HAEMATEMESIS

✓ Medically ReviewedSYMPTOMID: MDBT0105🚨 TRIAGE: EMERGENCYICD-10: K92.0

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Definition

CLINICAL DEFINITION

Haematemesis is vomiting of fresh red blood or coffee-ground material (dark grainy vomit from altered blood). It signals bleeding from the upper gut proximal to the ligament of Treitz (bend ending upper gut). Fresh blood suggests brisk active bleeding near gullet, stomach or duodenum (first bowel loop). Coffee-ground shows blood altered by gastric acid (stomach acid) into dark haematin (blood pigment). Any haematemesis needs emergency assessment for shock (collapse from blood loss) and ongoing bleed.

IN PLAIN ENGLISH

Vomiting blood is called haematemesis. It can look bright red. It can look dark like coffee grounds. It comes from the food pipe, stomach or top gut. It is an emergency and needs fast care.

COMMON MISCONCEPTION / WHAT IT DOES NOT MEAN

Haematemesis is not haemoptysis (coughing blood) from lungs with froth and breath trouble. It is not swallowed epistaxis (nosebleed) with nose bleed and throat trickle. It is not haematochezia (fresh rectal bleeding) or melaena (black stools) alone without vomited blood. It is not food or iron tablets (iron pills) staining vomit without blood. Confirm vomited blood with history plus rectal exam and haemoglobin (blood count) review.

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Word Breakdown

haemat-

=blood, from Greek haima

emesis-

=vomiting, from Greek emesis

Literal Meaning: vomiting of blood

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Abbreviations

UGIB=Upper gastrointestinal bleeding - bleed above the upper gut bend

OGD=Oesophagogastroduodenoscopy - camera test of gullet, stomach and duodenum

Hb=Haemoglobin - blood protein carrying oxygen that falls with blood loss

HR=Heart rate - pulse speed that rises with shock

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Synonyms & Variants

Vomiting blood›Coffee-ground vomitus›Bloody vomitus›

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Category-Specific Context

Haematemesis is a Symptom because it is the patient complaint of vomiting blood. It is not a Disease with single course like ulcer alone. Many diseases can cause it from ulcers to varices (swollen veins). Care starts with resuscitation (fluid and blood support) then finds the source. It sits under upper gut bleeding with shock as its urgent face.

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Clinical Context & Usage

CLINICAL SETTINGS

Emergency DepartmentAcute Medical UnitEndoscopy UnitIntensive Care UnitGastroenterology WardPrimary Care Urgent Assessment

USAGE & DOCUMENTATION NOTES

Use haematemesis for witnessed vomited blood, not nausea alone. Record colour, volume, clots, melaena (black stools) and haematemesis episodes. Document vitals, postural symptoms (dizzy on standing), liver disease, NSAID (painkiller) and anticoagulant (blood thinner) use. Do not label haemoptysis (coughed blood) or nosebleed swallow as haematemesis without gut source.

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Primary Causes & Pathophysiology

PATHOPHYSIOLOGY

Mucosal breach (lining break) exposes vessels to acid and pepsin (stomach juices). Erosion into an artery causes brisk fresh bleeding with clots. Portal hypertension (high vein pressure) ruptures oesophageal or gastric varices (swollen veins) with massive bleed. Slow oozing altered by acid forms haematin (dark pigment) seen as coffee-ground. Volume loss cuts preload (heart fill) and causes shock (poor organ flow).

PRIMARY CAUSES

Peptic ulcer of stomach or duodenum

Ulcer erodes through mucosa (lining) into a submucosal artery so arterial bleeding vomits as fresh blood

Oesophageal or gastric varices with portal hypertension

High portal pressure dilates veins that rupture under thin wall tension causing massive fresh bleed

Mallory-Weiss tear at the gullet-stomach junction

Forceful retching splits mucosa (lining tear) after vomiting and bleeds from small arterial vessels

Acute erosive gastritis

Diffuse chemical injury from acid, alcohol or drugs breaks barrier and oozes from many surface points

Oesophagitis with ulceration

Reflux or pill injury ulcerates gullet lining (food pipe skin) exposing fragile vessels that bleed when vomiting

Upper gastrointestinal malignancy of oesophagus or stomach

Tumour neovessels (new fragile vessels) bleed easily and ulcerated tumour oozes with retching

Dieulafoy lesion with large surface artery

Abnormally large artery sits just under mucosa (thin cover) and bursts through a tiny defect with brisk bleed

