Vomiting Blood : Causes, Symptoms, Diagnosis & Treatment

Last Updated: 15/09/2022

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.

Causes of vomiting blood

peptic ulcer

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.

Diseases of the gastroduodenal zone

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:

  • Acute erosive gastritis . Vomiting is preceded by moderate pain in the epigastric region, nausea, belching with air, loss of appetite. With small hemorrhages, streaks of blood are found in the contents of the vomit, with extensive damage to the organ and massive bleeding, vomiting of "coffee grounds" with a black tarry stool (chalky) begins. Similar symptoms are found in hyperplastic gastritis.
  • Hemorrhagic gastritis . Inclusions of blood in the vomit are characteristic of acute profuse bleeding. Vomiting develops against the background of pain in the epigastrium, which increases immediately after eating. Before an attack, severe nausea is felt for some time. With chronic blood loss, a metallic taste in the mouth, frequent dizziness, and shortness of breath when performing the usual physical activity are possible.
  • Diverticulum of the stomach . Hematemesis is a late sign of diverticulosis. Such a complication, as a rule, occurs during the long-term existence of the disease and indicates an erosive process that damages the arteries. Before vomiting or simultaneously with it, there is a sharp pain in the epigastrium. The next day, the stool usually becomes dark, tarry.
  • Acute dilatation of the stomach . Repeated vomiting of gastric contents, and then masses with an admixture of bile and blood, begins after the sudden onset of severe diffuse pain in the abdominal cavity and uncontrollable hiccups. More than 7-8 liters of vomit are released per day, while attacks occur spontaneously without the patient's conscious efforts. There is gas retention and bloating. The condition is somewhat relieved in the knee-elbow position.
  • benign tumors . Vomiting "coffee grounds" and melena are the first symptoms of massive bleeding in gastric leiomyoma, which, due to slow progression, is latent for a long time. Large bleeding polyps of the stomach are characterized by the presence of separate streaks of blood in the secreted vomit against the background of other dyspeptic disorders.
  • Erosive bulbitis . Hematemesis indicates severe bleeding from an eroded vessel in the wall of the duodenal bulb. Due to significant blood loss, general well-being disorders are possible - weakness, pallor, fainting. Unlike most other pathologies, tarry stools often precede vomiting, less often melena occurs after an attack.

 

Diseases of the esophagus

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:

  • Mallory-Weiss syndrome . Bleeding is provoked by prolonged vomiting or hiccups, in which the smooth muscles of the gastrointestinal tract wall and the abdominal muscles are strongly strained. Against the background of another vomiting urge, a sharp burning pain is felt in the area of ​​​​the xiphoid process, after which profuse vomiting with blood begins. The symptom is also determined by ruptures of the esophagus of another etiology (with burns, thoracoabdominal injury).
  • Acute esophagitis. A prerequisite for bleeding and vomiting is the formation of erosions or ulcers of the esophagus due to a protracted course of the inflammatory process. With the onset of an attack, the sharp pains behind the sternum, typical for lesions of the esophagus, that occur after eating and in a horizontal position, intensify. There are signs of posthemorrhagic anemia - weakness, fatigue, dizziness. Before vomiting, belching with air, heartburn, nausea are observed.
  • Hernia of the esophageal opening of the diaphragm . Vomiting with blood is one of the signs of infringement of the hernial sac. It occurs suddenly or against the background of nausea and is combined with a sharp retrosternal pain, which can radiate to the shoulder blades, neck. The general condition of the patient is severe - pronounced shortness of breath, the skin becomes cyanotic, the pulse quickens to 10 or more beats per minute, blood pressure drops.
  • Perforation of the esophagus . With a through defect in the wall of the organ, repeated vomiting with impurities of fresh blood is characteristic, then the vomit takes the form of "coffee grounds". Severe pain is noted, which in intensity resembles a myocardial infarction or a perforation of a stomach ulcer. When air enters the cellular space of the mediastinum and neck, subcutaneous emphysema develops, breathing becomes difficult.
  • Tracheoesophageal fistula . Hematemesis is provoked by the presence of an acquired anastomosis between the esophagus and the trachea, which contributes to the destruction of the vessels of the mucosa. The symptom is often accompanied by respiratory disorders - coughing, suffocation, hemoptysis. The possible presence of a three-esophageal fistula as a cause of vomiting is evidenced by moderate pain in the chest and epigastrium, coughing up pieces of food, and a tendency to frequent diseases of the lungs and bronchi.
  • Esophageal carcinoma. Vomiting usually appears with a large size of the tumor, which partially closes the lumen of the organ. The symptom is combined with difficulty in swallowing solid food, a constant sensation of a foreign body (“lump”) behind the sternum, hoarseness, and a constant dry cough. The presence of streaks of blood in the composition of the vomit is characteristic of the late stage of the disease with ulceration and decay of neoplasia.

portal hypertension

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.

infectious diseases

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.

Hemorrhagic syndromes

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.

Acute conditions

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.

Pathology of ENT organs

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.

Complications of pharmacotherapy

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:

  • Non-steroidal anti-inflammatory drugs (NSAIDs) : aspirin, indomethacin, butadione.
  • Glucocorticosteroids : prednisolone, dexamethasone.
  • Direct acting oral anticoagulants : dabigatran, apixaban, rivaroxaban.
  • Anti-gout drugs : atofan, tsinhofen.
  • Hypotensive sympatholytics : reserpine.
  • Psychostimulants : caffeine, some drugs (cocaine, methamphetamines).

Survey

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:

  • Endoscopic methods . To accurately determine the site of bleeding and visualize a defect in the mucous membrane of the upper gastrointestinal tract, endoscopy is performed. If necessary, during the procedure, coagulation of the affected vessel is performed, a biopsy is taken from pathologically altered tissue areas.
  • X-ray examination . X-ray with oral contrast is performed only after the cessation of vomiting and stabilization of the condition. The method is informative for the diagnosis of organic changes, hernial formations. Leakage of contrast outside the lumen of the gastrointestinal tract indicates perforation or fistulous tracts.
  • Sonography . Ultrasound of the abdominal cavity is prescribed for a quick assessment of the condition of the abdominal organs. Sonography is used to detect mass formations in the gastrointestinal tract, hernias, and to diagnose liver diseases. Doppler sonography is performed to assess linear blood flow in the hepatic and splenic veins.
  • Laboratory Methods . A general blood test is necessary to determine the degree of blood loss and the severity of the anemic syndrome. If hereditary defects in the hemostasis system are suspected, an extended coagulogram is performed with the determination of prothrombin time and other coagulation parameters. Serological tests are sometimes prescribed.

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

 

Symptomatic therapy

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.

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