Hematemesis AKA Vomiting Blood: Causes, Symptoms, And Treatment

What is Hematemesis?

The blood may originate from the mouth, pharynx, esophagus, stomach or small intestine. The blood that is vomited may be bright red, or slightly darker, appearing black.

Vomiting blood may also occur when blood is swallowed as a result of a nosebleed or forceful coughing. Slight flecks of blood in the vomit or coughing up blood in spit are known as hemoptysis. Hematemesis, on the other hand, is much more serious. The amount of blood loss may lead to shock and dizziness and may require immediate medical attention and sometimes hospitalization as well.

Before we go on to the causes of hematemesis, it is important to know what does this term actually mean. Hematemesis is 'vomiting blood' which exactly means 'blood coming from digestive system'. Do not confuse it with the term 'Hemoptysis' which means bloody sputum or blood with cough.

Causes of Hematemesis

Some of the most common causes of hematemesis involving the gastrointestinal tract include:

• Peptic Ulcer – An inflamed or bleeding ulcer is the most common cause of vomiting blood.
• Esophageal Disorders – These include enlarged blood vessels around the esophagus (esophageal varices) and inflammation of the esophagus (oesophagitis). 
• Pancreatic Ulcer
• Pancreatitis (inflammation of the pancreas)
• Damaged blood vessels of the upper gastro-intestinal tract
• Certain Cancers – Esophageal, stomach or upper intestinal cancer (benign or malignant).
• Gastritis (inflammation of the stomach)
• Gastric Erosion (abnormalities in the stomach lining)
• Liver Cirrhosis (chronic scarring of liver cells)
• Acute Liver Failure
• Portal Hypertension (high blood pressure in the vessels supplying blood to the liver)

There are some other causes that may result in vomiting blood. But these cause are seen in rare cases:

• Excessive use of Aspirin may cause hematamesis in some individuals
• Excessive use of NSAIDs (non-steroidal anti-inflammatory drugs)
• Mallory-Weiss tear (a tear in the lining of the esophagus due to pressure exerted during vomiting and coughing)
• Dieulafoy’s syndrome (protrusion of an artery from the stomach wall)
• Alcoholic Hepatitis
• Duodenitis (inflammation in first part of small intestine)
• Birth Defects
• Blood Clotting Abnormalities
• Milk allergies (usually seen in children)

Symptoms of Hematemesis

However, other symptoms may help the doctor diagnose the underlying cause of the bleeding as well.

For instance, of the origin of bleeding is a peptic ulcer, the individual is most likely to have other complaints such as abdominal discomfort, a feeling of fullness and acidity. If the underlying cause is a malignant tumor, the individual might also experience nausea, loss of appetite and weight loss.

See Also: Hemophilia: Rare Blood Disorder

More Serious Symptoms

If an individual experiences symptoms such as confusion, rapid shallow breathing, cold sweats and nausea, he or she may be going into shock. Immediate care must be provided in such cases.

Other serious symptoms that require urgent medical attention are:

• Dizziness
• Lightheadedness
• Pale skin
• Blurred vision
• Low urine output
• Weak pulse
• Low blood pressure
• Clammy skin

Why Is It Important To Diagnose And Treat Hematemesis

Repeated episodes of hematemesis can be dangerous for your body. This may result in anemia - low level of blood in the body. This is the reason why hematemesis should not be ignored.

Diagnosis of Hematemesis

To correctly diagnose the cause of hematemesis, it is necessary that you explain in detail your symptoms and general physical condition to your doctor.

Following are the things that must be told to the doctor for the accurate diagnosis:

• The time the vomiting started
• Whether it has happened before
• The amount of blood in the vomit
• The color of the blood
• Any recent outbreaks of nosebleeds, vomiting, violent coughing, stomach problems that you may have had
• Any surgeries or dental work you may have had
• Any other symptoms you may be experiencing
• Any other medical ailments or conditions that you may have
• Any medication you are on
• Whether you drink alcohol or smoke

The doctor may advice some tests according to the history and complaints. Some common tests include:

• Esophagogastroduodenoscopy (endoscopy of the upper gastrointestinal tract)
• Blood tests – Complete blood count (CBC), blood chemistry, clotting test
• Liver function tests (LFT’s)
• Nuclear medicine scan
• X-rays
• Rectal examination
• Inserting a tube through the nose into the stomach to check for any blood
  
  

Treatment of Hematemesis

The exact treatment depends on the basic cause and origin of the bleed. However, the first course of action is to stop the excessive bleeding.

An anesthetic is administered to help the individual relax.

In extreme cases, the bleeding may be so intense that determining the exact location through an endoscopy may not be possible.

Since the most common cause is usually an ulcer, treatment generally involves using a sclerosing agent on the ulcer, or banding any esophageal varices. Once the exact cause has been determined, treatment for its cure is also given.

If a lot of blood has been lost, emergency treatment is required. This includes:

• Blood transfusion
• Intravenous fluids to maintain blood pressure
• Antacids to decrease stomach acids in case of ulcers
• Surgery if the bleeding persists and the cause cannot be determined
  
  

Prevention of Hematemesis

Acute bleeding from the upper gastrointestinal tract may prove to be life-threatening if not treated and managed promptly. An individual suffering from such a condition requires aggressive medical treatment. An endoscopy to assess the location and course of treatment is vital. The individual may also require fluid resuscitation if he is diagnosed as being hemodynamically unstable.

One of the most common causes of such bleeding is a peptic ulcer. However, bleeding from varices also accounts for many cases of hematemesis and poses a much greater risk as well. In such cases, individuals must be tested for H. pylori infections, which is usually the underlying cause of most ulcers. Furthermore, individuals with a history of bleeding ulcers may need to follow a long-term regime of taking non-steroidal anti-inflammatory drugs. The treatment works better if these are given along with a proton pump inhibitor. 

Educating Patients about Hematamesis

The doctor must make it a priority to inform the patient regarding all the risks and complications associated with the condition. The patient must understand the importance of an accurate diagnosis and treatment regime. The doctor must also help the patient in understanding and recognizing the underlying causes of upper gastrointestinal bleeding.  

Any drugs, even Aspirins, must always be used if and as directed by the physician. If the patient is an alcoholic, he must be alerted about his condition and asked to take the necessary steps to stop drinking.    

See Also: Gastrointestinal Bleeding Or Blood In The Stool - What Does It Mean?

Getting an early consult might help prevent further complications, thus never dismiss such signs as unimportant. Moreover, if any of the symptoms continue even treatment, such as dizziness, weakness, bloody stools, etc, contact your doctor immediately. 

Lastly, the significance of regular follow-ups must be stressed upon, especially for those who have been treated for massive gastrointestinal bleeds. Serial hematocrit and hemoglobin tests must be performed to help keep track of progress and recovery.