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Hematemesis - Blood in Vomit

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Hematemesis is a dangerous condition that refers to the vomiting of blood and needs emergency treatment. Read the article to get an insight into it.

Medically reviewed by

Dr. Rajesh Jain

Published At December 19, 2022
Reviewed AtJuly 27, 2023

Introduction

Vomiting is an uncontrollable reflex that excretes the contents of the stomach through the mouth. It is not a disease but a symptom of an underlying condition. Vomiting lasts for a day or two because of food poisoning or other gastric-related conditions. The patient must consult a doctor when it lasts longer and at frequent intervals. Hematemesis is a serious condition wherein the person has bloody vomiting. Blood in vomiting indicates internal bleeding and requires immediate attention.

What Is Hematemesis?

Hematemesis refers to vomiting blood and other stomach contents through the mouth. The patient must always notice the color of the vomit. When it contains bright red or darker shades of red spots in the vomit, it must be immediately brought to the doctor's notice. Blood in vomit indicates bleeding happening within the digestive tract, which includes the esophagus (food pipe), stomach, and duodenum (the first portion of the small intestine). Hence, it must be consulted with a doctor as soon as possible to find the exact cause and get appropriate treatment.

What Are the Changes Noticed in Hematemesis?

In hematemesis, the patient can notice a change in the color of the vomit, which can vary from bright red, brown, black, or coffee ground. Apart from the color and the consistency of the blood vomit, other symptoms can also occur depending on the underlying cause. They include nausea, dizziness, pale skin, blurred vision, enlarged pupils, abdominal pain, weakness, shallow breathing, and cold skin. When the patient feels the above symptoms in addition to the blood vomiting, it should not be avoided and must consider immediate hospitalization.

What Are the Causes of Hematemesis?

There are many possible reasons for hematemesis to occur. They include:

  • Irritation in the lining of the stomach or the esophagus.

  • Presence of tears in the lining of the stomach.

  • Gastritis (inflammation of the stomach lining).

  • Poisoning due to food or any drug.

  • A severe gastroesophageal reflux disease (due to repeated expulsion of the acid contents from the stomach into the esophagus).

  • Bleeding from the esophageal varices (enlarged vein in the esophagus).

  • Chronic pancreatitis (inflammation of the pancreas) can cause damage to the blood vessels around the pancreas, and the blood can spread to the duodenum.

  • Trauma to the stomach or esophagus by violent acts or accidental injury during surgery can lead to internal bleeding.

  • Tumor in the stomach or esophagus.

  • Patients consuming medications such as painkillers and blood thinners for a long time.

  • In patients with increased alcohol consumption, it may cause heavy vomiting creating a tear in the esophagus. This condition is called Mallory-Weiss syndrome.

  • In patients with abnormal, dilated blood vessels that cause bleeding from the stomach.

  • Surgery involving an endoscope (a long thin tube with a camera attached at one end to visualize the inner structures in detail from the outside) can sometimes damage the digestive tract.

  • Patients with liver diseases such as hepatitis (inflammation of the liver) and cirrhosis (permanent liver damage due to the replacement of healthy tissue with scar tissue).

  • In patients with vitamin K deficiency or bleeding disorders, hematemesis can occur due to the inability of the blood to clot.

Why Does Alcohol Consumption Cause Hematemesis?

Patients with the habit of alcohol consumption usually have symptoms of vomiting. But, blood vomiting in these patients indicates a very severe complication. In the liver, excessive consumption of alcohol can cause scars on the liver and leads to the bursting of the blood vessels, and hematemesis occurs. Another complication of alcohol consumption is the formation of stomach ulcers due to the acid content in the alcohol that damages the stomach wall. The ulceration may bleed and lead to hematemesis. Hence, patients with hematemesis must quit the habit of alcohol consumption as it worsens the condition and does not provide any relief even when the patient is under treatment.

What Are the Investigations Done for a Patient With Hematemesis?

  • Medical History - A complete medical history of the patient is noted down. History regarding the frequency of vomiting, the color of vomit, and the presence of red spots or whole blood on vomiting. The patient is also asked if they are under any medications such as painkillers or Aspirin (blood thinner). Habit history regarding the consumption of alcohol is also noted.

  • Endoscopy - An endoscopy can be done to examine the digestive tract of the patient. The endoscope is inserted into the patient’s stomach carefully to detect damage or bleeding within the internal structures. A clear view of the internal organs, like the stomach and the esophagus, is obtained with the help of an endoscope.

  • CT Scan - A CT (computed tomography) scan is an X-ray to detect any tumors, tears, or obstruction within the stomach lining or the esophagus.

