What is hematemesis?
Hematemesis is the vomiting of blood. The bleeding is
usually from the upper gastrointestinal (GI) tract. This
means the bleeding may be from the esophagus (the tube that
connects the mouth and stomach), the stomach, or the upper
small intestine (duodenum).
How does it occur?
The most common cause of upper GI bleeding is an ulcer in
the stomach or small intestine.
Irritation of the stomach (gastritis) or esophagus
(esophagitis) can also cause bloody vomit. Medicines such
as aspirin, ibuprofen, and naproxen are common causes of
stomach and esophagus irritation.
Another common cause of bleeding is liver disease. When the
liver has scars from cirrhosis, the veins around the
esophagus become swollen, like varicose veins of the legs.
The veins may bleed suddenly after you cough or vomit, or
they may bleed for no apparent reason.
Sometimes the esophagus bleeds because it is torn. These
tears may happen after forceful coughing or vomiting,
especially, for example, after a severe bout of stomach flu
or from vomiting after drinking too much alcohol.
It is unusual for cancers of the stomach and esophagus to
cause large amounts of bloody vomit.
What are the symptoms?
Vomiting blood can be a very frightening experience. In
mild cases, you may notice small amounts of bright, red
blood or dark brown or black material that looks like coffee
grounds in your vomit. If the bleeding is severe, you may
keep vomiting large amounts of bright red blood.
You may have other symptoms, depending on the cause of the
vomiting of blood. These symptoms may be:
- heartburn
- stomach pain
- dark, black, tarry bowel movements.
Black, tarry stools may mean that you have had bleeding
from your stomach or intestines for some time. Blood that
passes through the intestines is digested and turns black.
How is it diagnosed?
If the bleeding is mild and not frequent, your health care
provider will first ask about your personal and family
medical history. You will have a physical exam. You may
also have:
- blood tests
- a test to look for blood in your bowel movements
- an x-ray of your esophagus or stomach.
If these tests do not show a cause of bleeding and your
symptoms continue or if you have more severe bleeding, you
may have an upper endoscopy. First your provider will give
you medicine to sedate you. Then he or she will insert a
thin, flexible tube with a tiny camera through your mouth,
into your esophagus and stomach, and into the upper small
intestine to look for causes of bleeding. The endoscope can
be used to look for varicose veins of the esophagus,
irritation of the lining of the esophagus or stomach organs,
or an ulcer.
How is it treated?
If the bleeding is severe, you will be treated in the
emergency room and hospital, maybe even in the intensive
care unit. The first goal of treatment is to stop the
bleeding. You need to have enough fluids and blood to
maintain a normal blood pressure to keep you alert and keep
your organs healthy (such as your brain, heart, and
kidneys). You will have an IV line for intravenous fluids
and medicines. You may also be given oxygen with a small
short tube in your nose. You will probably have a
nasogastric tube, which is a slim, flexible plastic tube
that passes through your nose down into your stomach. Your
health care provider can give you medicines through the
nasogastric tube to help stop the bleeding. Your provider
can also use the tube to get samples of stomach fluids so he
or she can tell if the bleeding has stopped.
If you have severe bleeding and it can't be stopped, a
special tube with a balloon on the end of it may be inserted
into your esophagus. Once in place, the balloon can be
blown up so that it presses on the area of bleeding to stop
it. You may need emergency surgery to stop the bleeding.
Depending on how fast your bleeding stops and why you are
bleeding in the first place, you will be in the hospital at
least 1 day or more. You will have treatment for the
underlying cause of the bleeding as well.
Whether the bleeding is mild or severe, you will have blood
tests to help measure how much blood you have lost and to
see if your blood has problems clotting. The tests will
also help determine why you are having the bleeding. You
may have one or more endoscopies to look for the cause and
to see if the bleeding is likely to restart.
If the bleeding is mild (occasional or small amount), the
treatment will depend on the cause of the bleeding:
- Irritating medicines will need to be discontinued.
- Forceful vomiting will be treated with antinausea and
vomiting drugs.
- Gastritis and ulcers will be treated with medicine. You
may need to stop smoking or stop drinking alcohol.
- Liver disease will be treated according to its cause.
- Varicose veins of the esophagus may need to be removed
with surgery or with chemicals applied directly to them.
- For all cases, your provider will recommend a soft
(nonirritating) diet.
How can I take care of myself?
- Follow your health care provider's instructions
carefully. Make sure you take all prescribed medicines
and follow any special diets your provider recommends.
- If the bleeding was caused by alcohol abuse, you need to
follow your health care provider's recommendations for
stopping drinking.
- Keep all follow-up appointments with your health care
provider.
- Make sure you know what to do if the bleeding starts
again.
How can I help prevent GI bleeding?
Prompt treatment of the frequent causes of vomiting blood
may prevent it from ever occurring. See your health care
provider if you have:
- symptoms of ulcers or irritation of the stomach or
esophagus, such as stomach pain, heartburn, or acid
indigestion
- black, tarry bowel movements.
If you drink too much alcohol, you are at high risk of
developing scarring of the liver (cirrhosis) and problems
with your esophagus and stomach that may cause sudden, severe
bleeding. You need to get help with your drinking problem.
This content is reviewed periodically and is subject to
change as new health information becomes available. The
information is intended to inform and educate and is not a
replacement for medical evaluation, advice, diagnosis or
treatment by a healthcare professional.
Copyright © 2005 McKesson Corporation and/or one of its subsidiaries. All Rights Reserved.