What’s the Buzz

Throwing Up Blood (Hematemesis) Overview 

The medical term for throwing up blood or vomiting blood is hematemesis or haematemesis (heme means blood, and emesis means vomiting). 

It is a very serious symptom and a sign of internal bleeding in the upper part of the gastrointestinal tract, including the esophagus (the tube that connects the back of your mouth to your stomach), the stomach, and the duodenum or first part of the small intestine. It takes a significant amount of internal bleeding for blood to show up in vomit.

Hematemesis, or vomiting blood, can have many possible causes and is a medical emergency.

How to Recognize Hematemeis Symptoms?  

You may vomit blood alone or blood mixed with partially digested food from your stomach. The blood in vomit may be bright red blood, which is a sign of fresh or active bleeding. This indicates an acute bleeding of the stomach or esophagus. 

The blood in vomit can also be darker, black or brown blood. The bloody vomit can sometimes be coagulated or lumpy blood that looks like coffee grounds. This is a sign of slower or older bleeding that may have stopped but should still be evaluated urgently.

What to Do If You Vomit Blood?

You should seek medical care right away if you vomit blood, especially if you just experience trauma or injury. This can sometimes be a sign of a serious condition that requires emergency treatment. Healthcare professionals cannot tell if retching blood is serious until they examine you and run some tests. That’s why doctors recommend seeking immediate medical attention if you have vomited blood. 

Should I Go To The ER If I Throw Up Blood?

Yes, you should go to the ER immediately if you vomit blood. You may need to call emergency medical services (EMS) or have someone drive you to the ER if you have other symptoms such as:

• Lightheadedness or dizziness

• Disorientation or confusion

• Weakness

• Nausea

• Severe abdominal pain

• Shallow breathing

• Severe chest pain

• Blurred vision

• Cold, clammy skin

• Decreased urination

Read next: “When to Seek Medical Attention for Vomiting.”

How Much Blood in Vomit Is Too Much?

Any amount of blood in vomit is worrisome. Seek emergency treatment even if you have vomited only a small amount of blood.

Can Throwing Up Too Hard Cause Bleeding?

Yes, throwing up too hard can cause bleeding due to trauma in the esophagus lining. You may see a little blood in your vomit after vomiting hard. But you should still seek medical care so that healthcare providers can rule out more serious causes of vomiting blood.

Can You Vomit Swallowed Blood?

Yes, it’s possible to have blood in vomit after swallowing blood. This blood may be from a nosebleed or bleeding in your mouth. However, it’s important to seek medical care so that a healthcare professional can make sure the blood in vomit is not from internal bleeding.

Save On Your Medications With BuzzRx! 

Possible Causes of Vomiting Blood

Common Causes 

• Bleeding peptic ulcer (open sore) in the stomach or duodenum. Duodenal ulcers and stomach ulcers can occur due to a bacterial infection such as H. pylori or long-term use of pain relievers called nonsteroidal anti-inflammatory drugs or NSAIDs (for example, aspirin, ibuprofen, and naproxen). 

• Esophagitis (inflammation of the esophagus lining), gastritis (inflammation of the stomach lining), or duodenitis (inflammation of the duodenum) can result in bleeding and blood in vomit. Possible causes of acute inflammation include the use of NSAIDs, heavy alcohol consumption, and severe acid reflux. 

• Portal hypertension (increased pressure in the portal vein in the liver due to cirrhosis) can cause increased blood pressure in the abdominal veins, leading to enlarged veins in the esophagus and stomach. A swollen, fragile blood vessel (varix) can rupture and cause bleeding. Bleeding esophageal varices (oesophageal varices) are extremely serious.

• Chronic pancreatitis (inflammation of the pancreas) can damage surrounding blood vessels, which can rupture and cause bleeding. The blood can make its way to the duodenum and show up as blood in vomit.

 Less Common Causes  

• Mallory-Weiss syndrome is a condition that causes bleeding in the upper digestive tract due to tears in the esophagus. A Mallory-Weiss tear can develop due to violent vomiting or be alcohol-related.

• Benign and malignant tumors of the esophagus, stomach, or pancreas can bleed and lead to vomiting blood. 

• Abnormal blood vessels called angiodysplasias in the stomach or intestines can cause bleeding.

• A blood condition such as anemia (low red blood cells), thrombocytopenia (low platelets), leukemia, or hemophilia can result in upper GI bleeding. 

• Traumatic blunt force injuries to the abdomen can cause acute bleeding in the esophagus or stomach. Rarely injuries to these internal organs can occur during medical procedures.

• Acute erosive gastropathy from swallowing poisonous, toxic, or corrosive substances, heavy alcohol use, or use of illegal drugs such as cocaine.

Serious Underlying Conditions  

Repeated episodes of vomiting blood, large blood clots in vomited blood, bright red blood in vomit, and dark blood that looks like coffee grounds are all serious symptoms and should be evaluated on an emergency basis. 

Vomiting Blood vs Coughing Up Blood

Vomiting blood (hematemesis) is a sign of bleeding in the digestive tract. Spitting up or coughing up blood (hemoptysis) is related to the lower respiratory tract (airways and lungs). Any active internal bleeding is an emergency.

Diagnostic Tests and Procedures  

Some of the tests healthcare providers may do to find the cause and location of internal bleeding in the upper gastrointestinal tract include:

• Blood tests such as a complete blood count (CBC), blood chemistry panel, blood clotting tests, and liver function tests.

• Imaging studies such as X-rays and upper endoscopy also called esophagogastroduodenoscopy (EGD). EGD is a diagnostic procedure that allows doctors to visualize your esophagus, stomach, and duodenum by inserting a flexible tube through your mouth that has a camera attached to its end. Doctors can also take a small sample (biopsy) from any suspicious area for examination in the laboratory.

• Nasogastric aspiration and lavage (insertion of a tube through the nose into the stomach) to apply suction and identify the location of the bleeding (upper versus lower gastrointestinal bleeding).

• Rectal examination.

What Is The Best Treatment for Vomiting Blood?  

Immediate Medical Treatments  

Immediate treatment for vomiting blood is to control the bleeding and stabilize your condition before undertaking further treatment for the underlying gastrointestinal and liver disease. This may include:

• Fluid resuscitation with IV fluids

• Blood transfusion

• Oxygen

• Laser treatment during EGD to stop the bleed

• Medications to reduce stomach acid

• Emergency surgery to stop bleeding

Long-Term Management and Prevention  

Long-term management and prevention of hematemesis (vomiting blood) will depend on the underlying cause. 

For example, if the cause of your bleeding is esophagitis caused by severe gastrointestinal reflux disease (GERD), your healthcare provider may prescribe medications to reduce stomach acid production and other treatments. If you are diagnosed with Helicobacter pylori, your doctor may prescribe antibiotics.  

Potential Complications  

While vomiting blood itself is not life-threatening, in rare cases, it can lead to severe blood loss, hypovolemic shock, organ failure, and death. For this reason, it is important to go to the nearest emergency department, especially if you are vomiting large amounts of blood. 

Prognosis and Follow-Up

Most causes of bleeding in the upper GI tract can be treated with medications, but some may require surgical treatment. Many of these conditions are curable. It’s important to go back to your gastroenterologist for the next review and to keep all your follow-up appointments after an episode of throwing up blood to ensure the underlying cause is properly managed.