Vomiting blood is the sudden, uncontrolled discharge of bright red (hematemesis) or brown (coffee grounds) vomit through the mouth. The symptom is most characteristic of gastric ulcer, other factors include inflammatory or destructive diseases of the esophagus and gastroduodenal zone, liver damage, pathologies of the blood coagulation system, and taking certain medications. To clarify the causes of vomiting, endoscopic, radiological, ultrasound and laboratory research methods are used. Drugs are prescribed only after a clinical diagnosis has been made.
Vomiting masses of the "coffee grounds" type are characteristic of massive bleeding from a damaged vessel at the bottom of the ulcer. The dark color is due to the reaction of blood hemoglobin with hydrochloric acid of the stomach, which is accompanied by the formation of hematin hydrochloride. A few days before bloody vomiting, there is an increase in dyspeptic disorders, abdominal pain. With the onset of bleeding, the pain subsides. The symptomatology caused by blood loss and hypoxia becomes the leading one: the patient feels dizzy, weak, the skin and visible mucous membranes become pale.
In the case of a simultaneous release of more than 5 ml of blood, it can enter the intestine, which is manifested by black stool (chalky) on the next day after vomiting "coffee grounds". With blood loss up to 15% of the BCC, the general condition is moderate, there is a sharp weakness, tachycardia, and a drop in blood pressure. There are complaints of dry mouth, intense thirst. With the loss of large volumes of blood, fainting, impaired consciousness are typical, the pulse becomes thready.
Blood-stained vomit is the first symptom of most stress ulcers with extensive gastroduodenal bleeding. Hematemesis opens suddenly in the absence of pain in the epigastric region, which is associated with the predominance of symptoms of the underlying pathology. Weakness quickly increases, dizziness appears, the skin turns pale, the pulse quickens. Bloody vomiting after night and morning "hungry" pain in the abdomen is also complicated by Zollinger-Ellison syndrome, in which multiple bleeding ulcerative defects of the gastric mucosa are formed.
Inflammatory processes, anomalies in the structure of the upper digestive tract and tumor formations can serve as predisposing factors for coffee grounds vomiting. The symptom occurs when the pathology is long-standing, when the mucous membrane is totally affected and the vessels are involved in the process. The difference from bleeding in ulcerative defects is the persistence of pain after the release of vomit. The causes of hematemesis are:
Esophageal pathology is accompanied by vomiting with the outflow of bright scarlet blood (hematemesis). The symptom is characteristic of inflammatory processes, in which the vulnerability of the mucous membrane increases, superficial or deep defects are formed. Hematemesis is provoked by traumatization of the esophageal wall by foreign bodies, iatrogenic injuries during medical procedures. Among the main reasons for the development of a symptom are:
The main cause of vomiting with blood when pressure in the portal vein increases is esophageal varicose veins. These vessels have a specific feature: they do not collapse, so blood loss is abundant (up to 30-40% of the BCC), which is life-threatening. Children may experience vomiting "fountain" with the release of bright red blood, which is a prognostically unfavorable sign. Portal hypertension with vomiting may be due to pylephlebitis, congenital liver fibrosis, abnormalities in the structure of large venous vessels in the abdominal cavity.
Bleeding from the esophageal veins is characteristic of the decompensated stage of the disease. At the same time, at the initial stages of portal hypertension, nausea, periodic heartburn or belching, and stool disorders are disturbing. With the progression of the pathological process, patients notice swelling in the lower extremities, an expanded venous network is clearly visible on the skin of the anterior abdominal wall. Dull pains are felt in the left hypochondrium, which are caused by an enlarged spleen.
Vomiting of blood occurs in the hemorrhagic form of dengue fever or yellow fever. These viral infections affect the vascular wall and disrupt the blood clotting system. Against the background of high temperature and general infectious syndrome, uterine, nasal, gastrointestinal bleeding occurs. Hematemesis can begin with the intestinal form of anthrax, in which case it is combined with melena, excruciating pain in the abdomen. Isolation of blood with vomit is typical of the initial period of the plague, which affects all organ systems.
Regurgitation of vomit with blood is a typical sign of gastrointestinal bleeding in hemorrhagic diathesis. More often, vomiting of “coffee grounds” complicates the course of thrombocytopenic purpura and hemorrhagic vasculitis. In addition to dyspeptic disorders, such patients complain of a spotted or papular rash on the extremities and trunk. Massive nasal and intestinal bleeding, triggering a gag reflex, is pathognomonic for rare hereditary pathologies - Wiskott-Aldrich syndrome and Rendu-Osler-Weber disease.
In children, vomiting with blood may be a sign of systemic intoxication with extensive burns or neurotoxicosis. Such conditions, in addition to regurgitation, are characterized by an extremely serious condition of the child, impaired consciousness, dysfunction of the cardiovascular and respiratory systems. Repeated hematemesis, detected on the second or third day of postresuscitation illness, acute peritonitis, cardiogenic shock, indicates gastrointestinal bleeding due to the developed hemorrhagic syndrome.
Vomiting "coffee grounds" is noted with heavy nosebleeds, which are accompanied by the ingestion of blood. In this case, dizziness, weakness, an unpleasant aftertaste in the mouth, and nausea often occur. Massive blood loss provokes fainting, tachycardia, and a sharp pallor of the skin. Isolation of vomit in the form of "coffee grounds" is also characteristic of combined burns of the pharynx, which are combined with damage to the underlying sections of the gastrointestinal tract, ammonia poisoning (if taken orally), causing destruction of the mucosa.
Sometimes hematemesis becomes a consequence of gastrointestinal bleeding provoked by the so-called ulcerogenic drugs - drugs that contribute to the formation of erosive and ulcerative defects of the mucous membrane of the digestive organs. As a rule, patients report long-term, sometimes uncontrolled use or high doses of medications of the following groups:
To identify the causes of vomiting with blood, the gastroenterologist prescribes a comprehensive examination, which is aimed at studying the morphological and functional features of the gastrointestinal tract. Instrumental studies have a high diagnostic value, laboratory tests help to establish the severity of hemodynamic and metabolic disorders. The survey plan includes:
With possible primary disorders in the vascular system, contrast angiography is performed; radioisotope scintigraphy is recommended to assess the state of the liver parenchyma. Additionally, a macro- and microscopic analysis of feces is performed; to exclude intestinal bleeding, the Gregersen reaction to occult blood is informative. If bloody vomiting is combined with signs of hemorrhagic diathesis, a general infectious syndrome, consultations of other specialists are required.
Before arrival
The appearance of blood in the contents of the stomach indicates serious diseases of the digestive system or other organs, so self-medication or delay in seeking medical help can be harmful to health. Patients with "coffee grounds" vomiting require rest and urgent hospitalization to determine the causes of the symptom and select a treatment regimen. At the preclinical stage, it is permissible to apply cold to the abdomen. Intensive therapy is aimed at stopping bleeding and normalizing hemodynamic parameters.