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Emergency Management of Hematemesis

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Hematemesis, or vomiting of blood, is a medical emergency, with treatments varying depending on the amount of blood lost. Read to learn more.

Medically reviewed by

Dr. Ankush Dhaniram Gupta

Published At April 4, 2023
Reviewed AtApril 4, 2023


The medical name for vomiting blood is hematemesis. Vomiting blood is caused by regurgitation (vomiting) of bleeding stomach contents. Vomited blood can be bright crimson, dark red, or the color of coffee grounds. Vomiting can contain both food and blood. It is sometimes confused with the more common hemoptysis (coughing up blood) or epistaxis (nosebleed). The source is usually in the upper gastrointestinal system, above the suspensory muscle of the duodenum. Ulcers, stomach or esophageal tumors, varices, prolonged and severe retching, gastroenteritis, ingested blood (from bleeding in the mouth, nose, or throat), or certain medicines can all cause it.

Hematemesis is a medical emergency, with treatments varying according to the volume of blood lost. Endoscopy is one of the investigations. Intravenous fluids and blood transfusions can be used to replace any blood loss.

What Is Hematemesis?

The vomiting of blood is known as hematemesis. This is due to bleeding in the upper gastrointestinal (GI) tract. The blood could be brilliant red or look like coffee grounds. Hematemesis is a medical emergency that must be treated right away.

What Does It Indicate When Someone Vomits Blood?

In general, vomiting blood indicates that there is bleeding in the upper gastrointestinal (GI) tract. The esophagus, stomach, and duodenum are all part of the upper GI tract. If one swallows blood as a result of a nosebleed or mouth bleed, one may vomit it. If individuals have not ingested blood, it comes from the upper digestive tract. Bright red blood signals an active bleed that may be larger and more urgent. Like coffee grounds, blood that looks brown and lumpy is older. It could be an indication of a slowed or stopped hemorrhage. It normally takes a substantial amount of bleeding to cause vomiting.

What Are the Causes of Hematemesis?

There are various causes of blood vomiting. The majority of them are really serious and necessitate emergency medical intervention. Among the possible causes are:

  • Excessive vomiting causes a tear in the lining of the esophagus.

  • Varicose veins are veins that swell in the lower esophagus and stomach. This is common in persons with severe liver impairment, particularly those who have been alcoholics for a long time.

  • Gastritis (a stomach inflammation).

  • Taking an excessive amount of Aspirin or nonsteroidal anti-inflammatory medications.

  • Cancer of the pancreas.

  • Duodenal ulcer or stomach bleeding.

  • Esophagitis (an esophageal irritation or swelling).

  • A significant abdominal injury caused by an accident or a punch to the abdomen.

What Are the Diagnostic Tests for Hematemesis?

Bloody vomit can be a symptom of a wide range of medical issues. The doctor will ask questions about the symptoms and whether or not the individual has been hurt recently in order to reach a diagnosis. A diagnostic imaging study can give the doctor a look inside the body. Damaged organs or unusual growths might be seen on imaging scans. Typical imaging procedures for such reasons include:

  • Comprehensive blood analysis, including a complete blood count and chemical and coagulation function testing.

  • Evaluation of liver health by liver function tests.

  • X-rays.

  • For detecting internal bleeding, a nuclear medicine scan will be performed.

  • Rectal examination.

  • A nasogastric tube is inserted into the stomach through the nose to determine the source of the bleeding.

  • EGD (esophagogastroduodenoscopy) is a test used to examine the upper digestive tract for the cause of bleeding.

  • A computed tomography (CT) scan is a diagnostic imaging method that creates images of the body's internal anatomy using X-rays and computer technology. Bones, muscles, fat, organs, and blood arteries can all be seen in exquisite detail.

How Is Hematemesis Treated?

The doctor will create a treatment plan that takes into account both the symptoms and the underlying illness causing the vomiting of blood after the reason has been identified.

Emergency Care and Management:

  • The healthcare team, on priority, will stabilize any life-threatening conditions brought on by excessive blood loss, such as low blood pressure or difficulty breathing, if a person experiences a case of bloody vomiting.

  • Severe blood loss often needs medical intervention, including a blood transfusion, assistance with breathing, and maybe blood pressure medication and medication to reduce stomach acid.

  • Upper GI bleeds are usually treated by endoscopic variceal ligation within 12 hours, and patients are kept on intravenous fluids and monitored for possible surgery (occasionally, endoscopic sclerotherapy is used).

  • Surgical shunting is performed if bleeding cannot be stopped endoscopically.

  • Once a patient's condition has stabilized, whatever is causing the bloody vomit will be addressed.

After arriving at a diagnosis of what is the cause of the bloody vomiting, treatment is given for the underlying cause. The treatments can be:

  • Medication to suppress stomach acid production is an option. If an ulcer is to blame for the hematemesis, this might help.

  • Medicine to stop bleeding from an accident or rip may also be recommended.

  • The underlying cause of the bleeding could be treated with endoscopy. It is possible that the doctor will use heat to seal a tear. Some types of tissue can be clipped together to aid in the healing process.

  • If a patient loses a lot of blood, they will be given a blood transfusion.

  • To locate and stop arterial bleeding, angiography is performed. To take X-rays of the blood flow, a contrast liquid is injected into an artery.

  • Even after treatment, if the patient experiences significant bleeding due to any tears in the stomach or intestines, or if other therapies have failed, then there is a need for surgery.

  • Surgery may be necessary if there is an impediment or a tumor in the way.


There must be something wrong if there is blood in the vomiting. Blood in the vomit is not the same as blood in the spittle or the cough. The stomach is responsible for vomiting, and only a large amount of blood will cause vomiting and be expelled from the vomit. There may be a dire need to treat active internal bleeding. Until the medical staff can determine the root of the problem, they will treat it as an emergency. First, they will try to stop the bleeding and stabilize the condition so they can get to the root of the problem. Although not every cause warrants immediate medical attention, many of them are serious and may need emergency care and follow-up.

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Dr. Ankush Dhaniram Gupta
Dr. Ankush Dhaniram Gupta



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