Last updated: August 24, 2012

throwing up blood

Throwing up blood: Introduction

Throwing up blood is always a medical emergency.If you are actually throwing up blood at this time, please stop reading this and call 911. You need to be in an Emergency department as soon as possible.There is not an easy way to tell if your symptom of throwing up blood is life threatening or not. Even an experienced Emergency Department doctor can only make an educated guess about the possible cause of throwing up blood after a thorough evaluation. Please do not ignore your internal bleeding just because someone on “Yahoo answers” tells you that it is not a big deal. If you had thrown up blood in the past but are not bleeding right now, you may keep reading to learn more about it.If you have a close friend or a family member who is being treated for throwing up blood, you may find the information here very useful. I will be sharing the stories of my real patients who had been treated for throwing up blood to teach you the real life examples of how throwing up blood occurs and how it is treated in actual patients.

You do not need any medical background to understand what I will tell you about throwing up blood. I have written each and every word for my patients and have paid very close attention to make sure I am not using any medical terms that my average patients would not understand. I will use my patient centered approach here to educate you about the causes, diagnosis and treatment of throwing up blood in plain English.

Throwing up blood

Image courtesy of: National Kidney & Urologic Diseases Information Clearinghouse (NKUDIC)

Lets look at this simple drawing to see how you throw up blood. This is our upper digestive system. You can see the mouth, it connects to the food pipe at our throat and the food pipe goes down and meets our stomach. The stomach opens into the upper part of our intestines. Mostly, true vomiting blood comes from one of these areas. Sometimes blood from nose bleed, tooth bleed and other types of bleed can go down our throat and may come back as vomiting blood but those are not true blood vomiting. The food pipe is a common source of bleeding. It has many blood vessels that can rupture and bleed. The stomach can have bleeding ulcers. The upper part of the intestine can also bleed and if it is a rapid bleeding it can come out as vomiting blood. So, how do you know where you are bleeding from when you throw up blood? The simple answer is: you simply don’t.
You may have read somewhere that the color of blood is important. If you were reading some health forum, you may seen posts that tell you that coffee ground colored or dark colored blood is dangerous but bright red blood is not a big problem. Is that true?
When you have bleeding in any of these places, the blood that comes out is always bright red at first. If it sits down in your stomach for a while and gets partially digested, it then turns dark. If you see dark colored blood when you throw up it only means that the blood had been in your stomach for at least some time. It does not tell you where it came from or if how serious the bleeding is. Bleeding from your food pipe can go down and sit in your stomach for a while before you throw it up. It does not mean that dark colored blood is always from bleeding in your stomach.

In patients with alcoholic liver disease throwing up blood can be a catastrophic event that may lead to death from excessive bleeding within a few hours. The most common cause of throwing up blood in all patients is bleeding ulcer. In alcoholics, throwing up blood can be from esophageal varices. Alcoholics can also develop tears in their food pipe that can result in vomiting blood.

Throwing up blood: A 21 year old college student after her first drinking

Miss D is a healthy 21 year old female with no history of any previous medical problems. She went to a party at her local community college. She had never had alcohol before. After the college party, some of her friends invited her to go bar hopping. She reluctantly agreed. At first she was just taking diet coke but after her friends insisted, she took a shot of tequila. Within a few minutes, she wanted another one. She liked how she felt. In the next three hours she took so many shots she lost count. Her voice was slurry and she could hardy walk. Her friends were worried about her and took her back to her apartment and left her in bed. She woke up in a few hours and felt very bad. Her head was throbbing and she started to throw up continuously. She emptied everything in her stomach but was still retching very hard. After about two hours of retching, she started throwing up blood. She also had a sharp pain in her chest. When she could not stop throwing up blood, she felt like she was going to die. She called 911 and told them she was throwing up blood and was too weak to drive to the hospital. They send an ambulance right away and took her to the ER.

She had a few more episodes of throwing up blood while she was in the ER. She was then rushed to ICU and I took over her care as the on-call doctor. Her blood pressure was OK but we gave her iv fluids to prevent it from going down. We checked her blood level. She had not dropped her hemoglobin significantly. We started her on medications to make her stop throwing up blood. When she became more stable, she was taken down for a scope. They passed a long tube with camera and looked down into her stomach. There was a small tear right in the middle of the food pipe. Fortunately, the bleeding from that tear seemed to have stopped. The final diagnosis of her throwing up blood was Mallory-Weiss Tear. It is the medical term describing this kind of tearing of the food pipe in patients with multiple episodes of persistent vomiting or retching.

Patient was observed in the hospital overnight and did not have any further symptoms of throwing up blood. She was discharged home in the morning. After this episode of throwing up blood, she decided not to drink alcohol ever again.

Not all patients with throwing up blood have this kind of happy ending. Some patients with alcoholic liver disease who  develop throwing up blood may die from excessive bleeding. Miss. D was young and otherwise healthy. She was not a habitual drinker. She had a relatively better chance of surviving something like this.

I hope the story of Miss D helped you understand more about throwing up blood and Mallory-Weiss Tears. Please check back soon as I will be uploading more stories about patients who had throwing up blood. I will upload stories with several different final diagnosis. I need to warn you that not all my patients were lucky enough to have a happy ending like Miss D.