Vomiting blood, medically known as hematemesis, signifies bleeding somewhere within the upper gastrointestinal (GI) tract, which includes the esophagus, stomach, and the first part of the small intestine. This occurrence is a serious medical event that requires immediate attention because it indicates internal bleeding. The severity of hematemesis can range from relatively minor irritation to life-threatening hemorrhage, and nearly all instances warrant prompt evaluation by a healthcare provider to identify the source and control the bleeding.
Assessing the Appearance and Severity
The appearance of the blood in the vomit provides important clues about the source and the rate of bleeding within the digestive system. When the expelled blood is bright red, it typically indicates a fresh and active bleed, meaning the blood has not been in the GI tract long enough to be significantly altered by digestive enzymes or stomach acid. This presentation often suggests a source in the esophagus or the upper stomach and usually signals a rapid rate of blood loss.
In contrast, vomit that contains material resembling dark brown, granular coffee grounds suggests that the blood has been exposed to stomach acid for some time. Gastric acid oxidizes the iron component in hemoglobin, which results in the characteristic dark, coarse texture. This “coffee ground” appearance usually indicates a slower, less acute bleed, often originating lower in the stomach or the duodenum. Seeing only small streaks or flecks of blood can sometimes result from minor irritation or forceful retching that causes small tears in the lining of the throat or esophagus.
Immediate Action: When to Seek Emergency Care
Any instance of vomiting blood must be treated as a medical emergency until a healthcare professional determines the source and stability of the patient’s condition. If the volume of blood is large, or if the vomiting is accompanied by specific systemic symptoms, emergency medical services should be contacted immediately. These accompanying symptoms are signs the body is struggling to compensate for rapid blood loss, a state known as hypovolemic shock.
Signs of shock include feeling dizzy or faint, especially when standing up, which is a response to a drop in blood pressure. The skin may become cold, pale, and clammy as the body redirects blood flow away from the extremities to protect the internal organs. A person may also experience a rapid heart rate or a weak pulse as the heart attempts to pump the remaining blood volume more quickly. Other serious symptoms include confusion, difficulty breathing, or severe, persistent abdominal pain.
If the bleeding is minimal and there are no signs of shock, a person should still immediately proceed to an Emergency Room for evaluation. Even a small volume of blood can be the precursor to a larger bleeding event. Delaying an assessment can increase the risk of complications, especially since many causes of hematemesis can escalate quickly. Medical professionals will prioritize stabilizing the patient before attempting to find the specific source of the bleeding.
Common Underlying Causes of Vomiting Blood
The bleeding that leads to hematemesis originates from the upper GI tract, and the underlying conditions vary widely in their mechanism and seriousness. One common cause is the Mallory-Weiss tear, a laceration of the mucous membrane where the esophagus meets the stomach. This tear is typically caused by severe or prolonged retching and vomiting, often following heavy alcohol consumption, and usually presents with bright red blood. Minor bleeding can also result from severe inflammation of the stomach lining, known as gastritis, or the esophagus, called esophagitis.
More concerning causes often involve a breakdown in the protective lining of the GI tract, such as peptic ulcers in the stomach or duodenum. These ulcers are frequently associated with infection by the bacterium Helicobacter pylori or the regular use of nonsteroidal anti-inflammatory drugs (NSAIDs). An ulcer erodes the lining, potentially exposing and damaging an underlying artery, which can lead to significant and recurrent bleeding.
A particularly serious cause involves esophageal varices, which are enlarged, fragile veins in the lining of the esophagus. These varices develop due to portal hypertension, a condition where blood flow through the liver is obstructed, often as a result of advanced liver disease. The increased pressure causes the veins to swell and rupture easily, resulting in a sudden and massive hemorrhage. Less commonly, malignant tumors in the esophagus or stomach can cause bleeding, but this typically manifests as chronic, low-level blood loss.
Medical Evaluation and Diagnostic Procedures
Upon arrival at a medical facility, the immediate focus is on stabilizing the patient, which may involve administering intravenous fluids or blood transfusions to compensate for lost volume. Initial laboratory work will include a complete blood count to assess the degree of blood loss and tests to evaluate blood clotting function. The blood urea nitrogen (BUN) to creatinine ratio is also analyzed, as an elevated ratio can suggest significant upper GI bleeding.
The definitive procedure for diagnosing the source of hematemesis is an upper endoscopy, also called an esophagogastroduodenoscopy (EGD). During an EGD, a flexible tube equipped with a camera is passed down the throat into the stomach and duodenum. This allows the physician to visualize the upper GI tract, locate the precise source of bleeding, and often treat it directly using specialized instruments passed through the endoscope. This procedure is typically performed urgently, ideally within 24 hours, to facilitate both diagnosis and intervention.