Hematemesis is the medical term for vomiting blood (vomiting blood), usually due to bleeding in the upper gastrointestinal (GI) tract. Any bleeding in the gastrointestinal tract is potentially life-threatening, with a lethality rate of about 10 percent, and should be promptly evaluated by a physician.
What is vomiting blood?
Infographic on the anatomy and causes in hematemesis. Click to enlarge. Hematemesis is the vomiting of blood as a result of bleeding in the upper gastrointestinal (GI) tract, specifically the esophagus (food pipe), stomach, and duodenum (small intestine). As a rule, the vomited blood has a bright red color. However, if this has come into contact with stomach acid, so-called hematin is formed, giving the blood a coffee grounds-like color. In the long term, hematemesis can lead to anemia (pallor, shortness of breath, feeling of weakness), circulatory impairment and, in the case of massive blood loss, to shock-like conditions (anxiety, palpitations, pale as well as cold sweaty skin, impaired consciousness) due to the loss of blood, which is why immediate medical clarification is required in the presence of hematemesis.
Causes
Hematemesis, along with tarry stools, is considered a leading symptom of upper gastrointestinal tract bleeding due to a variety of causes. The upper gastrointestinal tract includes the esophagus (food pipe), stomach, and duodenum (small intestine). Most commonly, vomiting blood is caused by bleeding ulcers (ulcers) in the stomach (ventriculi ulcer) or duodenum (duodenal ulcer), as well as damage to the mucosa or burst varices (varicose veins) in the esophagus or stomach (gastric fundal varices). In addition, Mallory-Weiss syndrome, which is associated with abrupt and intermittent vomiting followed by bleeding in the gastrointestinal tract due to longitudinal mucosal lesions, and erosive gastritis (precursor of ventricular ulcer) may result in hematemesis. In rare cases, hematemesis may also be due to gastric cancer, gastric polyps, or vascular disease. In contrast, a profuse nosebleed that has entered the esophagus and is subsequently vomited is very rarely the cause of hematemesis.
Diseases with this symptom
- Esophageal cancer
- Alcoholism
- Esophageal varices
- Mallory-Weiss syndrome
- Cirrhosis of the liver
- Liver disease
- Gastritis
- Stomach cancer
- Gastric polyps
- Esophageal variceal bleeding
- Gastric ulcer
- Duodenal ulcer
Diagnosis and course
Hematemesis is diagnosed on the basis of the presence of blood in the vomit, as well as known previous diseases that may cause vomiting blood. Here, the color of the blood may already indicate the underlying cause. For example, bright red blood usually indicates bleeding in the esophagus, while a black or coffee grounds-like coloration points to bleeding damage in the stomach or duodenum. An endoscopy of the esophagus and gastrointestinal tract should be performed to precisely localize the source of bleeding. In some cases, supplemental blood tests, radiographs, and sonographs (ultrasound examinations) are used to confirm the diagnosis. Hematemesis is usually well treatable depending on the underlying disease. To avoid compromise of the circulatory system from massive blood loss, the cause of hematemesis should be treated quickly.
Complications
Vomiting blood is merely a symptom, not a disease in its own right. From this, it can be inferred that a disease exists that causes vomiting of blood. Most complications that may occur are due to the underlying disease. Complications that occur directly as a result of the process of vomiting blood may include aspiration of the vomit and anxiety. In aspiration, the vomit enters the trachea, so it is inhaled. This initially causes a strong urge to cough, the aim of which is to expel the aspirated vomit from the respiratory tract. If this is unsuccessful, the worst-case scenario is suffocation. If the vomit reaches the lungs, it can lead to infection and inflammation.Anxiety up to downright panic attacks is another complication of hematuria. In the worst case, the patient is paralyzed by fear and unable to act rationally. This in turn promotes aspiration of the vomit. The underlying disease that triggers the symptom of vomiting blood can involve various complications, some of which are life-threatening. One example is severe blood loss with multiple negative consequences. In general, the consequences and complications of the diseases that may be present cannot be elaborated more precisely, since quite a few diseases and injuries can lead to vomiting of blood.
When should you go to the doctor?
