vomiting blood

  Last week, I woke up in the middle of the night and began vomiting.  It continued for about 2 hours off and on and was pretty violent.  Towards the latter stages of the vomiting, I noticed about 2-3 tablespoons of bright red blood in my vomit.  This really freaked me out.  It turns out, I had the stomach flu for the next 2-3 days (fever, diarrhea, etc.).  I feel fine now, other than a tad queasy every now and then.  I vomited so far, in fact, that I had some hemmorrhaging in my sclera of my eyes.  Anyway, my question is this:  is it possible to vomit so violently that blood appears in the vomit.  Thank you.

[HFHSM.D.-rf]

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Dear Tom,
Thank you for your question.  The answer to your question is yes, vomiting can cause gastrointestinal bleeding. When one vomits there is reverse motion of the stomach.  This means that instead of muscle contractions moving gastric contents into the small intestine, the contents are propelled back into the esophagus and mouth.  During these reverse contractions it is possible to tear the inner lining, usually at the junction of the stomach and esophagus.  Bleeding can result but it is usually not too serious and will subside without surgery.  This condition is called Mallory-Weiss bleeding.  The classic description for this condition is several episodes of retching or vomiting of nonbloody material that is followed by the vomiting of blood.
Parenthetically, severe vomiting can have serious medical consequences.  It is possible to rupture the esophagus.  This condition is called Boerhave syndrome.  Boerhave was a Dutch ( I beleive) admiral who was a glutton and used to induce vomiting so that he could eat and drink more.  One one occasion the vomiting was so severe that he ruptured his esophagus leading to his death.  Today, we can surgically repair the esophagus so death is not a certain outcome of esophageal rupture.
This information is presented for educational purposes.  ASk specific questions to your personal physician.
HFHSM.D.-rf
*keywords: gastrointestinal bleeding, vomiting, Mallory-Weiss tear of the esophagus, Boerhave syndrome
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