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. Vomiting blood causes death in as high as 8% of patients admitted to the hospital with internal bleeding. There is no 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.

You do not need any medical background to understand what I will tell you about throwing up blood (medical term hematemesis). 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.

What does blood in vomit look like?

The appearance of blood in your vomit depends on how long the blood has been sitting in your stomach. Vomiting bright red blood is a sign that the bleeding is still fresh. Vomiting blood clots is also not uncommon when large amount of bright red blood is in the stomach. If the blood has been partially digested, it may look like coffee ground vomit. If it is older blood, it may look like brown vomit or even black vomit. If you see dark colored blood when you throw up, it only means that the blood has been in your stomach for at least some time. It does not tell you where it came from or 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. On the other hand, vomiting blood and diarrhea can be a sign of catastrophic bleeding especially if the diarrhea is black like tar. Read this article on black diarrhea for details.

Vomiting blood causes

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.

Minor and self limited causes of vomiting blood

Sometimes blood from nose bleed, tooth bleed and other types of oral bleed can go down our throat and may come back as vomiting blood but those are not true throwing up blood. You may have small amount of blood in vomit after a tooth bleed if you vomit right after a dental procedure. Similarly, it is not uncommon to see small amount of bright red blood in vomit after a nosebleed. These are the only times that you do not need to worry about life threatening internal bleeding.

Vomiting blood caused by alcohol

Alcohol is one of the most common causes of throwing up blood. From throwing up a little blood after drinking to life threatening massive bleeding from alcoholic liver disease, vomiting blood due to alcohol can be complicated.

In mild cases, vomiting blood after drinking can be from a small tear in the food pipe. It can happen after a night of binge drinking. Some people get extremely nauseated when they are hung-over after drinking. When they use excessive force to vomit, they can have small tears in their food pipes and they may start throwing up blood.

Alcohol can also cause inflammation of the stomach and can erode a blood vessel leading to vomiting blood.

In patients with severe alcoholic liver disease throwing up blood can be a catastrophic event that may lead to death from excessive bleeding within a few hours. Alcoholics with bad liver disease have distended variceal veins in their food pipes. It is very difficult to stop bleeding in an alcoholic vomiting blood due to variceal veins. These patients also have impaired blood clotting system due to liver failure. Vomiting blood causes death in these patients unless emergent resuscitative treatment is initiated.

Vomiting blood caused by excessive use of certain pain medications

High doses of certain medications of the class NSAIDs that include Ibuprofen, Aleve can erode your stomach lining and you end up throwing up blood.

Vomiting blood caused bleeding ulcers

Stomach and upper intestine may develop bleeding ulcers that may result in throwing up blood. Please read this article on bleeding ulcers to learn more.

Throwing up blood: A 21 year old college student first time throwing up blood after 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 having small amount of blood in vomit.

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. Administering IV fluids is usually the most important first step in vomiting blood treatment. We checked her blood hemoglobin 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 an endoscopy. 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. I need to warn you that not all my patients were lucky enough to have a happy ending like Miss D.


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