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Drug-Induced Causes

💊 NSAIDs such as ibuprofen, diclofenac and naproxen ↗

Mechanism: Block protective prostaglandins (lining chemicals) and impair clotting so ulcers form and bleed heavily

→ Stop NSAID where possible, give high-dose proton pump inhibitor (acid blocker), arrange urgent endoscopy and review analgesia

💊 Anticoagulants such as warfarin, apixaban and rivaroxaban ↗

Mechanism: Impair clot formation so small mucosal breaks (lining cracks) bleed longer with larger vomited volume

→ Hold or reverse per bleeding protocol, check clotting with haemoglobin, give transfusion and endoscopy pathway as needed

💊 Antiplatelets such as aspirin and clopidogrel ↗

Mechanism: Block platelet plugs (clot starters) so ulcer or tear oozing persists and rebleed risk rises

→ Weigh heart risk with bleed, hold short term if major bleed, give acid blocker and urgent gastro-cardiology review

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Epidemiology

Prevalence:Haematemesis is a common emergency presentation in acute care. Ulcer bleeding dominates in older adults using NSAIDs (painkillers) or aspirin. Variceal bleeding clusters with cirrhosis (liver scarring) and alcohol-related liver disease. True rates shift with prescribing, endoscopy access and liver disease burden.

Age Group:All ages can present when cause is present. Ulcer and drug-related bleeds rise with older age. Variceal bleeds peak in adults with cirrhosis (liver scarring). Mallory-Weiss tears span young adults with heavy retching and alcohol use.

Geographic Distribution:Haematemesis occurs worldwide without single clustering. Ulcer patterns track Helicobacter pylori (stomach germ) and NSAID (painkiller) use. Variceal cases track cirrhosis (liver scarring) from alcohol and viral hepatitis (liver infection). Detection follows emergency and endoscopy (camera test) access.

Red Flags & Triage ★

TRIAGE LEVEL

🚨 EMERGENCY

DO NOT MISS — LIFE-THREATENING PRESENTATIONS

Variceal bleed with cirrhosis stigmata
Hypovolaemic shock with ongoing loss
Rebleed after initial settling
Aspiration with breath trouble after vomit
Upper gut malignancy with weight loss and anaemia
Aortoenteric fistula with brisk bleed and prior graft

URGENT EVALUATION TRIGGERS

Fresh large-volume vomited blood or clots
Low pressure, fast pulse, faint or confusion
Melaena with collapse or haemoglobin fall
Known varices or liver disease with any bleed
Ongoing vomit, black stools or low urine output

Contraindications & Precautions

CONTRAINDICATIONS

Do not discharge ongoing fresh haematemesis for outpatient review
Do not give NSAIDs, aspirin or alcohol during acute bleed
Do not delay transfusion when shock or ongoing loss is present
Do not attempt outpatient endoscopy when unstable or vomiting blood

SPECIAL PRECAUTIONS

Nurse upright where possible with suction ready for rebleed
Gain two large-bore cannulas with bloods and crossmatch early
Keep nil by mouth until endoscopy plan is set
Monitor pulse, pressure, breathing, urine and mental state often
Review anticoagulant, antiplatelet and NSAID use with cardiology input

Complications

DOWNSTREAM CLINICAL COMPLICATIONS

Hypovolaemic shock with organ failure (collapse from blood loss)
Severe anaemia with fatigue and breathlessness (low blood count)
Rebleeding after initial stop with fresh haematemesis
Aspiration pneumonia from inhaled blood (lung infection)
Acute kidney injury from poor perfusion (kidney shutdown)
Hepatic encephalopathy in cirrhosis (confusion from liver failure)
Death from massive or variceal bleed

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Reference Ranges

CRITICAL (PANIC) VALUESystolic below 100 with pulse above 100 plus fresh blood marks major bleed. Dizziness, faint, low urine or confusion signals shock (poor flow). Any varices with vomited blood needs emergency endoscopy pathway.

