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:

• 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)
• Swallowing blood (for example, after a nosebleed)
• Tumors of the mouth, throat, stomach or esophagus

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:

• 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, smoke, or use tobacco?

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
• X-rays

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 treatments to stop the bleeding
• Fluids through a vein
• Medicines to decrease stomach acid
• Possible surgery if bleeding does not stop

Hematemesis; Blood in the vomit

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.

Updated 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.