In hematemesis, vomiting blood, the blood comes from one of the areas of the upper gastrointestinal tract: the esophagus, stomach, or duodenum. Vomited blood that has passed through the stomach acquires a blackish, coffee grounds-like appearance there due to stomach acid, which is why vomiting blood is popularly known as coffee grounds vomiting. In contrast, vomited blood that has not been in contact with stomach acid appears a fresh red color and usually comes from a damaged varicose vein in the esophagus. Vomited blood may also, in rare cases, originate from the nasopharynx, for example, in cases of severe nosebleeds. In case of hematemesis, a doctor should always be consulted. After all, 10% of bleeding from the gastrointestinal tract is fatal! The main causes of hematemesis are ulcers of the stomach or duodenum, gastritis, and injuries to the mucous membrane and ruptured varices in the esophagus or stomach. Hematemesis occurs in Mallory-Weiss syndrome associated with mucosal lesions, often preceded by excessive alcohol consumption over several years. In addition to these particularly common triggers of hematemesis, vascular diseases, gastric polyps, and gastric cancer should also be considered when determining the cause. In cases of vomiting blood, the general practitioner is a competent contact who, after an initial assessment, usually involves other specialists in the treatment: above all, the gastroenterologist, internist or oncologist.
Treatment and therapy
Therapeutic measures in hematemesis are aimed primarily at stopping the bleeding immediately and eliminating the underlying disease. To this end, in many cases, fluid and electrolytes are infused intravenously to stabilize the circulation to compensate for water and mineral loss resulting from hematemesis. In the event of massive blood loss, intravenous infusion of blood units or red blood cell concentrates (concentrated red blood cells) may be required. To clarify the cause of hematemesis, a prompt emergency endoscopy (endoscopy) is usually performed, during which the gastrointestinal bleeding can not only be localized but, if necessary, the underlying disease can be eliminated at the same time. For example, if there is a ruptured esophageal varicea (varicose vein in the esophagus), it can be sclerosed (obliterated) endoscopically, thus stopping the bleeding. If a bleeding ventriculi ulcer (stomach ulcer) is present, surgery may be indicated to remove the ulcer. If the ventricular ulcer is causally due to infection with Helicobacter pylori, antibiotic therapy (including amoxicillin or clarithromycin) is subsequently used. In addition, regardless of a possible bacterial infection, proton pump inhibitors such as pantoprazole or omeprazole are used to reduce gastric acid production to accelerate regeneration (healing) of the gastric mucosa and prevent rebleeding.
Outlook and prognosis
Acute vomiting of blood is an emergency. Quick action must be taken. Life-saving hemostasis must be performed immediately. Often, another illness is the cause of the hematemesis. Once it is clarified what it is, the sputum can be cured. If this clinical picture develops after great physical exertion, most likely walls of blood vessels are torn. It is then important to give the body sufficient rest. The injured blood vessels will heal by themselves. If the cause of the vomiting is an eating disorder, this is a great strain on the organism. Regular vomiting can damage blood vessels. The affected person should definitely start a therapy of the eating disorder.If successful, the vomiting of blood is alleviated and, in the best case, completely cured. As a side effect of a strong or chronic cough, hematemesis is also possible. With appropriate treatment of the cold, the symptoms will improve. After complete healing of the cold, the bloody sputum will also be gone. In the worst case, the vomiting of blood is caused by a tumor or a benign ulcer. In this case, the symptoms will not subside until the tumor or benign ulcer is surgically removed.
Prevention
Hematemesis can be prevented by taking steps to minimize the risk of mucosal defects. An unhealthy diet, excessive alcohol and nicotine consumption, and long-term use of certain pain-relieving medications (acetylsalicylic acid, diclofenac) are among the risk factors for conditions that can result in hematemesis.
Here’s what you can do yourself
Vomiting blood is almost always a sign of serious illness. When a first-time attack occurs, the necessary self-help measures should be taken immediately. The emergency physician must be informed immediately. The affected person should slightly straighten the upper body, if possible. Ideally, a sufferer should get into a sitting position and lean the upper body slightly forward. Under no circumstances should the patient lie on his or her back, as there is then a risk of blood getting into the lungs. Vomiting blood often triggers shock in the affected person. The patient should then be placed in the shock position and the legs elevated. If the patient loses consciousness before the emergency physician arrives, he or she should be placed in the recovery position. For regular vomiting of blood, a disease of the gastrointestinal tract is usually responsible. Gastritis is often the trigger. In this case, the patient himself can do a lot to ensure that the underlying disease heals and the symptom of vomiting blood occurs less frequently. A change in lifestyle is particularly helpful. Those who smoke and regularly drink alcohol should refrain from doing so. Heavy, high-fat food is also better replaced by light, vegetarian food. In addition, too much black or very strong coffee can irritate the stomach. If the gastritis is stress-related, learning a relaxation technique will help.
