Introduction
Vomiting is a symptom or a concomitant of many diseases. It can occur in many different variations. A special form of vomiting is the vomiting of blood.
This is a blood admixture, which in most cases comes from the upper gastrointestinal tract. In medical terminology, vomiting blood is called haematemesis and indicates an injury in the digestive tract. The blood often originates either from the stomach, upper sections of the intestine or even the esophagus.
A further distinction is made as to whether the blood is fresh or already older. Fresh blood can be recognised by its light red colour and that it is still very fluid. Old blood is rather dark red to brown.
This is because the blood has been in the stomach for a longer time and has already clotted there. The blood is usually already clotted and the vomit looks like coffee grounds. Sudden vomiting of blood can indicate a serious illness or injury in a patient.
Therefore, a doctor should be consulted immediately upon occurrence. Possible illnesses include esophageal cancer or injury such as a tear, bleeding stomach ulcer or cancer, severe gastritis, or various intestinal diseases that affect the duodenum. The cause of the discomfort should be identified as soon as possible, because if the injury continues to bleed, it can also lead to internal bleeding.
In some cases, the cause can be harmless, such as nosebleeds, from which the affected person has become sick and therefore had to vomit. Bleeding that occurs in the lower digestive tract does not tend to cause vomiting, but is rather an admixture or deposit during bowel movement. Here too, it is easy to distinguish between fresh and old blood. This often gives a first indication of where the bleeding could be located.
Causes
There are several different causes that can lead to hematemesis. Hematemesis is an important symptom of bleeding in the upper digestive tract (gastrointestinal tract). The source of bleeding can be located in a variety of different places.
Typically, this is light red blood that is vomited. The upper digestive tract extends from the oesophagus to the transition from the duodenum to the jejunum. The most common cause of such a bleeding is intestinal or gastric ulcer, which can have various causes.
In addition, injuries to the mucous membranes of the oesophagus can lead to haemorrhaging. A severe reflux disease of the esophagus can also cause vomiting of blood. Other causes are tumors of the stomach and esophagus, which can also bleed.
One cause that should not be neglected is bleeding from the esophagus, which is often associated with cirrhosis of the liver that has existed for years or excessive alcoholism. These include, for example, variceal haemorrhages in which it bleeds from pathologically dilated vessels of the oesophagus. In this context, the Mallory-Weiss Syndrome should be mentioned, which occurs mainly in alcoholics and leads to tears in the mucous membrane of the oesophagus, which also cause vomiting of blood.
There are other possible causes of blood vomiting. – Oesophagus: The most common cause of blood vomiting is a torn oesophagus or oesophageal cancer. – Stomach area: Severe gastritis can damage the stomach lining to such an extent that even deeper wall layers that are well supplied with blood are affected by the inflammation, causing the stomach contents to become mixed with blood.
Finally, another possible cause of vomiting blood can be cancer. The cancer can be located in the esophagus as well as in the stomach or upper intestinal tract. The cancer often develops in the organs lined with mucous membrane, such as the stomach, intestines and the oesophagus, as a result of inflammation.
For example, a chronic inflammation of the stomach mucosa can lead to massive damage to the tissue, which can even penetrate into deeper layers of the wall. This damage leads to increased cell division to repair the mucosal defect. It can happen that the tissue does not differentiate into the original tissue of the stomach mucosa but degenerates.
In this case the medical term is metaplasia. Based on this degeneration of the cells, dangerous tumour cells can also develop, which eventually multiply and also grow aggressively into the surrounding tissue. Thus, in addition to the top layer of mucous membrane, the other tissue layers are also displaced and damaged by tumour cells.
Since tumours with rapid growth have to be supplied with blood, the blood vessels often proliferate there as well. If the tissue is eventually damaged, the tumour can also cause bleeding and therefore also haemorrhaging. Similarly, the cancer also develops in the oesophagus or intestinal cancer.
Another possibility is that cancer cells spread to the above-mentioned organs via the blood or lymphatic pathways and the primary tumour is located somewhere else. In this case one speaks of metastases. A stomach ulcer is a damaged area of mucous membrane in the stomach lining.
