficulty in swallowing (dysphagia) loss of appetite and weight over a period of time.
If the bleeding is large volume or recurrent, blood might find its way down through the digestive tract and be converted by bacteria in the large intestine to become a very smelly tarry black stool called Melaena. Doctors would ask about this and do a rectal examination as well. Some patients first present with Melaena rather than vomiting of blood.
An endoscopic examination called Gastroscopy will usually be offered, as it allows direct visualisation of the oesophagus, stomach and upper part of the small intestine where the blood vomited is most likely from. Gastroscopy also allows the doctor to stop bleeding from ulcers if it is still carrying on, using injections, heat devices, metallic clips or Hemospray – a fine powder that is sprayed onto a bleeding vessel which would stop the bleeding. Oesophageal varices are banded by rubber bands and bleeding gastric varices can be stopped up by injection of a kind of super-glue.
Is vomiting blood immediately life threatening?
That depends on the volume of blood already lost and whether the bleeding is continuing. Acute blood loss in large volumes can be fatal.
What can be done to save patients?
If considerable volume of blood has been lost over a short time, it is necessary to resuscitate the patient using the “Airway, Breathing, Circulation (ABC)” sequence. Blood volume can be replaced by intravenous fluids or blood products. Gastroscopy will likely be done soon after resuscitation to determine the cause and stop bleeding if it is continuing, followed by the appropriate medical treatment depending on the underlying cause.
This article was written by Dr Tan Chi Chui and originally published in Gastroenterology & Medicine International. To make an appointment with Dr Tan, click here.
by Hridya Anand
A biochemist by education who could never put what she studied to good use, finally found GetDoc as a medium to do what she loved - bring information to people using a forum that is dedicated to all things medical. View all articles by Hridya Anand.