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Blood Breaking (hematemesis) symptoms, causes, therapies
Gushy or caffeine-type vomiting
Breaking blood usually indicates a disease in the esophagus, stomach or duodenum. In any case, medical assistance is necessary. In the case of bilious vomiting, a hospital should be visited or the emergency physician should be called. In at least half of the cases, the cause of blood in the vomit is an ulcer in the stomach (gastric ulcer) or the duodenum (ulcer duodeni). Likewise, cause inflammation or tumors in the area of the esophagus, stomach and duodenum in question. Life-threatening is the (mostly gush-like) bleeding from varices of the esophagus (esophageal varices), which, however, occurs less frequently. If the bleeding occurs after violent retching and vomiting, it is likely tears of the esophageal mucosa, the so-called Mallory-Weiss syndrome.
contents
- Gushy or caffeine-type vomiting
- Vomiting blood - the most important thing in brief
- Common causes of blood in the vomit
- Vomit looks like coffee grounds
- Gushing with bright red blood
- Smaller amounts of fresh blood
- Rarer reasons for hematemesis
- risk groups
- Associated symptoms
- Frequency and mortality
- diagnosis
- therapy
Vomiting blood - the most important thing in brief
ImportantBleeding is an emergency requiring immediate medical attention. The causes of blood in the vomit can sometimes be life-threatening. The source of bleeding should be promptly detected and treated. Here is a brief overview of the symptoms:
- definition: The term hematemesis in medicine refers to the vomiting of blood.
- to form: The color and consistency of the vomit may vary depending on the source of the bleeding. Coarse distinction is made between so-called Kaffeesatzerbrechen and Schwallartigem passing with bright red coloring.
- Common causes: Erosive gastritis, gastric ulcer, duodenal ulcer, gastric perforation, ruptured varicose vein in the esophagus (esophageal varices), mucosal tear between stomach and esophagus (Mallory-Weiss syndrome).
- Rarer causes: Ingested poisons or acids, leukemia, thrombocytopenia, hemophilia, anemia, cancer in the esophagus or stomach, respiratory disease, lung cancer.
- Associated symptoms: Low blood pressure, short unconsciousness, impaired consciousness, difficulty breathing, inner restlessness, anxiety, shock.
- risk factors: frequent alcohol consumption, smoking, poor diet, bulimia, liver disease.
- diagnosis: Anamnesis, blood test, endoscopy of the esophagus, stomach and duodenum, x-rays, ultrasound examination of the abdominal cavity.
- therapy: First priority is stopping the bleeding. This occurs either during mirroring or through surgery. Thereafter, depending on the cause, further treatment is initiated to prevent the recurrence.
Blood breakage can have different causes, but should be evaluated as an alarm signal in any case. (Image: Alexey Achepovsky / fotolia.com) Common causes of blood in the vomit
Vomiting of blood can sometimes be a sign of a serious problem. Patients should always consult the GP. In some cases, immediate hospitalization is required. The underlying causes can vary greatly. The color, amount, and consistency of the blood that is in the vomit provides an initial clue as to what the cause is. The following explanations are intended to provide an overview of which symptoms are associated with hematemesis. They are for general information and can not replace a medical diagnosis.
Vomit looks like coffee grounds
If the vomit looks like coffee grounds, it indicates that the blood has been in the stomach for some time. A so-called erosive gastritis (gastritis) can cause irritation and damage to the gastric mucosa, which may also be associated with bleeding. From such inflammations, but also by smoking, frequent alcohol consumption, improper diet or regular intake of gastrointestinal drugs (such as acetylsalicylic acid, ibuprofen and diclofenac), a duodenal or gastric ulcer may arise. This is often responsible for blood vomiting in the advanced state.
The ulcer penetrates into the deeper layers of the stomach wall and injures blood vessels there. From these injured vessels, blood enters the interior of the stomach, mixes with the stomach acid and clots. The stomach contents turn dark red to black and it comes to the typical Kaffeesatzerbrechen. In addition, vomiting of blood may also lead to other symptoms such as a tarry, black bowel movement and severe stomach problems. In particularly bad cases, there may also be a gastric perforation (gastric perforation).
If the vomit looks like coffee grounds, then the blood is most likely from the stomach where it has clotted. (Image: rdnzl / fotolia.com) Gushing with bright red blood
If the blood in the vomit is bright red, this indicates that it has not yet come in contact with the stomach contents. When it comes to bubbly vomiting of blood with red blood, the cause lies mostly in the esophagus or in the mucous membrane between stomach and esophagus. This could be so-called esophageal varices. These are spider veins (varicose veins) in the esophagus that cause a bubbly vomiting when they burst or rupture. Often there is an advanced disease of the liver (liver cirrhosis), which favor such varicose veins.
Furthermore, the so-called Mallory-Weiss syndrome as the cause of hematemesis into consideration. The cause here is a tear in the mucous membrane that lies between the stomach and the esophagus. Again, the blood has not clotted and is more of a light red color. Irritation of the mucosa over an extended period of time can lead to such a tear. Alcoholism or frequent vomiting, as is the case with bulimia, for example, are the greatest risk factors for the occurrence of a Mallory-Weiss syndrome.
Smaller amounts of fresh blood
Violent and prolonged gastroesophageal reflux, better known as heartburn, may also be the source of the bleeding. In the process, acid enters the esophagus from the stomach and leads to irritation, which can also cause bleeding in the advanced course. However, if smaller amounts of fresh blood without stomach contents are being strangled or coughed out, then the problem is often not in the stomach, intestine or esophagus, but in the respiratory tract. Here one speaks less of vomiting blood than rather of bloody expectoration.
