Sudden vomiting of blood in a person with chronic liver disease should never be treated as a minor problem. In patients with liver cirrhosis, enlarged blood vessels in the oesophagus can rupture and cause severe bleeding. Without prompt treatment, blood pressure may drop rapidly, leading to shock and potentially life-threatening complications.

Family members often struggle to understand why such bleeding occurs and what immediate steps they should take. Awareness is essential because reaching a hospital quickly and receiving appropriate treatment can play a crucial role in saving the patient’s life.

Why Do Blood Vessels in the Oesophagus Become Enlarged in Liver Disease?

Liver cirrhosis damages the normal structure and function of the liver. This can obstruct blood flow through the liver, increasing pressure in the portal vein. This condition is medically known as portal hypertension.

The increased pressure causes certain blood vessels around the oesophagus and stomach to enlarge. These enlarged veins in the oesophagus are called oesophageal varices. Their walls are relatively fragile, making them vulnerable to rupture and potentially severe bleeding.

However, not every patient with liver disease develops this complication. Vomiting blood is also not always caused by ruptured oesophageal varices. Other digestive tract conditions, including stomach ulcers, can cause bleeding as well. Therefore, identifying the exact source of bleeding is essential.

Which Symptoms Signal Danger?

When oesophageal varices rupture, a patient may suddenly vomit a large amount of bright red blood. Sometimes, the vomit may contain dark blood or material resembling coffee grounds. Significant bleeding can also cause black, sticky, tar-like stools.

Particular attention is needed if a patient develops any of the following symptoms:

Sudden vomiting of blood or blood clots.

Black, sticky stools.

Dizziness, extreme weakness or cold sweats.

Rapid heartbeat, paleness or difficulty breathing.

Fainting, confusion or reduced consciousness.

Waiting when these symptoms appear can be dangerous. Even if the patient’s blood pressure initially appears normal, serious bleeding may still be occurring. The patient must be taken to an emergency department immediately.

What Treatment Is Provided at the Hospital?

Bleeding of this kind is considered a medical emergency. Upon arrival at the hospital, doctors initially assess the patient’s breathing, blood pressure, heart rate and the severity of the bleeding. Intravenous fluids, blood transfusions and measures to protect the airway may be required.

Emergency endoscopy is generally needed to identify the source of bleeding. This procedure allows doctors to examine the oesophagus and stomach and determine where the blood is coming from.

If the bleeding is caused by ruptured oesophageal varices, doctors can use a special device during endoscopy to place bands around the affected veins and stop the bleeding. Alternative endoscopic techniques may be used in certain cases.

Depending on the patient’s condition, doctors may also prescribe medicines to reduce bleeding and antibiotics to prevent infections. If bleeding cannot be controlled or the risk of recurrent bleeding is high, a specialised procedure known as transjugular intrahepatic portosystemic shunt (TIPS) may be considered for selected patients.

The choice of treatment depends on the patient’s overall condition, liver function and the severity of the bleeding.

Does the Risk End Once the Bleeding Stops?

No. Even after the initial bleeding has been controlled, there remains a risk of further bleeding. Continued observation, assessment of the severity of liver disease and a plan to reduce future risks are therefore essential.

Depending on the doctor’s recommendations, the patient may need specific medications, repeat endoscopy and other treatments. Identifying the underlying cause of the liver disease and managing its progression are also important.

Family members should follow medical advice, ensure that the patient attends scheduled follow-up appointments and seek immediate medical attention if any new warning signs appear.

What Should Family Members Do?

If a patient vomits blood, emergency medical care must be arranged immediately. If there is heavy bleeding, dizziness or loss of consciousness, an ambulance or other emergency assistance should be sought.

Do not attempt to give the patient medication without medical advice or rely on home remedies. In particular, if the patient has reduced consciousness or continues vomiting, do not give food, water or oral medication, as these may enter the airway and cause serious complications. Follow the instructions of emergency medical personnel.

If the patient has a known history of liver disease, bringing previous medical records and details of regularly used medications may help doctors. However, gathering these documents must never delay the journey to the hospital.

Awareness and Timely Treatment Are Crucial

Vomiting blood in a patient with liver cirrhosis is a serious warning sign. Reaching a hospital promptly, identifying the source of bleeding and initiating appropriate treatment are essential to saving lives. Even after the bleeding has stopped, regular medical care and follow-up remain important to reduce the risk of future complications.

Remember: Never ignore vomiting of blood in a patient with liver disease. It may indicate life-threatening internal bleeding. Seek emergency medical care immediately.

By Dr. S. M. Sohel Rana
Attending Consultant, Gastroenterology and Hepatology
Evercare Hospital Chattogram