Bile and blood in vomit: what to do

Fresh blood may look bright red, while partly digested blood can look dark brown or like coffee grounds. Yellow-green fluid may be bile, especially after repeated vomiting or when the stomach is empty. Appearance alone cannot show the cause or how much blood has been lost.

Bleeding can come from the oesophagus, stomach, or first part of the small intestine. Possible causes include an ulcer, inflammation, a tear after forceful retching, swollen veins, medicine-related irritation, or a tumour. Oesophageal cancer and stomach cancer can present with vomiting blood, but this symptom also occurs in non-cancerous conditions and cannot identify a diagnosis by itself.

Swallowed blood from a nosebleed or mouth injury can sometimes be vomited. Even then, ongoing bleeding, weakness, or uncertainty about the source warrants urgent assessment.

Arrange urgent medical care rather than waiting to see whether it happens again. Do not drive yourself if you feel faint, weak, confused, or unwell. Sit or lie somewhere safe, keep the vomit or take a photo if this can be done without delaying help, and note its colour, approximate amount, and whether there was retching, pain, black stool, or recent nose bleeding.

Tell clinicians about blood-thinning medicines, aspirin, anti-inflammatory painkillers, liver disease, ulcers, recent procedures, cancer treatment, and alcohol use. Do not take an extra dose of any medicine to treat the bleeding. A clinician should advise what to do with prescribed medicines because abruptly stopping some treatments can also cause harm.

Call emergency services now if vomiting contains more than a small streak of blood, bleeding recurs, or there is fainting, dizziness, confusion, cold clammy skin, rapid breathing, severe abdominal or chest pain, black tar-like stool, breathing difficulty, or marked weakness. These signs can accompany significant blood loss or another serious problem.

A person who is drowsy or actively vomiting blood should not be left alone. If they become unresponsive but are breathing, place them on their side if it is safe to do so and follow the emergency call handler's instructions.

Once you are stable, ask where the bleeding is thought to have started, which tests are needed, whether any medicine could be contributing, and how recurrence should be handled. Clarify when eating and drinking can resume, which prescribed medicines to take, and whether follow-up with a digestive-disease or cancer specialist is required.