By Patty Weasler, RN, BSN 

 Medically reviewed by Jay N. Yepuri, MD

"Hematemesis" is the medical term for vomiting blood. Blood that is vomited comes from the upper gastrointestinal (GI) tract. It can be caused by something minor or a severe condition. Common causes are peptic ulcer disease and esophageal varices.

Vomiting blood is a medical emergency. You should head to a hospital emergency department.

This article will cover the causes, diagnosis, and treatment of hematemesis. It will focus on identifying blood in vomit and why it is a medical emergency.

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What’s Considered Hematemesis?

Hematemesis is when someone vomits blood. The vomit could be made up entirely of blood or it could be the stomach contents mixed with blood.

Bleeding in the GI tract can cause hematemesis. The GI tract includes the:

• Mouth

• Throat

• Esophagus

• Stomach

• Duodenum (the upper part of the small intestine)1

Color

Hematemesis can be a wide range of colors. The blood may be mixed in with vomit that contains stomach contents, or it can be only blood.

Hematemesis colors could include:1

• Bright red

• Dark red

• Black

• Blood mixed with food

• Coffee ground (dark red or black with a coffee ground-like consistency)

Blood that is red and appears to be fresh indicates severe and active bleeding, while blood that resembles coffee grounds indicates older blood and previous bleeding.2

Source of Bleeding

The source of bleeding in hematemesis is usually somewhere in the upper GI tract.1

The upper GI tract includes the mouth, throat, esophagus, stomach, and duodenum (the upper part of the small intestine).1 Bleeding can originate in any of these areas of the body.

Oftentimes, the source can only be found by a healthcare provider after diagnostic testing has been done.

When to Seek Medical Care

Anytime someone is vomiting blood, they should seek immediate care. The bleeding can be something minor to a life-threatening condition, and a healthcare provider will need to determine that.

Even a small amount of blood can mean something serious or quickly turn into a large amount of blood.

Vomiting blood can be mistaken for coughing up blood (hemoptysis). Whatever the cause, it's crucial to go to an emergency department or call 911.

Signs of Shock

Hematemesis can cause you to lose a significant amount of blood. Hypovolemic shock will occur when one-fifth of your blood is lost.3 This is a life-threatening condition.

Hypovolemic shock is when there is not enough blood and fluid pumping through the heart. The large decrease in the blood supply means that organs and tissues will receive less oxygen and nutrients. This causes organ and tissue damage, which can lead to death if not promptly treated.3

The signs of hypovolemic shock are:3

• Clammy, cool skin

• Pale skin

• Decreased urination

• Confusion or anxiety

• Weakness

• Breathing fast

• Fast heart rate

• Low blood pressure

Shock is an absolute medical emergency. Head to a hospital emergfency department right away.

Reasons You Could Be Throwing Up Blood

The causes of vomit in blood can range from very minor conditions to severe diseases. In most cases, the cause is not immediately obvious and can be caused by medication, injury, or a disease process.

The most common causes of GI bleeding that cause hematemesis are:2

• Peptic ulcer disease

• Varices

• Mallory-Weiss tear

• Cancer

• Swallowing blood after a nosebleed

• Forceful or prolonged vomiting

Other causes of vomiting blood are:2

• Esophagitis

• Gastritis

• Blood clotting disorders

• Gastric antral vascular ectasia (GAVE)

• Dieulafoy's lesions

Diagnostic Process With a GI Specialist

A GI specialist is a healthcare provider who diagnoses and treats conditions of the GI tract. If you have hematemesis, you will see a GI specialist, who will perform certain diagnostic testing to determine the cause of the bleeding.

The types of tests will depend upon the severity of bleeding and if there is a known cause. You can expect the following tests:1

• Blood test : to assess blood count (CBC), liver function tests, and blood clotting

• Rectal exam

• Esophagogastroduodenoscopy (EGD): An EGD is also known as an upper GI. During an EGD, the patient is sedated and a GI specialist will insert a small scope with a camera into the patient's mouth. They will guide it down the esophagus, to the stomach, and upper small intestine.4

The EGD looks for bleeding in the upper GI tract. This helps healthcare providers make a diagnosis and form a treatment plan.

Risk of Anemia

Anemia is when the blood does not carry enough oxygen for the body. It can be caused by red blood cell injury, blood loss, and not enough red blood cells being produced.5

A GI bleed that causes a large amount of bleeding or bleeding over a long time puts you at risk for anemia. A slow GI bleed that has been occurring for a long time can go undetected until a blood test reveals anemia.

Hematemesis increases your risk of anemia due to the blood lost during vomiting.

Emergency Treatment

In the emergency room, the medical team will monitor your breathing, blood pressure, heart rate, and urination.

Initial treatment will be aimed at keeping the patient's vital signs stable with oxygen, intravenous (IV) fluids, blood transfusions, and medications.

An EGD may be performed to stop the GI bleeding that causes hematemesis. The healthcare provider can apply medications to the bleeding site, treat the bleed with a laser or heat probe, or stop bleeding with a clip or band around the blood vessels.6

Summary

Hematemesis is the act of vomiting lood. It is a medical emergency. The blood could come from anywhere in the upper GI tract, and finding a specific source can be difficult. A healthcare provider will be able to assess the severity of the bleed as well as determine the best treatment options. Treatments can be as simple as medication or involve an invasive procedure.

 Sources

MedlinePlus. Vomiting blood.

Kim BSM, Li BT, Engel A, et al. Diagnosis of gastrointestinal bleeding: A practical guide for clinicians. World J Gastrointest Pathophysiol. 2014;5(4):467-478. doi:10.4291/wjgp.v5.i4.467

MedlinePlus. Hypovolemic shock.

MedlinePlus. EGD - esophagogastroduodenoscopy.

MedlinePlus. Anemia.

National Institute of Diabetes and Digestive and Kidney Diseases. Treatment for GI bleeding.

MedlinePlus. Coughing up blood.

By Patty Weasler, RN, BSN
Patty is a registered nurse with over a decade of experience in pediatric critical care. Her passion is writing health and wellness content that anyone can understand and use.