In medical terminology, the gastric ulcer is called ventriculitis. The ulcer can have various causes. In many cases there is an excessive production of gastric acid.
Although the mucous membrane of the stomach is protected from hydrochloric acid by a layer of mucus, it can happen that the mucous membrane does not offer sufficient protection at various points in the stomach. The gastric acid is then in direct contact with the cell layer and damages it. As a result, severe inflammation occurs, which can penetrate into deeper layers.
Furthermore, different medications can also have a similar effect if taken frequently. These drugs include acetylsalicylic acid (ASA) or drugs containing cortisone. These should therefore always be taken together with a stomach medicine.
Another trigger for a stomach ulcer can be a certain bacterium, Helicobacter pylori. This bacterium colonises the stomach and neutralises the stomach acid with a certain enzyme. This enables it to break through the protective mucous layer of the stomach lining cells.
These are then also no longer protected from the hydrochloric acid of the stomach and an inflammation develops. Peptic ulcers cause severe pain and food intolerances in the patient. In addition, bleeding can also occur when these ulcers break through.
The blood mixes with the stomach contents. Many patients become sick and vomit. The vomit contains fresh or older blood admixtures.
Vomiting of blood is often one of the complaints that occur after years of excessive alcohol consumption. The alcohol causes massive damage to the liver, so that the liver cells are increasingly destroyed. As a result, the liver is gradually no longer able to fulfil its function.
The blood supply to the liver is also disrupted, as the blood transported to the liver accumulates. Over the years, bypass circuits develop, which also lead to increased blood flow back towards the oesophagus. Since the oesophagus cannot withstand the pressure of the increased blood volume, thickened veins form in the oesophagus, which are called varices, i.e. varicose veins.
In extreme cases, these veins can tear, resulting in life-threatening and massive esophageal varicose bleeding, which is also accompanied by vomiting. In addition, alcoholics have increased inflammation of the mucous membrane in the oesophagus and stomach due to the toxic alcohol and regular harmful consumption. This means that there may also be more blood admixture during vomiting, as these inflammations occasionally bleed spontaneously.
Crohn’s disease is a chronic inflammatory disease of the digestive tract. Inflammatory defects of the mucous membranes occur more frequently, which are preferably located in the small and large intestine and very rarely in the oesophagus. The cause for the occurrence of this disease is not yet completely understood.
It is still known today that there is an inherited component, which means that the disease can occur more often in a family. Furthermore, it can also be an autoimmune reaction. This means that antibodies of the body’s own defence system are directed against the intestinal tissue and destroy it.
The inflammation of the mucous membrane often runs through almost all wall layers, which is called transmural. Inflammation foci form which can also break open, which can occasionally lead to bleeding. Since the disease can occur in relapses, the patient suffers in an acute phase and pain, weight loss and diarrhoea.
In addition, severe inflammation can lead to fever, nausea and even vomiting. The vomiting may well be mixed with blood and gives an indication that deep layers of the mucous membrane have already been damaged. There is then an increased risk of stronger intestinal bleeding (i.e. “affecting the intestine”).
These should be checked and treated as soon as possible by means of a colonoscopy. Vomiting can also cause inflammation in the oral cavity. Voltaren® or Diclofenac is a medium strength painkiller which can be used in many ways.
Voltaren® tablets are not well tolerated by all patients, as they can often cause stomach problems. After prolonged use, the ingredients attack the mucous membrane of the stomach and can cause inflammation or even ulcers. These inflammations can lead to different degrees of mucous membrane defects in different places.
These defects can spread over a large area but can also penetrate deep into the mucosa. The patients then suffer from severe stomach pain or cramps. Diarrhoea or vomiting can also occur.
When vomiting, blood may be mixed in. This can happen if the ulcers tear or inflammation causes deep wounds that then start to bleed. Often the bleeding itself makes the patient feel sick so that he or she has to vomit.
In the case of vomiting, the bleeding should definitely be followed up. The patient can consult the treating doctor at the first symptoms. In the best case, complications such as stomach ulcers and inflammation can be prevented early on by discontinuing the medication.
