Vomiting bloodHematemesis; Blood in the vomit
Vomiting blood is regurgitating (throwing up) contents of the stomach that contains blood.
Vomited blood may appear bright red, dark red, or look like coffee grounds. The vomited material may be mixed with food or it may be blood only.
It may be hard to tell the difference between vomiting blood and coughing up blood (from the lung) or a nosebleed.
Coughing up blood
Coughing up blood is the spitting up of blood or bloody mucus from the lungs and throat (respiratory tract). Hemoptysis is the medical term for cough...Read Article Now Book Mark Article
Conditions that cause vomiting blood can also cause blood in the stool.
Blood in the stool
Black or tarry stools with a foul smell are a sign of a problem in the upper digestive tract. It most often indicates that there is bleeding in the ...Read Article Now Book Mark Article
The upper GI (gastrointestinal) tract includes the mouth, throat, esophagus (swallowing tube), stomach and the duodenum (first part of the small intestine). Blood that is vomited may come from any of these places.
Vomiting that is very forceful or continues for a very long time may cause a tear in the small blood vessels of the throat. This may produce streaks of blood in the vomit.
Swollen veins in the walls of the lower part of the esophagus, and sometimes the stomach, may begin to bleed. These veins (called varices) are present in people with severe liver damage.
Repeated vomiting and retching may cause bleeding and damage to the lower esophagus called Mallory Weiss tears.
Mallory Weiss tears
A Mallory-Weiss tear occurs in the mucus membrane of the lower part of the esophagus or upper part of the stomach, near where they join. The tear ma...Read Article Now Book Mark Article
Other causes may include:
- Bleeding ulcer in the stomach, first part of the small intestine, or esophagus
- Blood clotting disorders
- Defects in the blood vessels of the GI tract
- Swelling, irritation, or inflammation of the esophagus lining (esophagitis) or the stomach lining (gastritis)
Esophagitis is a condition in which the lining of the esophagus becomes swollen, inflamed, or irritated. The esophagus is the tube that leads from y...Read Article Now Book Mark Article
- Swallowing blood (for example, after a nosebleed)
- Tumors of the mouth, throat, stomach or esophagus
Get medical attention right away. Vomiting blood can be a result of a serious medical problem.
When to Contact a Medical Professional
Call your health care provider or go to the emergency room if vomiting of blood occurs. You will need to be examined right away.
What to Expect at Your Office Visit
The provider will examine you and ask questions such as:
- When did the vomiting begin?
- Have you ever vomited blood before?
- How much blood was in the vomit?
- What color was the blood? (Bright or dark red or like coffee grounds?)
- Have you had any recent nosebleeds, surgeries, dental work, vomiting, stomach problems, or severe coughing?
- What other symptoms do you have?
- What medical conditions do you have?
- What medicines do you take?
- Do you drink alcohol or smoke?
Tests that may be done include:
- Blood work, such as a complete blood count (CBC), blood chemistries, blood clotting tests, and liver function tests
- Esophagogastroduodenoscopy (EGD) (placing a lit tube through the mouth into the esophagus, stomach and duodenum)
- Rectal examination
- Tube through the nose into the stomach and then applying suction to check for blood in the stomach
If you have vomited a lot of blood, you may need emergency treatment. This may include:
- Administration of oxygen
- Blood transfusions
- EGD with application of laser or other modalities to stop the bleeding
- Fluids through a vein
- Medicines to decrease stomach acid
- Possible surgery if bleeding does not stop
Kovacs TO, Jensen DM. Gastrointestinal hemorrhage. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 126.
Meguerdichian DA, Goralnick E. Gastrointestinal bleeding. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 27.
Savides TJ, Jensen DM. Gastrointestinal bleeding. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 20.
Review Date: 1/14/2021
Reviewed By: Michael M. Phillips, MD, Emeritus Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.