Hematemesis; 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.
Conditions that cause vomiting blood can also cause blood to appear in the stool.
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) may be present in people with severe liver damage.
Repeated vomiting and retching may cause bleeding and damage to the lower esophagus called Mallory Weiss tears.
Other causes may include:
Get medical attention right away. Vomiting blood can indicate a serious medical problem.
Contact your health care provider or go to the emergency room if vomiting of blood occurs. You will need to be examined right away.
The provider will examine you and ask questions such as:
Tests that may be done include:
If you have vomited a lot of blood, you may need emergency treatment. This may include:
DeGeorge LM, Nable JV. Gastrointestinal bleeding. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 26.
Kovacs TO, Jensen DM. Gastrointestinal hemorrhage. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 126.
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.BACK TO TOP
Review Date: 1/30/2023
Reviewed By: Michael M. Phillips, MD, Emeritus Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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