Considerations

It can sometimes be difficult to tell the difference between vomiting blood and coughing up blood (from the lung) or a nosebleed.

Conditions that cause vomiting blood can also cause blood in the stool.

Causes

The upper GI tract includes the stomach, mouth, throat, esophagus, and the first part of the small intestine. Blood that is vomited may come from any one of these places.

For example, vomiting that is very forceful or continues for a very long time may cause a tear in the small blood vessels of the throat or the esophagus, producing streaks of blood in the vomit.

Swollen veins in the walls of the lower part of the esophagus, and sometimes the stomach, may begin to bleed. These veins are present in people with severe liver damage.

Other causes may include:

• Bleeding ulcer in the stomach, first part of the small intestine, or esophagus
• Defects in the blood vessels of the GI tract
• Swelling, irritation, or inflammation of the esophagus lining (esophagitis) or the stomach lining (gastritis)
• Swallowing blood (for example, after a nosebleed)
• Tumors of the stomach or esophagus

Home Care

Although not all situations are the result of a major medical problem, this is difficult to know without a medical evaluation. Seek immediate medical attention.

When to Contact a Medical Professional

Call your doctor or go to the emergency room if vomiting of blood occurs -- this requires immediate medical evaluation.

What to Expect at Your Office Visit

The doctor will examine you and ask questions such as:

• When did the vomiting begin?
• Have you ever vomited blood before?
• How much blood was in the vomit?
• What color was the blood? (Bright red or like coffee grounds?)
• Have you had any recent nosebleeds, surgeries, dental work, vomiting, stomach problems, or severe coughing?
• What other symptoms do you have?
• What medical conditions do you have?
• What medicines do you take?
• Do you drink alcohol or smoke?

Tests that may be done include:

• Blood work, such as a complete blood count (CBC), blood chemistries, blood clotting tests, and liver function tests
• Esophagogastroduodenoscopy (EGD)
• Nuclear medicine scan
• Rectal examination
• Tube through the nose into the stomach to check for blood
• X-rays

If you have vomited a lot of blood, you may need emergency treatment, which may include:

• Blood transfusions
• Fluids through a vein
• Medications to decrease stomach acid
• Possible surgery if bleeding does not stop

Alternative Names

Hematemesis; Blood in the vomit

References

Overton DT. Gastrointestinal bleeding. In: Tintinalli JE, Kelen GD, Stapczynski JS, Ma OJ, Cline DM, eds. Emergency Medicine: A Comprehensive Study Guide. 6th ed. Columbus, OH: McGraw-Hill; 2006:chap 74.

Henneman PL. Gastrointestinal bleeding. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier;2009:chap 22.

Update Date: 1/7/2012

Reviewed by: Jacob L. Heller, MD, MHA, Emergency Medicine, Virginia Mason Medical Center, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.