Blood In Vomit And Stool: Hematemesis, Melena Or Hematochezia

It is awfully scary for a person to see blood coming out of his body, may it be in the form of vomiting, sputum, or with stools. Such an occurrence should not ignored, since symptoms like these may be indicative of certain conditions that are typically known to cause excretion of blood from the body. If left untreated, most of these conditions can be fatal. Knowing the differences between the conditions that may cause bleeding can be helpful in case of an emergency.

The blood is usually seen coming with vomiting or during defecation. Vomiting of blood is known as hematemesis and fresh blood coming with stools is called hematochezia. On the other hand, the passage of black tarry stools is called Melena.

What Is The Difference Between Melena And Hematochezia?

Melena and hematochezia are both related to blood coming along with defecation. However, both of these conditions are totally different from one other.

The part of the digestive tract that lies above the small intestine is called the upper gastrointestinal tract. If there is a bleeding in this part of the digestive tract, it either spills out in the form of vomiting, which is called hematemesis, or stays in the digestive tract and is excreted with bowel movements. This results in the clotting of blood within the digestive tract which turns its color black, and explains why patients with upper gastrointestinal bleeding usually present with the complaint of black stools aka melena.

The part of digestive system starting from the large intestine and ending at the anal opening is referred to as lower gastrointestinal tract. Bleeding in any part of the lower gastrointestinal tract will cause the blood to ooze out of the anal sphincter with bowel movements, or even after bowel movements in some cases. This leaking of fresh blood with stools is called hematochezia. In this case, the blood does not stay in the digestive tract for a long time, which is the reason this blood is fresh red in color.

Tests And Diagnosis

Usually, hematochezia is easily diagnosed because anybody can notice fresh blood coming with or after bowel movements. However, in very few cases, the amount of blood is so less that it may go un-noticed. Routine stool examination is the best way to confirm the fact that red blood cells really are coming along with stools. Similarly, hematemesis can easily be diagnosed because the blood is visible to the naked eye.

It must be kept in mind that hematemesis is different from hemoptysis – bloody sputum with coughing. It has been seen that quite a large number of patients consider hemoptysis as hematemesis. Confusing these terms can result in a mistaken diagnosis.

See Also: Hirschsprung's Disease: Abnormal Contraction And Relaxation Of Colon

Some conditions can present along with other symptoms like fever, chest pain, and abdominal pain. However, there are a few conditions that solely present with vomiting blood or black stools.

Causes Of Blood With Vomiting Or Stools

Conditions That Can Cause Hematemesis

Most people panic when they notice blood in their vomit.

Listed below are the conditions, arranged according to their occurrence that may result in vomiting blood.

• Gastritis: Long-term inflammation or rupture of the inner lining of the gastric mucosa is known as gastritis. It may be acute or chronic. This is one of the most common causes of hematemesis.
• Esophageal Varices: Bleeding esophageal varices are the result of the rupture of swollen veins in the lower esophagus. This is a medical emergency, since even a slight delay in treatment can make the blood go inside the lungs and cause death.
• Liver Cirrhosis: Scarring of liver cells is called cirrhosis. It is a chronic condition that is caused by prolonged exposure to toxins such as viral infections (hepatitis B and C) or alcohol.
• Other Conditions: Some other conditions that may result in vomiting blood include:
  • Gastric Carcinoma (stomach cancer)
  • Esophageal Carcinoma (cancer of esophagus)
  • Acid Peptic Disease (APD)
  • Liver cancer
  • Infection of esophagus – esophagitis
  • Hemophilia – a blood disorder
  • Alcoholic liver disease

Conditions That Can Cause Melena

Many disorders that cause hematemesis can also cause melena – black/tarry stools. This is because blood in the upper gastrointestinal might not be expelled from the mouth; it would rather stay inside the stomach and be excreted from the anus mixed with stools. Listed below are the conditions that may cause black tarry stools:

• Esophageal Varices: Bleeding esophageal varices is a condition that may cause melena, hematemesis, or even both simultaneously.
• Stomach Ulcer: The bleeding is usually slow in this condition which is why it rarely manifests in the form of vomiting. The stored blood mostly leaves the body in the form of black stools. This condition can sometimes be very painful. 
• Crohn’s Disease: This disorder causes the inflammation of the small intestine. After a certain period of time, the inflamed tissues of the small intestine begin to bleed resulting in black stools. This condition is progressive and must be treated immediately.
• Other Conditions: Some other conditions that can cause melena include
  • Necrotizing Enterocolitis (NEC) – usually seen in newborns but may occur at any age.
  • Gastric Carcinoma (stomach cancer)
  • Intussusception – telescoping of one part of the intestine into its adjacent part.
  • Diverticulitis

Conditions That Can Cause Hematochezia

There are a few conditions that cause fresh blood to be excreted with or after bowel movements.

The conditions that may cause hematochezia include:

• Colorectal Carcinoma (Rectum Cancer): This is the most common cause of hematochezia in old age. It rarely occurs in young adults or children. Fresh painless bleeding is the presenting symptom of this disease.
• Anal Fissure: It refers to a tear in the lining of the lower rectum which causes blood to originate while defecating. Sometimes, it may present as dripping of blood drops after bowel movements are completed.
• Ulcerative Colitis: An inflammation of the large intestine is called ulcerative colitis. Most of the patients suffering from this disorder complain of fresh blood coming with their stools.
• Other Csonditions:
• • Crohn’s disease
  • Internal or external Hemorrhoids
  • Food poisoning
  • Salmonellosis
  • Dragon fruit consumption

See Also: How To Deal With Irritable Bowel Syndrome

It is possible that a patient may experience only one episode of blood with defecation or vomiting. This occurs in the cases where there is minor rupture of the inner lining of the digestive tract. Such injuries usually heal spontaneously without any external intervention.