Vomiting blood (called hematemesis) is never harmless and must be the subject of a consultation. The blood may be red, black, thin or with clots. What causes? The sign of cirrhosis?
Hematemesis refers to a discharge of blood through the mouth from the digestive tract, usually during vomiting. The amount of blood rejected is variable, as well as its severity. Hematemesis is never trivial and requires always a medical consultation.
Vomiting red blood: the sign of what?
Hematemesis is a rejection of more or less dark red blood (it may turn black) during vomiting. It can be of low abundance, with threads of blood in the vomiting or cataclysmic, constituting a real haemorrhage, which can lead to death. This constitutes a medical emergency. Vomit from Red blood is undigested blood that comes from the upper part of the digestive tract.
Vomiting black blood: the sign of what?
Of the brown or blackish bleeding correspond to digested blood, which therefore comes from the lower part of the digestive tract.
What are the possible causes?
Among the most common causes of hematemesis are:
- Gastric or duodenal ulcer
- Uliver disease
- esophagitis
- The evolution of gastritis
- Hepatic cirrhosis
Blood can come from the oral or pharyngeal cavity, and comes back up after being swallowed. In case of bloody evacuation with coughing efforts, it is hemoptysis, that is to say that the origin of the bleeding is bronchial. It is a symptom to be well differentiated from hematemesis. Ingestion of toxic drugs for the stomach (anti-inflammatories, aspirin…) can cause hematemesis.
What test should be done to make the diagnosis?
An esophago-gastro-duodenal endoscopy is necessary to make the diagnosis of the origin of hematemesis. This examination makes it possible to visualize using a camera introduced into the oral cavity and the esophagus, the digestive walls, up to the duodenum. The appearance of streaks of blood in the vomitus should prompt an oesogastro-duodenal fibroscopy and a biological assessment to look for anemia and/or hepatic abnormalities.
Is it an emergency or not?
► When the hematemesis is of low abundance (in threads of blood for example), that it accompanies, for example symptoms of gastroenteritis and that it takes place during intense and repeated vomiting efforts, it is simply due to irritation of the esophageal or oropharyngeal mucosa and usually disappears when vomiting stops. Consult all the same
► On the other hand, a hematemesis that is repeated or that is abundant requires a consultation. When it comes to hemorrhage, urgent transfer to hospital is necessary.
What support ?
Faced with hematemesis, it is often necessary to perform an esophago-gastro-duodenal fibroscopy. In the case of oesophigian varices, the risk of hemorrhage is high and requires sclerosis. In case of ulcer or esophagitis, treatment with antacids and a suitable diet are necessary. In all cases, it is useful to monitor the blood count, because repeated hematemesis can lead to more or less deep anemia.