Specks of blood in vomit: what to know

Bright red streaks may reflect fresh bleeding in the mouth, throat, food pipe, or stomach. Dark brown or coffee-ground material can indicate that blood has remained in the stomach and changed appearance. Repeated retching can irritate or tear small surface blood vessels, while ulcers, inflammation, medicines, liver disease, and other conditions can also cause bleeding.

The appearance alone cannot identify the source. Blood swallowed from a nosebleed or mouth injury may be vomited later. Cancers of the food pipe or stomach are possible causes, but specks of blood do not by themselves diagnose either condition. A clinician will consider pain, dizziness, black stools, medicines, alcohol use, and previous digestive problems.

Stop and note the colour and amount, whether vomiting continues, and whether the material looks mixed with food or like coffee grounds. Avoid alcohol and do not take anti-inflammatory pain medicines unless a clinician has advised them. Do not drive yourself if you feel faint or weak. Arrange prompt medical assessment, particularly if the cause is not clearly a small mouth or nose bleed.

A clinician may check vital signs, blood tests, medicines, and the digestive tract. Take a list of prescribed and over-the-counter medicines, including blood thinners, to the assessment.

Call emergency services for vomiting more than a few streaks of blood, repeated vomiting, coffee-ground material, black or tarry stools, fainting, confusion, cold clammy skin, rapid breathing, severe abdominal or chest pain, or marked weakness. Urgent assessment is needed even when the bleeding seems to have stopped if these symptoms occur or if you take blood-thinning medicine.

Where might the blood have come from? Do my medicines increase bleeding risk? Do I need blood tests or a camera examination of the upper digestive tract? What warning signs should bring me back urgently? Could repeated vomiting have injured the lining?