What should you know about portal hypertension vomiting blood?

Portal hypertension is raised pressure in the vein carrying blood from the digestive organs to the liver. When blood flow through the liver is restricted, veins in the oesophagus or stomach can enlarge and become fragile. These varices may bleed suddenly, producing bright-red blood or dark, coffee-ground vomit.

Bleeding can cause dizziness, weakness, pale or clammy skin, fast breathing, black stools, or fainting. It may occur with advanced liver disease, but vomiting blood can also have other causes, including ulcers or a tear. The appearance of the vomit cannot identify the source safely at home.

Call emergency services immediately, do not drive yourself, and tell responders that portal hypertension is present. Sit upright or lie on your side if you feel faint. Do not eat, drink, or take aspirin or anti-inflammatory pain medicines unless an emergency clinician tells you to do so.

Hospital care may include blood tests, medicines to reduce bleeding, fluid or blood support, and an urgent endoscopy to locate and treat the source. Tell the team about liver disease, cancer history, blood thinners, alcohol use, and all medicines. Oesophageal or stomach conditions may need separate assessment, but emergency stabilisation comes first.

Any vomiting of blood needs emergency assessment, even if the bleeding stops. Treat black, tar-like stools, fainting, confusion, severe abdominal pain, or increasing sleepiness as urgent warning signs. Do not wait for a routine appointment or try to monitor the bleeding at home.

What caused the bleeding, and were varices found? Do I need an endoscopy or treatment to prevent another bleed? Which medicines should I avoid or continue? What signs should lead my family to call emergency services?