  • Blood Test - A complete blood count is done to check for iron levels and the clotting process. The presence of anemia (low red blood cells) and the amount of blood loss that occurred are checked.

  • Biopsy - The doctor may also suggest a biopsy wherein a portion of the suspected tissue is removed and sent to the laboratory for a microscopic examination. This test is done to confirm cases where cancers or tumors are causing hematemesis.

What Is the Treatment for Hematemesis?

The doctor thoroughly checks the patient’s medical condition, habits, drug history, and allergy history. The exact cause for the hematemesis is found and confirmed with imaging and blood tests. The doctor must carefully prescribe a drug that does not precipitate the patient's present condition. Some painkillers and antibiotics decrease the clotting ability and might increase the chances of bleeding and hematemesis. Hence, the aim of the treatment must be to detect the cause of bleeding, identify the source of bleeding, and restore normal blood volume.

  • In cases of minimal blood loss, drugs like proton-pump inhibitors (a drug that decreases stomach acid secretion) can be tried if the cause is stomach ulceration. If the hemoglobin level is low, a blood transfusion can be done to restore the normal hemoglobin level.

  • In cases of increased blood loss by vomiting blood, the patient is provided with intravenous fluid and blood transfusion. The airway and breathing of the patient are checked. If there is any obstruction, they are cleared away and secured. An emergency endoscopy is done to check the internal structures, and surgery is performed if necessary.

Conclusion

Hematemesis is an emergency condition that needs immediate attention and consultation with a doctor. The cause for the blood vomiting is found to start the treatment towards providing a permanent cure. Until then, only symptomatic treatment is being provided. The treatment outcome is good, and the main aim must be to restore the blood volume and prevent further complications from developing.

Frequently Asked Questions

1.

What Causes Hematemesis?

 - The causes of hematemesis are 
 - Bacterial infection. 
 - Acute inflammation of the stomach lining and esophagus. 
 - Chronic alcoholism. 
 - Severe acid reflux.
 - Regular use of NSAIDs (non-steroidal anti-inflammatory drugs). 

2.

How to Diagnose Hematemesis?

Hematemesis can be diagnosed by performing the following.
 - Blood tests. 
 - Liver function tests.
 - X-rays.
 - Nasal endoscopy.
 - Rectal examination.
 - Nuclear medicine scan.

3.

How Can Hematemesis Be Prevented?

Hematemesis can be prevented in the following ways. 
 - Avoid taking NSAIDs (non-steroidal anti-inflammatory drugs).
 - Avoid smoking.
 - Avoid alcohol and caffeine intake. 
 - Eat healthy food.
 - Stay hydrated. 

4.

How Can Hematemesis Be Managed?

The treatments of hematemesis include:
 - Medications that reduce the acid production in the stomach.
 - Endoscopy to identify and treat the cause of hematemesis.
 - Blood transfusion.
 - Angiogram to identify the bleeding spot and stop it.
 - Surgery to correct the stomach lining tear or removal of the tumor. 

5.

What Are the Factors Associated With Hematemesis?

Hematemesis is associated with the following:
 - Bleeding ulcers.
 - Vigorous retching causes esophageal mucosal tears.
 - Intestinal varices.
 - Vascular malformation of the gastrointestinal tract. 

6.

Does Hematemesis Occur During Pregnancy?

Hematemesis can occur during pregnancy due to the following causes:
 - Pregnancy gingivitis.
 - Throat irritation.
 - Esophageal tear.
 - Stomach ulcer.

7.

What Is Hematemesis?

Hematemesis is characterized by internal bleeding, in which the individual vomits red with a coffee-ground appearance. Severe gastritis is an essential cause of hematemesis, requiring immediate attention to prevent its progression.

8.

Does Blood Loss Cause Vomiting?

Severe bleeding (external or internal) or fluid loss can cause hypovolemic shock. Also, the individual may experience a few symptoms like nausea and headache. However, the symptoms may worsen when more than 15 to 30 percent of the blood is lost.

9.

Does Vomiting Affect the Blood pH?

Gastric acid contains hydrochloric acid. During vomiting, the gastric acid containing hydrogen and chloride ions is excreted, whereas the bicarbonate ion gains the extracellular space, leading to an alkaline pH (increased pH) in the blood.

10.

Is Hematemesis Fatal?

An episode of hematemesis can cause blood loss. If severe, it can be life-threatening. The individual can go for a hypovolemic shock (due to loss in blood volume) due to the bleeding, and the condition becomes fatal.
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Dr. Rajesh Jain

General Practitioner

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