Vomiting blood: haemorrhaging of the upper gastrointestinal tract

By Cristiano Antonino On Jul 6, 2022

Vomiting blood: haemorrhage of the initial tract of the digestive tract results in haematemesis, i.e. vomiting of blood, often associated with melena (emission of black-picky stools)

If the bleeding is minor, anaemia may be the only symptom present.

True melena almost always follows bleeding from a region proximal to the jejunum, although the presence of blackish liquid stools is not uncommon in patients with small bowel or proximal colon bleeding.

Vomiting blood, the causes

Approximately 50 per cent of cases of upper gastrointestinal bleeding are due to gastric or duodenal ulcers while most of the remaining cases are due to gastric erosions, a Mallory-Weiss tear or oesophageal varices.

Less frequent causes include gastric carcinoma, ernobilia, systemic diseases such as uraemia, connective tissue disorders and infections, and systemic syndromes such as hereditary haemorrhagic telangiectasia and bullous blue nevi.

Diagnosis: history of the patient vomiting blood

Important aspects of the history include an estimate of the volume of blood lost, the time within which the bleeding occurred, previous abdominal symptoms or a positive history of ulcerative peptic disease, recent intake of non-steroidal anti-inflammatory drugs, including acetylsalicylic acid, vomiting or retching before bleeding, alcohol abuse, documented presence of hepatopathy or weight loss indicative of a malignancy.

Vomiting blood, the diagnosis: objective examination

It is important to recognise haemodynamic deficits that indicate blood volume depletion, such as a systolic blood pressure below 100 mmHg or a heart rate above 100 beats per minute, signs of chronic hepatopathy, epigastric tenderness abdominal distension with hyperactivity bowel sounds indicating the presence of large amounts of blood in the intestine, splenomegaly or distension of the veins in the abdominal wall typical of portal hypertension, purpura as a sign of generalised haemorrhagic disorders and nasopharyngeal bleeding, as a result of which ingested blood may give rise to haematemesis and/or melaena.

Diagnostic investigations

The blood count, urea and electrolyte profile should be checked urgently.

It should be borne in mind that haemoglobin and haematocrit values do not fall until haemodilution occurs, which may take several hours.

Blood urea values are generally elevated following significant upper gastrointestinal bleeding, and disproportionate to creatinine levels.

Vomiting blood, treatment

Endoscopy should be performed early, as it not only provides important diagnostic information but, in the case of bleeding peptic ulcers or varices, enables sclerotherapy to be performed.

It is essential to adequately resuscitate the patient prior to endoscopic examination, and in all patients admitted with suspected gastrointestinal bleeding, vascular access must be established early.

Patients who continue to bleed, in whom endoscopic treatment is not possible, not appropriate or has failed, should undergo surgery early, especially if they are elderly.

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