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Confused With (LASA & DDx) ★

LEXICAL (LASA) — SIMILAR NAMES

Haemoptysis

Shares haem prefix and blood idea but is coughed lung blood with froth, not vomited gut blood

Haematuria

Shares haemat stem but is blood in urine from urinary tract, not vomited blood

Haematochezia

Shares blood plus gut idea but is fresh rectal bleeding from lower gut, not vomited upper bleed

CLINICAL DIFFERENTIAL DIAGNOSES (DDx)

Haemoptysis from lower airways

Key Distinguishing Feature: Frothy bright blood with cough and breath trouble plus normal rectal exam, not dark vomit with melaena

Swallowed epistaxis with vomited blood

Key Distinguishing Feature: Active nosebleed with throat trickle and blood in spit, not melaena with ulcer or liver history

Lower gastrointestinal bleeding

Key Distinguishing Feature: Rectal bleeding with clots and stable vomit history, not witnessed bloody vomit from upper gut

Melaena without witnessed haematemesis

Key Distinguishing Feature: Black tarry stools alone from oozing upper source, without vomited blood episode

Food, iron or bismuth staining mimicking blood

Key Distinguishing Feature: Dark vomit after beetroot, iron or bismuth with stable vitals and normal haemoglobin (blood count)

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Clinical Pearls

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Treat any fresh haematemesis as major bleed until vitals, haemoglobin and melaena prove otherwise. Resuscitate first, scope promptly.

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Ask about NSAIDs, anticoagulants, alcohol, liver disease and prior bleeds in every case. Drug review changes transfusion and scope urgency.

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Use Glasgow-Blatchford to flag low risk and Rockall to judge rebleed and death risk. Scores guide ward, unit and timing, not gut feeling.

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Start high-dose acid blocker for ulcer-type bleed and variceal drugs plus antibiotics when varices are likely. Do not wait for scope to resuscitate.

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Arrange urgent inpatient endoscopy with banding or ulcer therapy as indicated. Rebleed, shock or varices need critical care input.

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Example Usage & SOAP

CLINICAL SENTENCE

""68-year-old man with fresh haematemesis and melaena has a bleeding duodenal ulcer.""

IN A SOAP NOTE

S: 68-year-old man with fresh vomited blood and black stools, dizzy on standing, NSAID use, no chest pain. O: Temp 36.7C, BP 94/58, HR 114, RR 24, SpO2 95 percent on air, pale and sweaty, melaena on rectal exam. Labs show low haemoglobin with high urea. A: Acute haematemesis with shock likely ulcer bleed. P: Resuscitation with fluids and crossmatch, high-dose proton pump inhibitor, urgent OGD, high-dependency review, hold NSAID.

DIFFERENTIAL DIAGNOSIS CONTEXT

Vomited fresh blood with melaena (black stools) favours haematemesis from upper gut. Frothy blood with cough favours haemoptysis (lung blood). Nosebleed with throat blood favours swallowed epistaxis (nose source). Rectal bleeding without vomit favours lower gut bleed. Check vitals, rectal exam and haemoglobin (blood count).

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Classifications & Scoring

SCORING TOOL

Glasgow-Blatchford Score

Risk tool for upper bleed using vitals, haemoglobin, urea and history. Low score flags low risk for outpatient care. High score needs urgent admission and scope.

SCORING TOOL

Rockall Score

Predicts rebleed and death using age, shock, comorbidity and endoscopy signs. Higher score means higher risk. Guides unit level and follow-up.

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Prognosis

SHORT-TERM OUTCOME

Small self-limited bleeds settle fast with observation and acid control. Large fresh bleeds can collapse within hours without fluids and blood. Variceal bleed carries higher early rebleed and death risk. Early resuscitation with urgent endoscopy (camera test) improves short term course.

LONG-TERM PROGNOSIS

Ulcer healing is good after Helicobacter pylori (stomach germ) cure and NSAID (painkiller) review. Varices often rebleed without pressure lowering and banding (tie treatment). Malignant causes depend on cancer stage and treatment. Repeated bleeds cause iron deficiency (low iron) and frailty without prevention.

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References & Coding

ICD-10 DIAGNOSTIC CODE

K92.0

LITERATURE CITATIONS & GUIDELINES

[1]WHO ICD-10 K92.0 Haematemesis

[2]NICE guidance on acute upper gastrointestinal bleeding

[3]British Society of Gastroenterology guidance on upper gastrointestinal bleeding

[4]Harrison's Principles of Internal Medicine gastrointestinal bleeding

MEDICAL DISCLAIMER — This content is intended for educational purposes and qualified healthcare professionals only. Always refer to current clinical diagnostic criteria, institutional protocols, and official guidelines. Medobo is not responsible for clinical decisions made based on this content.