If smaller amounts of fresh blood are strangled or coughed up, the cause tends to be in the airways. (Image: ryanking999 / fotolia.com) Possible causes include severe bronchitis, COPD, pulmonary embolism, tuberculosis, pneumonia or lung cancer. Fresh coughing or excess blood is a strong alarm signal and should definitely be examined by a doctor. But there are also less threatening causes conceivable, such as blood that has run during a nosebleed or a pharyngeal injury in the esophagus and there provides the cough or nausea. More information can be found in the article "spitting blood".
Rarer reasons for hematemesis
Rarely can the blood in the vomit have the following causes:
- Swallowed poisons like arsenic or corrosive acids,
- a reduced number of blood platelets in the blood (thrombocytopenia),
- leukemia,
- hemophilia,
- anemia,
- Cancer in the esophagus or stomach.
risk groups
Certain groups of people are at a higher risk of vomiting. These include, for example, people who consume excessive alcohol for several years. In addition, people with liver disease are more at risk of developing varicose veins in the esophagus that can rupture and thus cause vomiting. Bulimia sufferers are also in the risk group, as they irritate the frequent passing of the mucous membranes between the stomach and esophagus, which can then tear (Mallory-Weiss syndrome). Other risk factors for hematemesis include smoking and poor nutrition.
An overview of the most common reasons and risk factors that lead to hematemesis. (Image: leremy / fotolia.com / heilpraxis.de) Pre-existing diseases that promote vomiting
Patients suffering from cirrhosis of the liver are at greater risk of varicose veins in the esophagus, causing a vomiting of the blood. Even if there is a splanchnic thrombosis, the risk of hematemesis is high. This type of thrombosis is often not detected early. In most cases, it will not be diagnosed until bleeding starts. Furthermore, ulcer disease is a risk factor that can lead to vomiting with blood. Ulcer disease may result from gastritis and is mostly caused by the bacterium Helicobacter pylori. Similarly, a cancer in the gastrointestinal tract may cause nausea and vomiting with blood.
Other risk factors are certain surgical procedures that have taken place recently. These include, in particular, percutaneous transluminal coronary angioplasty (PTCA), a treatment method for dilating coronary blood vessels caused by arteriosclerosis or blood clots, and ablation of intestinal or gastric polyps (polypectomy). In addition, all diseases of the category "Hematologic Neoplasia" are considered potential triggers for hematemesis. These are malignant diseases that affect the blood or blood-forming organs. These include, for example:
- Leukemia like:
- acute myeloid leukemia (AML),
- acute lymphoblastic leukemia (ALL),
- chronic lymphocytic leukemia (CLL),
- chronic myeloid leukemia (CML).
- Malignant lymphomas like:
- Hodgkin's disease (Hodgkin's lymphoma),
- Non-Hodgkin's lymphoma (NHL),
- Plasmocytoma (multiple myeloma),
- Malignant bone marrow diseases such as polycythemia vera
- Myelodysplastic syndromes (MDS)
Certain pre-existing conditions such as bulimia, alcoholism, leukemia or severe liver damage increase the risk of vomiting. (Image: Monkey Business / fotolia.com) Associated symptoms
In combination with vomiting blood can be more typical symptoms set. For example, blood pressure can settle to a very low level. Doctors are talking about orthostatic dysregulation. Even a brief unconsciousness (syncope) is not uncommon. Furthermore, as a result of hematemesis, a disturbance of consciousness (vigilance reduction) may occur. In addition, there is a risk that vomit may enter the airways. This aspiration can cause breathing difficulties or even respiratory distress. In addition, bloody vomiting is not uncommonly associated with a strong internal agitation (agitation) of those affected and can lead to anxiety or shock states.
Frequency and mortality
Gastrointestinal bleeding (GIB) is differentiated into upper and lower GIB. In the case of vomiting of blood, the upper GIBs are considered in the first place. At lower GIB, the source of bleeding is located in the small bowel, colon or rectum. This is more likely to be due to blood in the stool. In over 75 percent of all GIB cases, there is an upper GIB. The most common cause is a duodenal ulcer (ulcer duodeni) or a gastric ulcer (gastric ulcer). Every year around 40,000 to 80,000 people in Germany suffer an upper GIB. Upper gastrointestinal bleeding can sometimes be dramatic, posing a medical emergency. The mortality rate at GIB is between five and ten percent, with factors such as over 65 years of age, heart failure, or lung disease having a negative impact on disease progression.
diagnosis
A small sample of the vomit can provide the attending physician with important clues to the diagnosis. It is important to confirm that the vomited blood is actually from the stomach or esophagus and has not been coughed out of the airways or lungs, because the underlying causes would be completely different in this case. In addition to a blood test, in most cases, a mirroring (endoscopy) of the esophagus, stomach and duodenum is performed. It is used for the safe localization of the source of bleeding, which may need to be closed. Other diagnostic options include X-rays or an abdominal ultrasound scan.
With the help of an endoscopy, the source of bleeding can be both discovered and cared for. Some patients may require additional surgery. (Image: romaset / fotolia.com) therapy
After the source of bleeding has been identified, it must first be closed. Smaller sources can already be treated during mirroring. For example, small tools that are inserted through the tube can drain, sew, or stick to bleeding. Advanced gastric ulcer may require surgery to remove the inflamed tissue. In the case of heavy fluid loss, replacement fluid must be urgently supplied as compensation by means of a venous cannula. Greater blood loss can be compensated by stored blood or packed red blood cells.
If the bleeding is supplied, the subsequent therapy depends on the cause found. Sometimes life changes may be necessary to permanently prevent the causes of blood vomiting. If, for example, alcohol addiction or bulimia is responsible for the hematemesis, the addiction must be combated as the therapy progresses so that the secondary symptoms, such as vomiting, do not reappear. It may also require medication and other surgeries to deal with an underlying liver disease, for example. (jvs; vb; updated November 26, 2018)