Hematemesis, or vomiting blood, is a medical emergency that often signals bleeding in the upper gastrointestinal (GI) tract. The sight of blood in vomit can be frightening, and rightly so—it may indicate conditions ranging from stomach ulcers to life-threatening variceal bleeding.
Early recognition, prompt diagnosis, and timely treatment are critical for preventing complications and saving lives. This article explains hematemesis in detail, including its causes, symptoms, diagnosis, treatment options, and when to seek urgent medical care.
What Is Hematemesis?
Hematemesis refers to the vomiting of blood, usually originating from the upper gastrointestinal tract, which includes:
Esophagus
Stomach
Duodenum (first part of the small intestine)
The blood may appear:
Bright red, suggesting active and rapid bleeding
Dark brown or black, resembling coffee grounds, indicating slower bleeding where blood has been partially digested by stomach acid
Hematemesis is different from hemoptysis (coughing up blood) and should never be ignored.
Why Is Hematemesis Dangerous?
Vomiting blood can lead to:
Severe blood loss
Death if untreated
The severity depends on:
The cause of bleeding
Amount of blood loss
Speed of diagnosis and treatment
Patient’s age and existing medical conditions
Common Causes of Hematemesis
1. Peptic Ulcer Disease
One of the most common causes, peptic ulcers develop due to:
Excess acid production
Ulcers can erode blood vessels, causing bleeding.
2. Esophageal Varices
These are dilated veins in the esophagus, usually seen in patients with:
Variceal bleeding can be massive and life-threatening.
3. Gastritis and Erosive Esophagitis
Inflammation of the stomach or esophagus may result from:
4. Mallory–Weiss Tear
A tear at the gastro-esophageal junction, often caused by:
Repeated forceful vomiting
Severe coughing
Alcohol binge
Bleeding is usually sudden but often self-limited.
5. Upper GI Malignancies
Cancers of the:
Stomach
Esophagus
may cause chronic or acute bleeding, often accompanied by weight loss and anemia.
6. Swallowed Blood
Blood from:
Nosebleeds (epistaxis)
Oral injuries
may be swallowed and later vomited, mimicking hematemesis.
Symptoms Associated With Hematemesis
In addition to vomiting blood, patients may experience:
Fainting
Appearance of Blood in Hematemesis
| Appearance | Possible Meaning |
|---|---|
| Bright red blood | Active, ongoing bleeding |
| Coffee-ground vomitus | Slower bleeding, blood exposed to stomach acid |
| Clots in vomit | Heavy or recent bleeding |
When Should You Seek Emergency Care?
Seek immediate medical attention if:
You vomit any amount of blood
There is dizziness or fainting
Blood pressure drops
Heart rate increases
There is black stool along with vomiting
Do not wait for symptoms to worsen.
How Is Hematemesis Diagnosed?
1. Clinical Evaluation
Doctors assess:
History of vomiting
Alcohol or drug use
Previous ulcers or GI bleeding
2. Blood Tests
Hemoglobin and hematocrit
Coagulation profile
3. Upper GI Endoscopy
The gold standard for diagnosis:
Identifies the source of bleeding
Allows therapeutic intervention (clipping, banding, cauterization)
4. Imaging Studies
CT scan in selected cases
Treatment of Hematemesis
Treatment depends on the cause and severity of bleeding.
1. Initial Stabilization
IV fluids
Blood transfusion (if required)
Oxygen support
Continuous monitoring of vitals
2. Medications
Proton Pump Inhibitors (PPIs)
Reduce stomach acid and promote clot stabilityVasopressors / Octreotide
Used in variceal bleedingAntibiotics
Given in cirrhosis or suspected infection
3. Endoscopic Therapy
During endoscopy:
Bleeding ulcers can be cauterized
Varices can be banded
Tears can be clipped
4. Surgical or Radiological Intervention
Reserved for cases where:
Endoscopy fails
Bleeding is uncontrollable
Recovery and Prognosis
The outcome depends on:
Cause of bleeding
Speed of treatment
Patient’s overall health
With early intervention, most patients recover well. However, recurrent bleeding may occur if underlying conditions are not managed.
Prevention of Hematemesis
Avoid excessive alcohol
Limit unnecessary painkiller use
Treat H. pylori infection
Manage liver disease properly
Regular follow-ups for high-risk patients
Hematemesis vs Melena
| Feature | Hematemesis | Melena |
|---|---|---|
| Blood exit | Vomiting | Stool |
| Appearance | Red or coffee-ground | Black, tarry |
| Indicates | Upper GI bleeding | Usually upper GI bleeding |
Frequently Asked Questions (FAQs)
Is hematemesis always serious?
Yes. Vomiting blood is always considered serious and requires urgent medical evaluation.
Can stress cause hematemesis?
Stress alone does not cause hematemesis, but severe stress may worsen gastritis or ulcers that bleed.
How much blood is dangerous?
Any visible blood in vomit is dangerous and should prompt immediate medical attention.
Can hematemesis stop on its own?
Some minor causes may resolve, but medical evaluation is still essential to rule out serious conditions.
Is hematemesis curable?
Yes, if the underlying cause is identified and treated promptly.
Can children have hematemesis?
Yes, though less common. Causes include gastritis, swallowed blood, or infections.
Does hematemesis always mean cancer?
No. Most cases are due to ulcers, gastritis, or varices. Cancer is a less common cause.
What tests confirm hematemesis?
Upper GI endoscopy is the most definitive diagnostic test.
Can lifestyle changes help prevent recurrence?
Yes. Avoiding alcohol, smoking, NSAIDs, and managing chronic illnesses significantly reduce risk.
Key Takeaway
Hematemesis is not a symptom to ignore. Vomiting blood signals potentially serious internal bleeding that requires immediate medical attention. Early diagnosis, timely treatment, and proper follow-up can be life-saving.
If you or someone near you experiences hematemesis, seek emergency care without delay.
#BhaloTheko
Disclaimer:
No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.
Sparsh Doctor List
