What is the difference between hemoptysis and hematemesis? How to identify?

Vomiting blood and coughing up blood are both called hematemesis in daily life, but many people easily confuse the two because they do not understand the pathogenesis of the two. So what is the difference between the two? How to identify it?

Key points for distinguishing hematemesis and hemoptysis:

Patients with vomiting blood usually have a history of gastric, intestinal, biliary tract diseases or portal hypertension due to cirrhosis. Before vomiting blood, there may be precursor symptoms such as upper abdominal discomfort, nausea and vomiting. Vomiting blood may be accompanied by dizziness, palpitations, pale complexion, sweating, and changes in blood pressure and pulse. Generally speaking, patients with vomiting blood bleed relatively more and in a more urgent manner. The color of the vomited blood is mostly dark red or brown, which is the result of the blood being affected by gastric acid. However, if the patient vomits blood continuously, the blood may be bright red, often mixed with undigested food residues and gastric juice. The patient often has symptoms of black stools shortly after vomiting blood.

Hemoptysis The underlying lesions of hemoptysis patients may include bronchial, lung, and cardiovascular system diseases. Before hemoptysis, patients often have symptoms of throat itching and cough. When hemoptysis occurs, there may be accompanying symptoms such as chest pain, palpitations, and cyanosis. The amount of hemoptysis is relatively less than the amount of hematemesis, and the color of the blood is mostly bright red. Patients often do not have symptoms of melena after hemoptysis, but it should be noted that melena may also occur if patients with hemoptysis swallow blood into the gastrointestinal tract.

Hemoptysis nasal bleeding mostly flows out from the anterior nostril, and the bleeding focus is often found in the front and lower part of the nasal septum. It is relatively easy to diagnose. Sometimes the amount of bleeding in the back of the nose is larger, and it is easy to misdiagnose it as hemoptysis: blood is seen flowing down from the posterior nostril along the pharyngeal wall, and the diagnosis can be confirmed by nasopharyngeal endoscopy. In addition, it is necessary to check for the possibility of nasopharyngeal cancer, laryngeal cancer, oral ulcers, pharyngitis and bleeding gums.

Hematemesis and hemoptysis can be distinguished from each other in the following ways:

1. Medical history: Patients with hematemesis often have a history of gastric, duodenal, or liver cirrhosis; while patients with hemoptysis generally have tuberculosis, bronchiectasis, cardiopulmonary disease, etc.

2. Bleeding method: Hematemesis is usually discharged with vomiting, while hemoptysis is usually spit out after coughing.

3. Blood color: The color of vomiting blood is mostly dark red, brown, and sometimes bright red; the color of hemoptysis is mostly bright red.

4. Mixtures in the blood: When vomiting blood, it is often mixed with food residues and gastric juice; when coughing up blood, it is mixed with sputum.

5. Symptoms before bleeding: upper abdominal discomfort, nausea, and vomiting are often present before vomiting blood; throat itching, chest tightness, and cough are often present before coughing up blood.

6. Acidity and alkalinity of blood: The blood in hematemesis is acidic; the blood in hemoptysis is weakly alkaline.

7. Characteristics of sputum after bleeding: no sputum after vomiting blood; bloody sputum for several days after hemoptysis.

8. Black stools: Patients with hematemesis often have tarry stools, which may last for several days after the hematemesis stops. Patients with hemoptysis generally have normal stools, unless they swallow a large amount of blood, in which case they may have black stools.

9. Different bleeding sites: Vomiting blood is the main clinical manifestation of upper gastrointestinal bleeding diseases, and the bleeding sites are mostly in the esophagus, stomach, duodenum, etc. Hemoptysis is a characteristic manifestation of respiratory bleeding, usually referring to bleeding in the respiratory tract below the larynx or in the lungs.

Many patients cannot distinguish between vomiting blood and coughing up blood, and often refer to both as hematemesis. If the patient's chief complaint is unclear, it is likely to lead to misdiagnosis by the doctor.