I’m not asking for medical advice–I’m going to call my doctor tomorrow–but just to satisfy my own burning nervous questioning until I can talk to her…
I just threw up (Vicodin sometimes makes me throw up and I took some Vicodin about an hour ago; I’m guessing that’s what did it) and at the end of it there was some fresh blood. Not a lot of blood, maybe a spoonful or so.
What kinds of things could cause that? How worried should I be? I’ve been really stressed out lately* and wondering if I could give myself an ulcer–could that be it?
*I think I may have an anxiety disorder. My psychiatrist and I are talking about it.
Anxiety doesn’t cause ulcers, that’s the old idea before H. Pylori was discovered. As for blood in vomit, that could be due to an active bleed in the stomach, or an active bleed in the esophagus. Either way, it is something you should talk to your doctor about.
Well, a quick perusal of Medline says it could be a bleeding ulcer, an infection, an inflammation, or a couple other things. It also says to seek immediate medical attention. Personally I would probably go to urgent care or the ER for that.
I’ve got a gruesome story that I’m not going to regail you with, suffice to say that blood coming out of your body in that manner needs a doctor visit ASAP, ER even.
I had a small amount of blood in vomit when I had severe flu. It was maybe a teaspoon total over about 3 vomits. (After I had already vomited 3-4 times before that) Fresh, watery-looking, pinkish blood in vomit in small amounts could be from straining, which can cause small vessels along the surface of the esophagus to rupture.
A spoonful all at once, and not after already straining several times, could be more serious. If the blood is regular fresh-cut color or darker, that would be much more alarming to me and would have sent me to the doctor. If there are clots, or dark coffee-ground specks, that’s really serious.
update: my husband, who is a podiatry resident at the hospital and thus knows everyone there and has the direct phone number to the ER desk, just got off the phone with the ER doctor and talked to him about it to see if they thought I should come in. Since it was only about a spoonful and there was no coffee-ground looking stuff in there, and since there is no pain or dizziness or anything like that, the doctor said that I should be fine waiting until tomorrow and calling my doctor. So unless something changes I am not going to the ER tonight, though if my doctor tells me to go tomorrow, I will.
If stress can’t cause ulcers, what can? Also, if someone has an ulcer, is it always treated or can they heal on their own? And what is the treatment?
There are many causes of ulcers, as for treatment, it depends on what caused the ulcer in the first place. In most cases, the pharmacologic treatment is to cure the cause (i.e. if it is H. Pylori they give antibiotics, if it is caused by NSAIDs give Misoprostol, etc), and then give various antacid type medications to allow the ulcer to heal, be it Proton Pump Inhibitors (PPI’s, like Omeprazole, Esomeprazole, etc), H2 receptor blockers (Famotidine, Ranitidine, etc), basic antacids (Calcium Carbonate, Magnesium Hydroxide, Aluminum Hydroxide, etc), or a mixture of the above.
Ulcers are very much treatable in this day and age, unlike in the 40’s or 50’s when it was a death sentence. Either way, it is defiantly something to see your doctor about, but if it was only one time vomiting blood, it should be fine to wait to see your doctor tomorrow.
It indicates the presence of old digested blood (wiki link). Either you have been eating black pudding, or you have had a more serious GI bleed that needs investigating. Fresh blood in vomit indicates a current GI bleed, but the volume and other monitoring can determine if it is serious or light - ie a major peptic ulcer or a Mallory-Weiss tear caused by vomiting itself.
Regardless of the amount of blood, and independent of the presence of “coffee ground vomitus” etc., the only way to be sure that bleeding from the upper GI tract (which is what you seem to have) is not serious, is to go the hospital for a more thorough assessment. Such an assessment need not include upper GI endoscopy, but should take into account things like your blood count and kidney function. I am referring to the so-called Glasgow-Blatchford bleeding score (that I am more than impressed has a Wiki page).
As stated in the article (and in the original paper in the medical journal ‘The Lancet’), it’s safe to not be admitted to hospital when the following have been determined:
Hemoglobin level >12.9 g/dL (men) or >11.9 g/dL (women)
Systolic blood pressure >109 mm Hg
Pulse <100/minute
Blood urea nitrogen level <18.2 mg/dL
No melena or syncope
No past or present liver disease or heart failure
If even one of the above criteria is not met (and note that #1 and #4 require blood testing), the patient should be admitted to the hospital (if only for a short time).
further update: my husband talked to one of the GI doctors at the hospital this morning and they’ve scheduled me to come in for an upper GI endoscopy first thing on Monday morning. I’ve had one once before, years ago, and I remember it being unpleasant, but not as bad as it could have been because I was partially sedated. I’m guessing this will be the same since they told me I had to have someone drive me home.
Hopefully it was some freak one-time thing and not anything chronic or serious. I’ll keep you posted.
ETA: they told me to keep my eye on my poop to see if it’s ever black (which I would have done anyway) and obviously if there is evidence of more bleeding I’ll go in sooner.
The doc might want to send you to a gastroenterologist for an endoscopy to check things out, especially if the reflux is long-standing. I had a consult with a gastro a couple of months back after some months of what may have been dramatically worsened reflux and practically the first words out of his mouth were “Have you heard of Barrett’s Esophagitis?” (I had, and it was part of the reason I insisted on a gastro referral - I was diagnosed with reflux 20 years ago).
Esophagitis is staged according to how much damage they see on endoscopy; I had stage I (mild irritation) which the doc said suggested my regimen of omeprazole was mostly doing its job. Higher stages (and sorry, I can’t find a good link) include greater irritation, signs of bleeding etc.
A teaspoon of blood doesn’t sound like an emergency since you’ve checked it out with the doc and are keeping an eye on it (obvious if it gets worse before tomorrow, then it might be ER time).
Ah - you posted while I was typing mine up - sounds you’re being told exactly what I was saying :).
Having just had an endoscopy (as part of a “north-and-south” look-see - you posted in my colonoscopy prep thread) the endoscopy was a COMPLETE non-event. The colon prep was un-fun but they gave me sufficient sedation that the last thing I remember was attempting to talk when they popped a sort of grommet-like thing in my mouth (presumably to hold the endoscope). Next thing I remember is starting to come awake, when someone was trying to take away the pillow my right arm was propped on. I grabbed onto that pillow for dear life, LOL!
I was the proud owner of an ulcer at the age of 17. That was caused (probably) by a poor diet - lack thereof - since I was a wrestler in a weight class about 35 pounds below my normal bodyweight. One meal a week (mmmm… steak and mashed potatoes every Sunday), supplemented by a can of Ensure every day and periodic indulgement in Coca-Cola. Cold Coca-Cola and in the can (the Coke was in the can, not me).
I tested negative for H-Pylori, which kind of confused my gastrologist since the current knowledge was that “all” ulcers were caused by the bacterium. Or virus. Whatever the hell H-Pylori is.
I was treated with Prilosec (prescription at the time), Prevacid, and Carafate/Sucralfate all at the same time. Oddly, once I went to college and didn’t bother to take the stuff, most of the irritation disappeared. I certainly don’t have the world’s healthiest tummy to this day, but I’m not puking blood, either.
Ok, mystery solved. I had the endoscopy and they found that I’d ruptured my esophagus while vomiting. It was a superficial tear and healing well. They’re giving me another medication to help with that.
Glad to hear it! Since it could have been a sign of worsening esophagitis given your long-term (I assume?) reflux, it’s good to know for sure that it’s just a random whoopsie!