Blood in Vomit and Blood in Stools
Hematemesis (blood in vomit) and malena (blood in stool) are the two most common presenting complaints of the patients with chronic liver failure (cirrhosis). Hematemesis is the vomiting of blood in which fresh, dark brown or coffee colored blood is welled up along with vomiting. If the source of bleeding is above the gastroesophageal sphincter fresh blood may be vomited out. Hematemesis happens to occur in patients with chronic liver disease (CLD) due to esophageal varices and esophageal varices result from portal hypertension. Mallory Weiss Tear is a lower esophageal tear that happens to occur due to trauma of retching and it may be the cause of fresh blood in the vomitus but after the initial vomit. 
Malena results from upper gastrointestinal bleeding (upper GIT bleed) in which the patient passes tarry and shiny black stools with characteristic odor. Remember, matt black stools are associated with oral iron or bismuth therapy. So do not confuse matt black stools of iron or bismuth therapy with the tarry or shiny black colored stools passed by the patients with chronic liver disease.
Whenever the patients complain of hematemesis or malena, enquire about ingestion of aspirin, NSAIDs (non-steroidal anti-inflammatory drugs), alcohol intake. Excessive alcohol intake causes blood in vomiting due to erosive gastritis. Prolonged use of NSAIDs produces peptic ulcers and causes gastric bleeding. Upper gastrointestinal bleeding is common in Asian countries and Rockall score is used to assess the mortality risk associated with it.
By: Dr. Muzammil Irshad
(drmuzammilirshad@gmail.com)
