Emesis of bile and blood - causes

While bile vomiting may suggest liver or gallbladder disease, it is most often the result of complications following laparoscopic procedures such as gallbladder resection, gastroscopy, or liver resection.

Potential causes of bile vomiting encompass: persistent vomiting, impaired flow below the sphincter of Oddi (also known as the Vater papilla), obstruction of the bile duct by a stone (gallstone disease), complications following gallbladder removal surgery where bile directly enters the intestine causing irritation and food reflux, resulting in gastric mucosal inflammation and vomiting, complications after partial gastrectomy, issues arising from a biopsy near the Vater papilla, intestinal obstruction, altitude-related illnesses between the 10th and 20th day of travel, and late-onset complications after surgical obesity treatment via gastric-intestinal bypass (Roux-en-Y gastric bypass - LRYGBP).

Based on the severity of blood discharge, the hemorrhage source can be precisely identified. Vomiting fresh blood (live blood) suggests bleeding from the upper gastrointestinal tract. Vomitus with gelatinous consistency and protein clots originates from the stomach, duodenum, or small intestine.

Potential causes of hematemesis include: bleeding from esophageal varices as a complication of liver cirrhosis or injury (e.g., during a suicide attempt); bleeding from gastric or duodenal ulcers – in such cases, the vomit has a distinctive, stringy consistency due to protein coagulation by gastric acid; esophageal or stomach cancer; hemorrhagic gastropathy, which refers to non-inflammatory damage to the gastric mucosa caused by medications (e.g., NSAIDs, chemotherapy), stress (trauma, burns, hypoxia), or refluxing bile; Mallory-Weiss syndrome, which involves a tear in the mucosal lining, typically caused by severe and profuse vomiting (though approximately 40% of patients deny experiencing such episodes). This syndrome most commonly occurs in alcoholics, individuals with alcohol abuse, pregnant women with uncontrollable vomiting, and patients with bulimia or hiatal hernia; early complications following bariatric surgery (Roux-en-Y gastric bypass – LRYGBP).