Recognising the different types of vomit according to colour

By Cristiano Antonino On Jul 1, 2022

At least once in our lives we have all been confronted with this problem. Let’s try to understand what the colours of vomit are and what their meaning is explained in simple detail

Green-coloured vomit

Vomiting that is green in colour is called ‘biliary vomiting’ and occurs with the emission of bile that has a characteristic dark yellowish-green colour.

The colour of the bile present in the vomit may vary from yellow to dark green depending on how long the bile has been stagnating in the stomach.

If the vomiting is biliary, it may be caused by a hangover, food poisoning or blockage of the intestine.

The green colour may in some cases also be caused by food that one has recently ingested.

Yellow-coloured vomiting

Yellow-coloured vomiting, as already mentioned, is often caused by the emission of bile.

In many cases it can be caused by a condition called ‘stenosis’, which is the narrowing of an orifice, duct, blood vessel or hollow organ, such that the normal passage of certain substances is obstructed or prevented.

Brown vomit with faecal odour

If the vomit is dark brown/brown in colour and also has a faecal-like odour, the cause may be ‘intestinal blockage’, i.e. stoppage of faecal output due to chronic constipation, gallstones in the intestines, polyposis, large colon tumours, choking due to hernias, paralysis of the colic wall or other obstructive reasons.

In the case of intestinal blockage, the more or less formed faecal material, unable to find its way to the anus, ascends in the opposite direction: in this case the vomiting is called ‘faecaloid vomiting’.

In general, the more ‘liquid’ and lighter brown the faecaloid vomit is, the more obstruction is present at a ‘high’ level of the digestive tract, while the darker and ‘harder’ it is, the more obstruction is present at a ‘low’ level (closer to the anus).

Caffeine-coloured vomiting

If the brown colour is similar to that of a coffee grounds, it is called ‘caffeine vomit’ and could be caused by internal bleeding with blood that has had time to coagulate or ‘be digested’.

In this case, unlike faecaloid vomiting, the faecal-like odour is absent.

Vomiting with digested/coagulated blood is typical of internal haemorrhages occurring in the ‘lower’ part of the digestive tract.

It is also easy to observe when blood comes out of the nose and one lies down: the blood will be digested and this will cause insistent retching.

Vomiting with bright red colour

Vomiting with bright red blood (called ‘haematemesis’) is usually caused by internal bleeding with blood that has not had time to clot or ‘be digested’.

This is possible, for example, in the case of an open ulcer in the stomach or oesophagus.

Haematemesis often occurs in the case of ruptured ‘oesophageal varices’, a serious pathological condition characterised by the formation and rupture of varices in the veins of the sub-mucosal plexus of the oesophagus, related to a state of chronic portal hypertension, which in turn is caused by chronic liver disease, such as cirrhosis of the liver, of which it is a dreaded complication.

Haemorrhage of the initial tract of the digestive system often results in melena (emission of black-picky stools) in addition to haematemesis.

White-coloured vomiting

White-coloured vomiting is caused by acidic gastric juices. It is often also accompanied by viscous or mucousy mucus.

When it is ‘mucousy’ it is usually not acidic.

When it is mostly gastric juices, it can be acidic.

White vomit can also occur when one has recently eaten something white, such as milk.

Vomiting of many different colours

This type is usually ‘gastric’ vomiting that contains undigested food or bits of food that have not had time to pass through the stomach.

Differential diagnosis

In addition to the colour, the type can also be useful to the doctor in understanding the cause of its occurrence:

food vomiting: if food is rejected even after meals;
watery vomit: if it is acidic, with little mucin, and gastric juices are present;
mucous vomit: if it is anacidic, rich in mucin, and gastric juices are present;
biliary vomit: if bile is emitted and has a characteristic dark green colour;
faecaloid vomit: if it has a dark brown colour and a typical faecal odour, due to prolonged stasis in the intestine (in the case, for example, of intestinal obstruction), whereby the bacterial flora proliferates indefinitely;
haemorrhagic vomiting or haematemesis, if bright red blood is present;
caffeine vomiting, if digested blood with a typical blackish colour (‘coffee grounds’) is present.

To aid in the diagnosis, the doctor may use various tools, including:

anamnesis (collection of the patient’s data and the symptoms he/she is experiencing);
objective examination (a ‘proper’ examination with collection of signs);
laboratory tests (e.g. blood tests, allergy tests, tests to assess liver and pancreatic function);
instrumental examinations such as X-ray of the abdomen with or without contrast medium, CT scan, ultrasound, oesophagogastroduodenoscopy, colonoscopy.

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