Throwing up blood an ominous sign for alcoholics

2012-02-28T08:38:00Z Throwing up blood an ominous sign for alcoholicsBy Nabin Sapkota Columbus Telegram
February 28, 2012 8:38 am  • 

Throwing up blood is always a medical emergency, but it can be a sign of a catastrophic event in alcoholics. Patients who have a history of esophageal varices can die within a few hours from exsanguination after they have the symptom of throwing up blood.

Today, I will be telling you what esophageal varices are and how throwing up blood can lead to rapid death in alcoholics with esophageal varices.

Esophagus is our food pipe which carries food down from the mouth to the stomach. Some veins from esophagus pass down into the liver before going into the general blood circulation. Normally, the flow of blood in these veins is very smooth and non-turbulent. In patients with liver cirrhosis, the normally smooth liver architecture is replaced by scar tissues and fibrous material. Cirrhosis is the result of repeated and multiple insults to the liver and the liver’s attempt to repair itself.

Liver is the organ with the most regenerative power. It has a great ability to heal itself. With frequent insults and damages, the repairs can become less than perfect and fibrous and scar tissues begin to appear. The end result is a hard scarred fibrous liver.

Now, the blood passing down the veins from esophagus have a hard time flowing through the liver. As a result, the veins begin to get enlarged and engorged with significant amount of blood flowing back upstream into the esophagus from the liver. When these severely engorged blood vessels rupture, throwing up blood in large quantity ensues.

The patient can lose significant amounts of blood within just a few hours. Death can occur rapidly without proper treatment.  

Throwing up blood from ruptured esophageal varices can occur in patients with liver cirrhosis from other causes, like chronic hepatitis and some genetic liver disease. By far, alcoholic liver disease is the most common cause of liver cirrhosis in the United States. Alcoholics are more prone to getting their esophageal veins ruptured as they frequently have nausea, forceful vomiting and retching from drinking too much alcohol.

Not all alcoholics with the symptoms of throwing up blood have bleeding from the esophageal varices. Other common causes of throwing up blood in alcoholics are bleeding stomach ulcers and simple tears of the food pipes.

When someone develops throwing up blood after drinking, it is very difficult to know if it is the bleeding from esophageal varices or something else. Only an experienced Emergency Department doctor can make an educated guess about the cause after doing some rapid blood tests and evaluation.

Patients with possible variceal bleeding are referred emergently to a liver and gastrointestinal specialist that may be able to perform a specialized procedure to try to stop the bleeding before the patient dies from loss of blood.

The best way you can help save lives from this dreadful condition is by raising awareness of this condition among your friends or family members who drink too much alcohol. In most alcoholics, it may not be too late to prevent irreversible liver damage.

As I stated, liver has a natural power to heal itself despite being probably the most abused organ in our society. If they stop drinking before the liver is completely exhausted, it may recover fully in time. If someone with known alcoholic liver disease has the symptom of throwing up blood, you may be able to save that person’s life by rushing him/her to the local ER right away.

Nabin Sapkota, MD, is board certified in internal medicine, a hospitalist with Inpatient Physician Associates of Columbus and a physician with the hospitalist program at Columbus Community Hospital. You can read about his new book project “Symptoms and Diagnosis” at

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